Scottish Government

7 Conclusions

7.1 This chapter provides our conclusions to the research and provides suggestions for consideration of forward action.

7.2 The picture that emerges is one of great variation across the 40 CHPs with a complexity of relationships and structures. The "no one size fits all" described in the statutory guidance has proved to be the case. The research team's sense is that the majority of those who have participated in this research like the fact that the CHPs have been allowed to develop according to local need and context and have no wish to see this change. The fact that there is so much variety across the 40 CHPs is testament to the local nature of each CHP and is seen as a strength.

7.3 The CHPs have successfully developed at a time of significant changes in terms of policies and new ways of working. In particular the advent of the SOAs has changed the relationship between local authorities and national government and has led to a greater emphasis on the role of community planning partnerships. Within this context the role for Health Boards, which still have to meet nationally-set targets, is sometimes perceived to be at odds with the local community planning approach.

7.4 There have been a variety of perceptions of the CHPs' role and purpose (see Chapter 3). One perception of the CHP role that we think is helpful was made during the research by an interviewee who likened the role of CHPs to "adaptors", meaning the role of providing the link between different bodies, to help them understand each other better and to broker joint working. These "adaptors" can be:

• between the public and the Health Board;
• between primary and secondary care;
• between the local authority and the Health Board; and
• between health and other community planning partners.

7.5 The term "adaptor" is similar to that of " CHP facilitator" now used in one Health Board area to describe the individual post-holders' function. This seems to us to be a good way to describe the role and explains why CHP relationships have been shown during this study to be so crucial.

7.6 The extent to which this adaptor/facilitator/link role is required and the form it takes varies from Health Board to Health Board. It depends on a number of factors including pre-existing and current relationships between the local authority, the Health Board, and other community planning partners as well as relationships within the health family itself. In a few areas, because existing relationships between local authority and Health Board were already close, it was less evident to those involved how this adaptor role could add value.

7.7 The CHP role is therefore potentially extremely complex, demanding and important.

7.8 The role is central in our view to addressing key priorities including shifting the balance of care, tackling inequalities , and integrating services for children, older people and other vulnerable groups. It can be visualized as acting horizontally across different areas of vertical service provision to help broker joint working and, where appropriate, integration.

7.9 This horizontal facilitating process is central to CHPs' work and one which in our view should be fostered. We have observed a shift in awareness of the potential of this horizontal role during the course of this study. Our sense is that representatives from both Health Boards and local authorities have become more aware that the role of adaptor, broker and manager of the horizontal process is critical and want to support it. The CHPs are well placed to fulfil this role and those who took part in the Findings and Reflection Events in Stage 3 recognised this. They wanted to see the CHPs take a greater role in managing the overall process of patient pathways between community care, primary and secondary care settings. Part of this process will involve CHPs having stronger relationships with GPs and this is an area that has been highlighted during the research.

7.10 Leadership - by Health Board Chairs and Chief Executives, elected Councillors and local authority Chief Executives, and by CHP General Managers - is a common theme throughout this report. It is recognised that where leadership has been effective the CHP has been able to achieve more because the leaders have supported the work of the CHP and importantly have made sure within their own organisations that the work of the CHPs is understood.

7.11 In terms of elected Councillors, there is huge commitment and energy shown by many, turning up to chair/attend meetings and engage with the issues. However, there is clearly also more to be done in terms of ensuring that newly elected members are brought up to speed and that key issues are fed back to appropriate parts of the local authority's structure.

7.12 Health Board Chairs and Chief Executives have a central role in taking forward what happens next to build on the findings of this report.

7.13 We provide suggestions for further consideration in Table 7.1. We are fully aware that due to the variability across CHPs some of these suggestions will not be relevant in some areas. However we hope they will serve to stimulate discussion.

7.14 The suggestions are grouped under the following headings:

• governance and structures;
• the role of CHPs;
• the horizontal pathway process.

These three themes have been selected as providing scope to address many of the key suggestions made during the course of the research. It is recognised that there will be some ideas/suggestions contained in the report that are not included here, which may be of particular interest to specific Health Boards and CHPs and we would encourage each Health Board and CPP to consider the findings of the report and relate these to their own local circumstances so that specific issues for action in each area can be identified.

Table 7.1: Ideas for further consideration

7.13 Despite the challenges raised during the study, many of those interviewed thought that the CHP in their area was working well and that they would continue to build on the progress that has been made so far. The overall sense is that the CHPs are ready to move onto the next chapter of their development.