Scottish Government

SECTION 1 - ADPs: AN OUTCOMES APPROACH

Introduction

1. This toolkit is intended to provide guidance for you as an Alcohol and Drugs Partnership ( ADP) in operating in an outcomes based environment and to support your working relationships with local partners and service providers. This toolkit is intended to assist you to identify local priority outcomes relating to alcohol and drugs.

2. The outcomes approach focuses on real and lasting results and should help create more confidence amongst a range of stakeholders (including service users and their families, service providers ¹, funders and the Scottish Government) that high quality services, which achieve their goals, are being delivered. It means we no longer focus simply on the inputs and actions being carried out.

The Policy Environment

3. On 2 March 2009, the Scottish Government published Changing Scotland's Relationship with Alcohol: A Framework for Action. Alcohol misuse is widely recognised by health experts as one of Scotland's most pressing public health concerns and the Framework addresses issues around reducing alcohol consumption, tackling the damaging impact alcohol misuse has on our families and communities, encouraging positive attitudes and positive choices and improving the support and treatment available to tackle alcohol misuse. The Framework for Action recognised that alcohol misuse is much more prevalent across Scottish society than previously recognised. As a result the Framework adopts a whole population approach, as well as recognising that some vulnerable groups require a more targeted approach.

4. The drugs strategy "The Road to Recovery" published in May 2008 sets out a significant programme of reform to tackle Scotland's drug problem. Central to the strategy is the concept of recovery - a process through which individuals are enabled to move-on from their problem drug use towards a drug-free life and become active and contributing members of society.

5. The drugs strategy and the alcohol framework both signalled the need to ensure that local delivery of alcohol and drugs services was effective, efficient, accountable and able to contribute to national and local outcomes.

Reform of local delivery arrangements for drugs and alcohol services

6. A Stocktake review of Alcohol and Drug Action Teams ( ADATs), published in July 2007, considered the performance of ADATs and their capabilities to deliver the future priorities on drugs and alcohol. Having considered this report, Scottish Ministers invited the Scottish Advisory Committee on Drugs Misuse and the Scottish Ministerial Advisory Committee on Alcohol Problems to establish a joint group to look at the future of delivery arrangements. This group, the Delivery Reform Group, met for the first time in January 2008.

7. The Delivery Reform Group's work covered three main strands:

• Clarifying responsibilities and accountability arrangements;
• Developing an outcomes toolkit for partners to use to assist in setting outcomes at the local level; and
• Recommending the employment of national support coordinators to work with Government, local partnerships, service commissioners and providers to support delivery improvements.

8. A joint CoSLA and Scottish Government agreement and framework on responsibilities, accountability and partnership working has been published in tandem with this toolkit.

The move to an outcomes approach

9. The environment in which local partnerships tackling alcohol and drugs misuse operate changed over the course of 2008. A National Performance Framework was introduced, identifying national outcomes, targets and indicators which the Scottish Government wants to achieve over the next 10 years. Single Outcome Agreements ( SOAs) between local and national government were agreed, giving local government the freedom to identify their own priorities and allocate funding to these.

10. The SOAs agreed in 2008 set out the outcomes each authority wished to achieve, working with its community planning partners. Each SOA should have identified local outcomes which expressed specific local priorities and which should inform one or more national outcomes. From 2009, SOAs will be more explicitly negotiated and agreed with Community Planning Partnerships. These will better reflect local needs, circumstances and priorities to be delivered in partnership. Guidance for Community Planning Partnerships on developing 2009 SOAs was published on 31 October 2008 and is available from http://www.improvementservice.org.uk/core-programmes/single-outcome-agreements-/.

Measuring, monitoring and evaluating outcomes

11. Demonstrating progress towards achieving outcomes can be challenging. External factors, for example economic issues or activity by other partners, can influence progress towards the outcome and identifying the actual impact of these can be difficult. Also it will, in many cases, be difficult to isolate the particular activity which enabled the outcome to be met. However, this does not mean that outcomes should not be measured or evaluated. Service delivery outcomes can be achieved and demonstrated and this activity can feed into the achievement of higher level outcomes, over a longer time scale.

12. This document sets out example outcomes and possible indicators and measures that could be used to demonstrate the achievement of drugs and alcohol outcomes. These are merely suggestions. Some of the suggested indicators and measures may not be currently available through routine data collection. It will be for services and partnerships to agree local indicators taking account of local data sources and monitoring arrangements.

Outcomes in alcohol and drugs work

13. As part of the reform of the delivery of alcohol and drugs services, the Delivery Reform Group has proposed that Alcohol and Drugs Partnerships ( ADPs) replace Alcohol and Drug Action Teams. A key function of these partnerships is to identify the priority outcomes on alcohol and drugs to be achieved locally.

14. Other partnerships, such as community safety partnerships and community health partnerships, should also have an interest in tackling alcohol and drugs misuse and activity in this area may be done jointly. Also, activity by these partnerships can help contribute to the achievement of high-level outcomes. Where there is overlap between partnerships or joint activity, it should be made clear which partnership is expected to lead on activity and report on progress and achievements.

15. A focus on and ownership of local outcomes for drugs and alcohol will be critical for partnerships. This is because the outcomes approach will help:

• improve the capacity of ADPs and local providers to plan, deliver and manage services for those affected by substance misuse;
• support substance misuse agencies in making best use of their own outcomes and monitoring information for internal planning, reflection and development purposes;
• identify better ways of designing and delivering services and to provide ideas for future projects;
• demonstrate the effectiveness of projects to funders and other stakeholders
• shift the assessment of interventions from measuring activity levels to measuring the impact (outcomes) achieved;
• demonstrate improved performance in terms of recovery from problem drug use;
• develop effective structures to enable substance misuse services to report meaningful outcomes and monitoring information to ADPs;
• identify what is effective and thus improve the quality of service provision; and
• ensure strategic and management processes are evidence-based.

16. We recommend that you use this outcomes toolkit in one or all of the following ways:

• to identify and show the positive impact on communities, families and individuals that supporting drugs and alcohol services delivers and the link this has with high-level and national outcomes. This will be key in dialogue with community planning partners and other strategic budget holders;
• to ensure that decisions on the mix of treatment and rehabilitation services are informed by evidence, including how they meet the identified need;
• in commissioning services and putting in place performance management arrangements to track progress; and / or
• to communicate the impact of activities to the wider public.

17. An outcomes approach is very much in line with the drugs strategy's focus on recovery. Working in terms of outcomes by treating the whole person, including all the things they identify as barriers to their own recovery, is as important as providing purely physical or psychological interventions.

18. This toolkit is intended to support you to operate within the outcomes environment. It provides a range of example intermediate and service delivery outcomes that you may wish to consider when identifying your local priorities. These outcomes are not an exhaustive list, they are simply examples. Some partnerships may have already developed their own local outcomes and may choose to either continue with these or to update them with some of the outcomes provided in this toolkit. You are not expected to work towards achieving all outcomes included in this toolkit; you should simply identify those outcomes which you and your partners consider to be a priority for your own local area.

19. The toolkit also suggests possible local indicators, some of which reflect data already collected locally. Again, these are not exhaustive; they are simply examples to assist you in planning how you may choose to monitor the achievement of your chosen outcomes. ADPs, service commissioners and services will wish to consider which indicators are best suited to their local environment and systems.

20. The toolkit has been developed in tandem with the Health Improvement Performance Management Review, which was commissioned by the Scottish Government and led by NHS Health Scotland. Some of the tools developed in the review were used to support the development of the toolkit. These tools will be made available on NHS Health Scotland website:

http://www.healthscotland.com/scotlands-health/evaluation/hi-performancemanagement-nhs.aspx
You may find it useful to use them alongside this toolkit to develop your own approaches to planning and measuring outcomes and to facilitate dialogue with community planning partners.

Change management

21. The Scottish Government will employ national support co-ordinators to assist you with understanding and implementing new delivery and accountability arrangements, and the development of outcomes, local indicators and measures. The national support co-ordinators will also be available as a resource to assist you to take forward the alcohol framework and drugs strategy.

Using this document

22. This document is set out in four main sections:

• This introduction forms the first section;
• Section two provides an introduction to working with outcomes, the terms used and how the levels of outcomes interact and link;
• Section three provides guidance for you in working with local partners, especially regarding your role in influencing the Single Outcome Agreement process; and
• Section four provides guidance for you in working with services or service commissioners to set achievable outcomes.

23. Other local partners and services may also find the toolkit helpful in developing their links and relationships with the Alcohol and Drug Partnership and in working towards an outcomes based approach. It is intended to provide guidance on working at all the "levels" of outcomes and with various different partners.