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Tackling inequality through partnership in Tayside
In 2010, a number of public sector partnerships in Tayside, Scotland, came together to discuss how they might use the opportunity of a new form of systemic data analysis, the Integrated Resource Framework (IRF), to tackle inequality, taking older people’s services as a first focus. The data afforded the opportunity to see the total cost of care including all NHS and Social Care costs. And it was therefore fundamental to best care/best value decision making.
There was a need to strongly support the Board and teams working on this, for effective partnership working and in particular, enabling a whole-systems view in a practical and meaningful way. Although the partners had worked for many years together and built an understanding of how each operated, ethos, performance measures and mindsets were substantially different; there also was a lot of history that both helped and hindered the partnership.
The programme was set up with a ‘ tests of change’ methodology, where particular projects were initiated with substantially different ways of working on behalf of communities, with a view to learning and extending that learning across the whole system.
The structure of the partnership
Partners included NHS Tayside, and the Social Services of Dundee, Perth and Angus Local Authorities.
The Project Board
Senior leaders within the partnership who were joint commissioners of the work. They were to set a common vision, release and align resources to test this vision, and gain political will and engagement within the rest of their organisations.
Members were senior officers up to Deputy CEO and CEO level, or representatives thereof. The Chair of the Project Board is the CEO of NHS in the area.
There was also a small senior finance team sourced from all organisations who are creating a ‘clean’ set of data across the system of both NHS and Social Care spend, in order to understand more fully the costs of inequality, plus enable better decision making on where investment should be made.
The Project Team.
A cross-organisational project management team, set up to create new methods/processes/structures for change that were to tackle the core aspects of inequality across the whole area. Representatives were very well known to one another and generally came from the local partnership teams.
Each Local Team
Each local area’s cross-organisational project team, set up to run and monitor new ways of working with communities. Members were generally from local CHPs, but also included a new finance support person able to offer the full system data view.
What we did
Lifetimeswork worked in partnership with Malcolm Young Associates, an Organisational Development organisation. This was a systems coaching programme, involving an overarching contract of enablement, with subcontracts for coaching being formed as necessary along the way. Coaching took the form of individual, small cohort of co-leaders, team, Board-only and full team sessions.
Jenny’s role supported individuals, co-leaders and teams to enable a full system-wide view whilst Malcolm’s role was to hold a systems-wide frame in terms of enabling teams and the board around enabling mindsets, structures & process. This combination to ensure a whole-system approach helped lead to considerable stretch being adopted within the programme. Consideration was given to pacing, to authority and power, to alignment around goals and to partnership history.
Jenny and Malcolm worked for a year on this programme.
Much of the core remit of this programme was replaced with the Scottish Government’s Change Fund programme. The success of the Tayside project was reflected in the feedback associated with each of the local applications which were considered to be of excellent quality, built through the work of IRF.
Examples of stretch included not only an integrated budget and service views, but also the inclusion of leading coproduction/mutuality processes as a new way of working with the community; consideration of how to achieve scale; consideration of social capital measures; and how to better align between partners.
The IRF Board continues in its role of supporting local teams in their Change Fund and integration work.
The emphasis on systems coaching and enablement was vital to the success of the IRF work. The expertise brought to this work by Jenny Campbell and Malcolm Young was both challenging and stretching, and contributed significantly to a growing sense of trust and maturity across the partners involved
Carrie Marr, Director, Tayside Centre for Organisational Effectiveness