Creating Hope Together: Year 2 Annual Report

Context for delivery

When considering the progress made in delivering Creating Hope Together, it is important to take account of the multitude of complex contextual factors that relate to the following question: “What helps and hinders you to make policy impactful and to deliver the strategic vision?”. Sessions were facilitated by our external evaluation support organisation to capture the views of partners around the context for delivery. The following section has been structured using the ISM (Individual, Social, Material) framework utilised by Scottish Government^[1].

Individual

Individual factors are those held by the individual that affect their choices and behaviours, such as their values, attitudes and skills, as well as the calculations they make before acting, including personal evaluations of costs and benefits. In this section we have considered the individual factors which have impacted the people involved in the delivery of Creating Hope Together rather than the factors which may impact on people affected by suicide.

Individual factors supporting the Creating Hope Together programme include:

• The people recruited as Strategic Outcome Leads have a wide range of relevant experience, including specific experience in suicide prevention work. They value this work and are committing time to it to make a difference. They were chosen to take on these roles for their values and approach and are taking genuine ownership of their areas of work.
• The commitment and goodwill shown by Outcome Leads and their organisations through their willingness to commit to planning and delivering work throughout the financial year.
• There are also strong incentives for each lead organisation to show success through the programme. The organisations involved in leading the programme put themselves forward for these roles through an application process that included expressions of interest and an assessment of readiness, resilience and flexibility. Their reputations and credibility as provider organisations rest on high-quality delivery of this work as a high priority for Scottish Government and COSLA. There is also benefit to being involved in the CHT Delivery Partnership and to lead on national work, including the opportunity to work collaboratively with other leading organisations.
• The National Suicide Prevention Delivery Lead takes a distributed leadership approach, with a focus on synthesising, sensemaking and continuous collaboration. The current post holder prioritises support for the Strategic Outcome Leads (SOLs) and holds a great deal of the central reporting and accountability workload. The ability to draw on 20 years of experience working in suicide prevention, and also of navigating the complex systems of Scottish public service and government acts as a supportive function for this role. This enables the ability to both support and advise the SOLs in their work and effectively represent it to Government and COSLA. It is important to ensure this essential role is filled by an individual with the necessary expertise and leadership skill to hold a large collaborative process together.

Across the delivery process, there are also individual factors that can hinder the work, these include:

• Suicide prevention can be an emotionally difficult topic area to work in. Many people connected with the programme are likely to have their own related lived or living experience which at times can be impacted by the work. This lived and living experience is also a positive, it means that many people delivering the work have a deep understanding of the impact of suicide and are committed to making a positive difference to reduce suicide. It also means that as a delivery collective, each member works hard to support each other and bring Time, Space, Compassion into our ways of working.
• The breadth of the programme means that there are a range of people involved across sectors whose engagement or actions are critical for impact. Many do not have specific suicide prevention expertise which means that a lot of time is spent bringing people up to speed with appropriate approaches. Their involvement in the programme of work also brings benefits in widening the awareness of suicide across topics and sectors and in bringing their expertise to the awareness of Suicide Prevention Scotland.

Social

Social factors are those that exist beyond the individual in the social realm, yet shape people’s behaviours. These influences include understandings that are shared amongst groups, such as social norms and the meanings attached to activities, as well as people’s networks and relationships and the institutions that influence how groups of individuals behave.

Social factors supporting the Creating Hope Together programme include:

• Co-production and involvement have become central to national work in Scotland, with the expectation that a diverse range of people will be involved in design, development and delivery of strategic programmes like CHT. Communication and engagement taking place online became the norm during COVID restrictions and this has continued, making it possible and practical to reach more people, more diverse groups, and all parts of Scotland with engagement efforts supported by technology.
• The delivery partners are from established organisations who work together in other areas and therefore have pre-existing relationships. Relationship building is essential but takes time, and CHT draws on the strength of existing partnerships while working to develop new ones. The relationships between the CHT leadership and partners enable the programme to remain functional and moving.
• The working culture between SOLs is informal, open, honest and transparent, with mutual trust and respect that enables collaboration and understanding around key decisions, including resource allocation. This structure means that people feel they have a part to play. It supports positive response to challenge and open discussion about different expertise and perspectives, (e.g. different ideas about what a Test of Change looks like) resulting in new and/or continually improving approaches. This way of working enables an openness to trying new things and taking iterative approaches, with access to peer support.
• This same approach is also fed into the Delivery Lead roles with an encouragement for them to actively engage with work across the action plan, share ideas and test out new ways of working using approaches such as Quality Improvement methodology. The Delivery Leads work across a range of organisations bringing different ways of working to the group and provide peer support to each other.
• Boundary-spanning roles enable the wider system to work together across potential siloes and hierarchies. For example, the National Delivery Lead working from within COSLA with joint reporting to COSLA and Scottish Government. Additionally, there is a strand of work dedicated to a whole of government approach, with Scottish Government Suicide Prevention Policy Team Leader drawing together relevant policy strands and teams that connect to suicide prevention work. Similarly, key opinion leaders in support of the work such as the Chair for the National Public Protection Leadership Group, are helping to make connections and raise the profile of the Strategy.
• The credibility, reputation and knowledge of the delivery partners and leads enables the Delivery Collective to have a strong influencing role. The Delivery Collective does not have the power to require specific actions of bodies like Health and Social Care Partnerships (HSCPs), local authorities, health boards or national policy teams, and so is required to take a softer convening, influencing and evidencing approach to progress its aims, bringing people and organisations along with it.

There are also social factors that can hinder the work including:

• There is a stigma to suicide prevention work that impacts on key groups’ willingness to discuss it specifically, with a common preference to focus more broadly on mental health. This can impact the programme’s visibility and ability to influence action. The Delivery Collective will continue to drive forward change through our work to address suicide stigma.
• Suicide prevention remains one among many issues competing to take priority at national and local level. Although the impact of Suicide is well understood on and by the individuals affected, suicide prevention can be seen as something that only affects a relatively small group of people. It is important that the programme of work continues to highlight and address the economic and personal impact suicide in Scotland has.
• The narrative around suicide prevention tends to focus on the numbers of deaths, rather than the impact of suicide attempts or on the people bereaved by suicide. It is important this is broadened so that it encompasses data and intelligence on suicidal thoughts, recognises the significant impact on mental health and wellbeing, and the potential economic savings for other services (e.g. emergency services).
• The programme structure is multi-faceted with many roles and functions shared across a range of groups and organisations. There are a number of groups that advise on and deliver the work, including the NSPAG, Academic Advisory Group, LLEP and YAG, which all meet separately and guide and advise on strategic direction and operational delivery. This brings a strength to the programme of work ensuring it is driven by data and the insights of academic, practice and lived experience and expertise.

The delivery partners often working in a competitive environment and deliver other work, often commissioned services for national and local government. While they value the chance to work collaboratively, CHT is the only piece of work where they all do so - bringing fresh perspectives and opportunities for joint working.

Material

Material factors are those that are ‘out there’ in the environment and wider world, which both constrain and shape behaviour. These influences include infrastructures, technologies and regulations, as well as time and resources.

The Creating Hope Together programme is working in a challenging material environment:

• The post-covid and cost of living financial environment creates challenges in delivery of the programme of work. Across sectors many stakeholders and partner organisations are facing financial difficulties which can make it more challenging to engage with the programme of work at the time the Delivery Collective needs to meet set milestones. The flexibility, creativity and innovative way of working has reduced the potential impact and enabled continued delivery of the action plan.
• Working in this way relies on strong relationships and effective partnerships, which require time and capacity to build understanding and trust. These relationships have been forged alongside the delivery of the programme which has led to strong support networks across the Delivery Collective.

There are also structural realities, processes, and complex systems that may affect the programme’s impact:

• Creating Hope Together is envisioned as a whole system change process, and must rely on influencing local authorities, health boards and national policy teams with little ability to direct management decisions around prioritisation or budgeting. The joint ownership of the strategy between Scottish Government and COSLA enables an ability to lever some influence where needed through policy teams in Scottish Government and COSLA Board structures.
• Suicide prevention attracts a lot of interest and scrutiny. Despite the regular reporting on progress set out in the Strategy, there are a considerable number of requests through parliamentary questions, ministerial correspondence, FOIs and media enquiries, often requiring a quick turnaround of information. This level of demand utilises capacity and impacts the ability to deliver the programme. Utilising the electronic recording system to gather relevant information to answer these queries is aiding the response times and reducing demands on the Delivery Collective.
• There are challenges for partners working together across organisations. Information governance and IT security policies have made it challenging to set up a shared online working space (e.g. a Teams channel) with universal accessibility for knowledge management or online meetings. The Delivery Collective also has no physical shared space, meaning that coordination of face-to-face meetings absorbs capacity and limits opportunities for informal discussions and smaller meetings.

There are also material factors that support the work:

• The lack of dedicated physical space means that meetings are hosted by team members, usually without cost to the programme, and colleagues have the opportunity to visit each other’s’ settings and build mutual understanding of their work.
• The programme is also drawing on 20 years of previous suicide prevention work in Scotland, including good processes and practices, a research and evidence base, and the findings of public consultation and engagement. The structure of the programme enables the work to draw on a range of expertise, including access to Scottish Government policy teams, an academic advisory function, and lived experience groups. It is a government priority, and the Suicide Prevention Strategy is jointly owned by local and national government and promoted as such by the Minister for Social Care, Mental Wellbeing and Sport and the COSLA Health and Social Care Spokesperson.
• The funding behind the strategy has enabled the creation of dedicated roles like the National Delivery Lead for Suicide Prevention, and protected time for Outcome and Delivery Leads. The Leads have clear processes for decision-making and a clear accountability structure, with regular meetings established.
• Recent legislation around online harms and media guidelines have helped to direct some of the suicide prevention work, as have recommendations from the National Confidential Inquiry into Suicide and Safety in Mental Health. The need for good data is supported by requirements in regulation for annual statistical publications.

While we recognise the impact the Individual, Social and Material challenges can have on the work, the cohesiveness of Suicide Prevention Scotland provides real opportunities to work collaboratively to generate creative and innovative approaches to overcoming these and progressing the work.