Strategic Public Social Partnership model: report

Findings of the research commissioned by the Scottish Government to explore the progress of the Strategic Public Social Partnership Model in Scotland.


4. Conclusions: lessons learned and considerations for future developments

4.1 Lessons learned

A number of lessons can be drawn from the experience of the Strategic PSPs in Scotland. These are discussed in turn below.

Government support for the model

The evidence suggests that the Strategic PSP model has served as a useful test-bed for piloting new approaches to partnership working. The model has enabled the capacity and credibility of (some) Third Sector providers to be enhanced. It has improved relationships among partners, promoting collaboration in different sectors and improved the quality of the services (new or re-designed) by reflecting the needs of service users. Ultimately, therefore, the Strategic PSP model has been implemented successfully on the basis of how it was initially conceived, and the Scottish Government investment in this programme was necessary in order to facilitate this. However, while the experience of the six Strategic PSPs has provided positive outcomes, more needs to be done to embed this way of working more deeply into the infrastructure of future service design and delivery.

Pathway to exploring more collaborative practices

The research carried out to assess the progress to-date of the Strategic PSP model indicates that this model is a pathway to more collaborative practices between sectors. But collaboration requires time and effortfor those involved, and changing ways of working that are often ingrained in organisational cultures. Moreover, such practices are sustained within the (wider) context when it is driven by competition and the realities of the austerity paradigm. In the view of most partners, the Strategic PSP model has been an important contributionto recognising the value of more-collaborative and inclusive ways of working. Supported by dedicated, hands-on, RfB support, the Strategic PSP model worked well.

Leadership

The importance of leadership in sustaining the development of the Strategic PSP model has been recognised and discussed, both in terms of knowledge of the Third Sector and in relation to dedicating resources. However, in all cases reviewed, leadership alone was not sufficient to guarantee the move to 'Stage 3': the commissioning of the service.

Commissioning target

Despite individual drive, experience and ambition, there has to be an identification of the commissioning target from the outset in order that piloted services can be commissioned. Funding for a successful service has to be ring-fenced in order to be able to mainstream new ways of working; otherwise issues of sustainability will never fully be resolved. Most of the Strategic PSPs filled gaps in provision or reflected wider (policy/legislative) changes – in other words, actions that needed to happen anyway – rather than resulting in any innovative approaches or 'new' services being mainstreamed.

Piloting and experimenting

While it has taken time to achieve recognition of this collaborative way of working, the Strategic PSP model has contributed to 'formalise' a process that combines narratives of transparency, cooperation and competition. Where the Strategic PSP model has been utilised effectively as an opportunity for change, as was the case with the SPT Community Transport Strategic PSP, and less as an entity in its own right, there have been examples of successful breaking down of siloed thinking. The community transport model does appear more straightforward than other sectors, however, and times have changed in favour of different ways of delivery. Ultimately, the Strategic PSP model has enabled the development of a space for different partners to come together and begin a learning process, adjusting practices and attempting to change ingrained ways of working.

Legislative underpinning

The Strategic PSP model has arguably worked best as part of a wider push towards co-production, for example in areas involving statutory bodies where changes in legislation have helped to create a conducive environment ( e.g. the personalisation of services agenda). In situations where the legislative push is not as strong, the Strategic PSP work is often seen as additional to mainstream provision.

4.2 Considerations for future development

In the right conditions, the Strategic PSP model has worked successfully in bringing different partners together to begin to address the issue of effective service design. The opportunity now presents itself for the Scottish Government to build upon this achievement ensuring there is enough understanding of the model, rules of engagement and procurement legislation to 'normalise' this way of collaborative working.

Development

Mainstreaming such an approach would indicate that Scotland is at the international forefront of new approaches to embedding the co-production of public service design and delivery. Indeed, our review of alternative PSP models internationally has indicated that while long-term sustainability still represents a major challenge, the transformation of the Italian commissioning process enabled social cooperatives to be identified as the main and preferred service providers. This, in turn, facilitated collaboration and consortium development among social cooperatives to address identified needs – through service provision. However, this is not tantamount to mainstreaming co-production.

A distinct 'Scottish Approach' to policymaking and delivery has been constructed, guided by the principles of collaboration, co-production and partnership. The time now seems ripe to push ahead with more collaborative commissioning practices. The government should now provide further strategic leadership by encouraging more inter-departmental working and collaboration across different divisions – building on the cross-divisional work already under way in relation to Low Moss.

A number of key considerations on what needs to be considered – directions going forward - have emerged as part of this study. These are presented and discussed in turn.

Directions going forward

Specific legislation

The exploration of the international literature has revealed that successful examples of co-production often require legislation and changes to the commissioning process and in apportioning/pooling budgets. As examples of collaborative commissioning approaches and participatory budgeting mechanisms increase in the UK and further afield, more could be done to 'normalise' collaborative ways of working between public, Third Sector and service users [14] . While specific legislation could be introduced to require collaborative/inter-sectoral working through partnership models (like PSPs) as the preferred mechanism for service design/re-design, it needs to be recognised too that legislative changes elsewhere in the 'system' can often create the conditions or facilitate an appetite for partnership working and PSP-type approaches (as with personalisation of budgets/Self-Directed Support in the context of welfare reform).

Top level commitment

Collaborative working needs sufficient time and resources to make the project work, and to overcome cultural barriers. Developing trusting relationships and sharing learning have been reported as crucial elements in facilitating balanced partnership working. Further, providing strategic awareness training to senior managers/commissioners within the public sector appears a possible way to overcome procurement barriers and to promote the Strategic PSP model as the future way of working.

Embed learning

It is important to ensure all that has been learned so far on how to implement a model of collaborative working is not lost. Ensuring that specific training is provided to all of those involved (both specifically in the Strategic PSPs and across commissioners and procurement specialists) appears as a feasible solution to enable processes of collaborative working. For example, in Brescia Citta' del Noi (see Chapter 2 and Appendix 2) the involvement of public sector officers at all levels is supported through intense training provided by one of the Universities involved. Similarly, Social Impact Factory in the Netherlands organises training events to embed management instruments in social enterprises and to develop connections between the public and private partners. Partnership working presents several challenges, particularly in terms of resources and time intensity but also in terms of conciliating the agenda, remits and structure of the partners involved. At a practical level, training provision appears to be important in order to support those involved in understanding commitment and procedures.

Post Strategic PSP routes for partnerships

The commitment to those Strategic PSPs still in receipt of funding should continue (with, where appropriate, direct investment and/or in-kind support) with a view to support a clear identification of commissioning routes 'post Strategic PSP'.

Appendix 1 - Methodology

The methodology chosen to address the aims and objectives of this research – that is to explore the progress of the Strategic PSP model in Scotland and advise on future investment relating to this – emphasises the role of context and plurality of perspectives in shaping the outcomes of a programme: realist evaluation. Realist evaluation is used to identify outcome patterns, generative mechanisms and contextual conditions which helps not only to assess what works, but also for whom, and in what circumstances (Blackwood et al., 2010; Pawson, 2013; Pawson et al. 2012; Pawson et al. 1997). Specific approaches to data collection then need to be developed by researchers, selecting and adapting methods that align the philosophical tenets of realism with the substantive focus of inquiry (Angus and Clark, 2012). In order to operationalise our understanding of the brief in line with realist evaluation techniques we adopted a mixed-methods approach to data collection which included the collation and analysis of both primary and secondary data.

Primary data

We conducted 28 in-depth face-to-face interviews with Strategic PSP strategic coordinators (n=6), Strategic PSP operational managers (n=3), representatives of Third Sector partners (n=7), representatives of public sector partners (n=11) and representatives of academia (n=1). In addition we conducted four focus groups with key members of four Strategic PSPs (public and Third Sector representatives and service users) in order to gather their views on the process of setting up the Strategic PSPs, their assessment on the strengths and weaknesses of the model, and their views on notable achievements to date (see Table 4 for full description). We also conducted 13 interviews with: key Third Sector funders (n=2); Ready for Business ( RfB) Consortium representatives (n=5); Scottish Government officials involved in procurement and the Change Fund PSP models (n=4); and other stakeholders promoting alternative models and commissioning processes (n=2) (see Table 5).

Table 4 – Voices involved in data collection for each Strategic PSP

PSP

Voices Involved from the Public Sector, Third Sector and

Service Users

Other Data Collected

Low Moss

2 representatives of Scottish Prison Service, 1 representative of Community Justice

1 Strategic PSP coordinator, 1 Strategic PSP manager

Observation and informal discussion with prison officers and analysis of the evaluation report (qualitative quotes of service users)

NHS Lothian

1 Strategic PSP Coordinator, 2 representatives of the NHS, 1 representative of Edinburgh Local Council

1 representative of Academia
1 representative of Third Sector interface, 1 representative of Third Sector organisation

East Renfrewshire

1 Strategic PSP Coordinator

6 Representatives of Third Sector organisations

The Life I Want

1 Strategic PSP Coordinator, 1 Strategic PSP project manager

7 service users

Participation and observation Operational group involving public sector representatives, Third Sector representatives and service users

SPT Community Transport

1 Strategic PSP Coordinator
2 Representative of SPT

6 representatives of community transport organisations

Elevate

2 representatives of NHS, 1 representative of public sector

1 Strategic PSP coordinator, 1 Strategic PSP manager, 8 representatives of Third Sector organisations

Participation and observation "Elevate Workstreams Event": involvement of service users, Third Sector organisations and public sector

Table 5 – Stakeholders interviews

Name of stakeholders

Total Number of Interviews

Who has been interviewed

Ready for Business

5 interviews

1 Representative of SENSCOT, 2 Representatives of CEiS, 1 Representative of Social Firms Scotland, 1 Representative of KPMG

Big Lottery Fund

1 Interview

Head of Policy and Learning

Robertson Trust

1 interview

Director

Improvement Service

1 interview

Chief Executive

The Social Investment Impact Partnership

1 interview

1 Representative

Scottish Government

4 Interviews

Change Fund, Health and Social Care, Procurement Unit

Secondary data

A number of secondary data reviews were carried out as part of this research. A review of alternative PSP models delivered elsewhere in the UK and further afield. This included a database search (of both Google and Google Scholar) for examples of alternative models and reports evidencing lessons learnt from various internationally developed alternative models of Public Social Partnerships. A further review of literature relevant to the Scottish model of Strategic PSPs was carried out alongside an analysis of secondary data pertaining to each of the six Strategic PSPs, including documents shared by the Scottish Government, the six Strategic PSPs, and RfB. The approach to analysis of the secondary data is detailed in the next section

Analysis

In line with the realist approach, the data have been imported into the qualitative data analysis software package NVivo 10 and analysed for emerging themes. A 'causation coding' method to analysing the data has been employed in order to establish the 'causal pathways' through which the intended (and/or indeed, unintended) outcomes are achieved. The mechanisms in play to achievement of such outcomes, and what (and how) contextual factors matter to the achievement (or not) have also been identified. The basic aim of such an approach is to understand what has and has not worked, and how. How context, mechanisms and outcomes interact in realist evaluation is described in Figure 5.

Figure 5 - Realist evaluation (adapted from Pawson and Tilley, 1997)

Info graphic

The scoping literature review approach

The aims of the scoping review on alternative PSP models were: to provide a description of international and other UK examples; to indicate what has reportedly worked, and what has not, in these contexts; and report on any evidence presented of lessons learned and impacts. The scope therefore was twofold: to identify other examples of PSP models; and to verify whether these or any others had been evaluated or assessed to measure impact.

The first part of the work focused on conducting an on-line search using the search engine Google – to identify policy and practitioner-based (so called 'grey') literature – and Google Scholar to search academic literature on evaluated, measured examples. International institutions' websites such as the European Union and the OECD were also screened to review international reports on co-production and social innovation, as were two online platforms: the Observatory of Public Service and Innovation [15] and Governance International [16] . The former is managed by the OECD and showcases relevant examples of public sector innovation. The latter is managed by a private organisation based in the UK which collects case studies of co-production, and aims to help other organisations to achieve better outcomes and efficiency savings.

The keywords used for the searches included: 'co-production', 'public private partnership', 'public social partnership', 'social innovation partnership' and 'European social partnership'. These keywords were identified through literature searches and interviews conducted with the stakeholders and experts involved in the assessment of the Scottish PSP model. The keywords 'evaluation' and 'assessment' were also used to ensure that the literature emerging included some evidence of lessons learned, outcomes, and impacts of these models. After a first screening of titles and abstracts, only papers and reports that analyse partnerships between Third Sector organisations and public sector organisations were downloaded and read in full. It is important to note that this review only includes cases and reports disseminated in English and Italian, but excludes other languages. Therefore, while other examples might well exist, their inclusion in this report was based upon the principal researcher's ability to understand the language.

Table 6 provides an overview of the number of reports or papers that have been screened and the ones that have been selected to inform this paper.

Table 6 – Reports and Papers screened and selected

Keyword

Total Number of Reports/Papers Downloaded

Number of Reports/Papers selected for the report

Co-production

70

31

Public private partnership

13

2

Public social partnership

28

17

Social innovation partnership

17

6

Social partnership

13

8

European social partnership

4

1

Workshop

Finally, we organised a half-day workshop with participants of the research in order to validate our data and analysis by discussing the emerging findings.

Appendix 2 - Alternative models of Public Social Partnership available internationally and in the UK

Italian Case studies

Brescia Cittá del Noi [17]

Brescia Cittá del Noi (Brescia: Our City) is a project launched in 2016 managed in a partnership between the department of welfare services of the local council of Brescia, three non-profit organisations and two universities. The partnership aims at reshaping the welfare services of the city to address increasing and changing societal needs in a context of budget austerity. The total cost has been estimated to be around 3 million euro - funded by the Cariplo Foundation (a private foundation) with 1.4 million euro, the local council and the two Third Sector organisations involved.

A number of working groups have been developed to:

  • - design welfare provision for specific target groups ( i.e. children, families, older people, marginalised adults and disabled people);
  • - monitor delivery and account for spending; collect and analyse data on societal needs;
  • - build the skills of council officers on how to deliver collaborative projects;
  • - raise awareness among the wider public; and,
  • - study future sustainability options for the services developed.

Outcomes

Although, the project only started in 2016 and is ongoing until 2019, a recently published social report of their Department of Welfare Services highlighted some of the results obtained through the partnership, such as an indication of increased knowledge-sharing among partners involved and new experimentations in social service design and provision. The partnership aims to change the relationship between the local council and Third Sector and develop a more community-based system of welfare that has the flexibility to address growing societal needs. The involvement of public sector officers at all levels appears to enable the process, supported through intense training provided by one of the Universities involved. Officers are supported in the process of learning and this arguably enables them to tackle the emerging issues relating to re-developing services more collaboratively, supported by strong political leadership.

Challenges

Although the project is still on-going, and more challenges are likely to emerge, the importance of establishing coherent mechanisms to enable the transition between experimentation and mainstreaming has been noted as the main challenge the partnership has had to face so far.

Bollate Prison [18]

In 2000, Bollate, a new Italian detention centre, was inaugurated near Milan with the idea to create a co-production process in which prisoners serve their sentences with minimal supervision. With the involvement of ten social cooperatives and the prison management and staff, prisoners were offered the opportunity to gain educational qualifications, improve or learn new skills and participate in a variety of activities to improve their health and well-being.

Outcomes

The work in Bollate prison has been extensively evaluated and represents a mainstream model of co-production in which a new service was developed with the involvement of public sector, Third Sector and with service users. Re-education, individualised treatment, education and work were all interconnected in a process aimed at supporting the lives of inmates. One of the evaluation studies reviewed investigated the differences between prisoners working and living in Bollate and a comparator group of inmates in other Italian prisons (Mastrobuoni and Terlizzese, 2014). The authors showed through a quasi-experimental investigation that spending time at Bollate reduced recidivism by 16% in comparison to mainstream prison. The authors of that evaluation study highlighted that the ability to work outside, and the sense of responsibility inherent in carrying out such work could positively affect recidivism rates, alongside increasing the health and well-being of inmates on a range of indicators. The success of Bollate was facilitated both by a strong commitment at the strategic level within the prison, but also through the development of a specific central government law (Legge Smuraglia of 2000 [19] ) promoting fiscal incentives to social cooperatives in the social integration of inmates.

Challenges

Despite positive outcomes, the example of Bollate has not been fully replicated in other prisons in Italy. Even if social cooperatives now have a growing role in working inside different prisons, their presence is still patchy: Italian prisons are still facing human rights problems such as overcrowding and quality of services [20] . Overall, the main challenge that the Bollate project faces is that the activities delivered by social economy actors are almost always funded by the organisations themselves, thus it is not mainstreamed. Bollate provides a space and access to prisoners to act as a 'free' workforce, but the service is additional to mainstream provision, not funded by the prison or the state, therefore not fulfilling the co-production ideal.

AVIS and the Italian transfusion system [21]

Italian legislation emphasises the strategic role of Associations of donors and entrusts them to promote blood donation, collect it and call donors. Avis (Italian Association of Blood Volunteers) is the main and largest Italian blood donor association and it includes around 1.3 million blood donors (more than 75% of the total number of Italian blood donors). At the national level AVIS is involved with central and regional government departments to structure organisational solutions that can guarantee the delivery of consistent efficient and effective services. Avis has well over 3,000 territorial branches managing different phases of the blood collection process, including promotion and awareness of blood donation, donors' recruitment and retention and blood collection in strong collaboration with the Italian National Health Service. The Italian transfusion system represents a model of co-production, involving a joint process of design and delivery between NHS, regional government, local authorities and non-profit organisations of blood donors.

Outcomes

The collaboration between Avis and the Italian NHS (at every level) represents a model of co-production fully mainstreamed. Avis is part of the complex system, and without the organisation it would not be possible to address the blood request. Thus, they represent an equal partner with the public sector in promoting and delivering blood donation. At the local level, recent research has analysed the added value that Avis provides to the Italian transfusion system (Saturni et al., 2017). Using a Social Return on Investment tool, the authors claimed that for every euro invested in the organisation there was a return ranging from 1,70 to 13,80 euro depending upon the branch evaluated.

Challenges

Although the co-production process is mainstreamed, standard agreements between the NHS and the associations have not always been updated (Saturni and Fiorentini, 2013). The austerity measures that have affected Italian health systems risks reducing budgets available for blood donor associations. The uncertainty behind the update of standard agreements could affect the continuity of the organisations.

Furthermore, despite the dominance of AVIS in the national blood donation system, a joint planning of strategies between the public sector and the non-profit sector is still lacking. The sharing of information concerning the demand and supply of blood, to ensure the development of a consistent provision in every Italian region, is also still lacking.

Netherland case studies

Social Impact Factory [22]

The Social Impact Factory was established in 2014 as a partnership between Utrecht local authority and the Kirkman Company, with the aim to promote social change and connectivity among different actors. The Municipality of Utrecht considered the Social Impact Factory as a means through which they could achieve their ambition of having the lowest unemployment rate in the Netherlands, using new collaborations, innovative solutions and public – private cooperation. Three main actions enabled the Social Impact Factory to develop. Firstly, social procurement was promoted from the outset: a transparent supply and demand system was implemented where municipalities and private companies publish their procurement needs while social enterprises, after being screened, offer their services. Secondly, different stakeholders engage in developing pilot projects to solve identified societal needs. Each project runs for six months and a long-term sustainability plan is at the core of the partnership process. Finally, the Factory organises training events mainly to embed management instruments in social enterprises but also to develop connections between the public and private sectors. The Social Impact Factory received funding for the first year from the municipality of Utrecht (200,000 euro) and other founding partners.

Outcomes

In its first year of operations, 90 social enterprises, 7 traditional businesses and 15 municipalities have been involved, leading to 21 matches worth 75,000 euro in revenue. Solutions to housing, transport and new job creations were developed and the local municipality invested 130,000 euro in such projects. Various events have been organised and a framework for evaluating social impact has been piloted. The Social Impact Factory has enabled a collaborative setting among public sector partners, social enterprises and Third Sector organisations to be developed ( OECD, 2017), advancing opportunities to share this approach in different geographical areas.

Challenges

Social Impact Factory as a model of co-governance has faced some challenges. Firstly, alongside constant tensions between social and financial missions, the organisation has experienced some resistance from potential partners suspecting the involvement of private companies, and criticising the encroachment of entrepreneurialism into the Third Sector. Secondly, tendering processes have not adapted to develop specific opportunities that explicitly favour social enterprises. The organisation is lobbying to understand how to change procurement guidelines.

Welkom in Utrecht [23]

In 2015, Welkom in Utrecht, a website platform and a Facebook page has been funded by private citizens, aiming to co-ordinate and facilitate activities for asylum migrants in the Utrecht Region offered voluntarily by residents and organisations. The website platform does not organise activities itself but rather coordinates the volunteering activities of others (organisations or citizens) in the city. It is a channel where people can submit initiatives, it provides information on what people can do, it sponsors activities and it collects voices of the people involved. The delivery of the platform and the Facebook page were then institutionalised as a foundation. A range of activities for refugees is offered through Welkom in Utrecht, supporting the well-being of people and engaging citizens in offering services and activities. Involvement of the local council has been important to promote the activities in the media to facilitate access to organisations and other official bodies.

Finnish, Swedish and Danish case studies

Finland

Village Sports [24]

The Village Sports project promotes health and well-being of rural inhabitants by means of physical exercise and social interaction. The project started with a preliminary enquiry about mapping the needs and resources of rural areas to encourage physical activities. It involved local municipalities, Third Sector organisations and citizens. Sports Villages were then developed, organising sports events and promoting cooperation between local sports organisations.

Outcomes

Evidence suggested that participants in the Village Sports project experienced increased social connectedness and cooperation, as well as increasing physical exercise among rural residents of South Savo.

Challenges

Some difficulties in managing the partnership were identified. Although cooperation between the various actors seemed functional on the surface, there was evidence of some tensions. For example, the need for the project was initially questioned, as well as the ability of the Third Sector to run the project. Also, there were some difficulties in trying to negotiate power dynamics, apparently related to the public sector being the sole funder of the project.

The Netty-Nysse Bus [25]

Netti-Nysse is an internet bus established in 2001 with the aim to reduce the digital divide in Tampere, offering courses in basic ICT training for elderly people alongside media education to pre-school children and a wide range of cultural activities in areas of poor digital connectivity. Since 2012, Tampere council decided to experiment with providing health advice and health care through the bus. Collaboration between health services and local Third Sector organisations enabled the delivery of this service with the aim to increase the capacity of local people to prevent health problems.

When the idea of the internet bus was first mooted in 2000, it fitted into the strategic framework of the City of Tampere and its e-government programme. Afterwards, the bus became a permanent arm of the local library, owned and financed by Tampere local council. A range of business partners were involved in helping to support and maintain mobile connectivity.

Sweden

Kulturverket [26]

In 2005, the City of Ulmea set up Kulturverket as a new cultural unit to implement a new approach to develop children services, and arts and culture. Its overall objective was to give all children in the municipality access to cultural experiences and to integrate creative learning processes into the everyday work of the schools. The unit involves artists from different fields ( e.g. filmmakers, musicians, librarians, artists, photography and technology) and Third Sector organisations working in the cultural field to co-produce and deliver the service. Two different approaches have been developed. The first approach is based on children's ideas, thoughts and creative work being developed together with older pupils, students and professionals (practising artists and cultural organisations). Children and young people are the creators, and take an active part at professional exhibitions, shows and concerts. These involve professionals and cultural organisations with their experience, knowledge and resources to implement children's ideas. The other approach brings together researchers, artists and school children where scientists or researchers give lectures. Children then have a discussion about the research discussed and they turn their new knowledge into art, together with the artists.

Kulturverket works with about 1000 – 1500 children aged 6 – 19 every year. Different art projects have been funded and developed. The municipality contributes around £400,000 every year alongside other public and private funding. One of the key success factors highlighted in this case study was the development of a strong partnership with cultural institutions, the local university and the local council.

Denmark

Cycling without Age [27]

Cycling without Age is a citizen-initiated co-production initiative that started in Copenhagen in 2012. The main aim of the initiative is about improving well-being of older people and reducing their social isolation through the possibility of having free rides on bicycle rickshaws. At the time of development, the City Council of Copenhagen had launched a strategy of collaborating with civil society and engaged 'networking agents' in its Health and Care Department to support new forms of collaboration with citizens. Through these networking agents the initiative was presented to the local council and a decision about supporting the project was made. Moreover the local council suggested that nursing homes should support and cooperate with the organisation for improving their welfare services. Today Cycling without Age is working across 65 Danish local councils and 27 international countries, including, most recently, in Scotland [28] .

Outcomes

According to the case study detailed in the Governance International Platform, the success of Cycling without Age depended upon the local councillors initially taking the risk to allocate funds to buy bicycle rickshaws (amounting to some £20,000) in the context of their ongoing commitment to fund care personnel and managers in care homes. However, the argument was made that if the commitment of care personnel and managers was high, then bicycle activity would be integrated successfully into the everyday life of older people and staff. Other factors of success include the alignment between the political focus on enhancing the quality of life of older people, the health and co-production agenda at the local level, and successfully communicating the benefits of the project.

Case studies from elsewhere in the UK

HMP Peterborough Social Impact Bond [29]

The Peterborough pilot has been the first Social Impact Bond ( SIB) promoted and evaluated in the UK between 2010 and 2015. This SIB was used to fund an intervention – the One Service – to reduce reoffending among those released from HMP Peterborough who had served a short prison sentence (of less than 12 months). Six actors were part of the Social Impact Bond mechanism: the UK Ministry of Justice had the overall responsibility of the project. Social Finance, a Third Sector facilitator, was the lead partner of the SIB, collecting funds from private investors and managing the service and the partnership. Private investors invested £5 million in the SIB, while the Big Lottery Fund also provided a guarantee to investors of £6.25 million. Social Finance used the funding to commission the delivery of the service to a number of Third Sector providers. A one-year renewable contract was established with three community organisations. The Ministry of Justice would pay up to 13.5% of the original investment, if the rate of reoffending events was reduced by more than 7.5% across all three cohorts compared to average figures across the entire prison estate. This SIB, although it was intended to run over three cohorts of prisoners was suspended after the second cohort. The reason was that the government introduced a general policy called "Transforming Rehabilitation" covering all prisons utilising a payment by results contract with an estimated value of £3 billion, which outsourced this function.

Outcomes

Results for Cohort 1 were published in August 2014. The analysis found an 8.4% reduction in the frequency of reconviction events within Peterborough Cohort 1. While this was below the 10% target required to trigger an early outcome payment for the first cohort, it was above the 7.5% target required for an outcome payment for the final combined cohort. In July 2017, results for Cohort 2 were published. The pilot achieved a 9.74% reduction in reconviction events for cohort 2 which was insufficient to trigger early payment for the second cohort as it did not reach the 10% threshold. However, the reduction achieved across both cohorts was 9.0%. This was above the minimum threshold and was sufficient to trigger payment. A number of mechanisms enabled the achievements outlined above. Firstly, strong leadership was important in developing the partnerships and instruments such as co-location, and joint access to the management database was developed. Secondly, formal agreements and procedures between Third Sector organisations and the prison service were established to coordinate the access to the prison. Thirdly, the Social Impact Bond helped to develop a flexible space where it was possible to decide how to improve service provision. Finally, it protected service providers and government in the event that it was not possible to achieve the agreed level of success.

Challenges

Challenges were faced in terms of long-term engagement of inmates with the services and the risk of not achieving a sustainable change in prisoners' lives. In addition, several possible limitations have been outlined concerning the Social Impact Bond mechanism. Firstly, there is a risk of adverse selection and 'cherry picking' of prisoners ( OECD, 2015). Secondly, there is a risk of earlier withdrawal of investors with consequent high costs for the government to act as a safety net funder ( OECD, 2016). Thirdly, there is an issue of evaluation and assessment of complex interventions with traditional positivist methods such as the ones that monetarise the results of the intervention with consequent difficulties in analysing if the intervention achieved the planned outcomes (McHugh et al., 2013). Finally, no evidence has been explored about the mainstreaming of services financed by SIB after the end of the pilot phase.

Partnership for Older People Projects [30]

The Partnership for Older People Projects ( POPP) was funded by the UK Department of Health to develop services for older people. The Department of Health designated 29 pilot local authority sites, in which to run projects between May 2006 and March 2009, and it invested £60m . The projects aimed at promoting health, well‐being and independence and prevention of need for higher intensity/institutional care. The 29 sites set-up 146 core local projects determined according to local priorities. In addition to these 'core' projects, a further 530 small 'upstream' projects were commissioned from the Third Sector. Altogether, 522 organisations were involved with projects across the POPP programme, including health bodies, secondary care trusts and ambulance trusts; and other bodies, such as the fire service, police, and housing associations; national and local voluntary organisations; and private sector organisations.

Outcomes

An evaluation was commissioned at the beginning of the project and an analysis of the outcomes of these partnerships was undertaken by an academic partner (Windle et al., 2010). Reduction in hospital emergency bed days and emergency department access were identified, and the evaluators claimed benefits in savings for every pound invested in the POPP. The majority of the projects have been sustained with only 3% being closed. In terms of partnership, service delivery teams comprised of staff employed by different agencies and relationships were particularly effective when they were working in the same location - barriers derived by a competitive context and lack of trust and confidence were overcome with the co-location of staff from different organisations.

In some cases, new posts were created for managing the partnerships and overcoming the possible barriers. This process incentivised a learning process between the public sector and the Third Sector, increasing local knowledge about communities for the former and skills and abilities for the latter.

The evaluation also identified the importance of discussing sustainability of the projects early in the process and the alignment to national and wider local strategic priorities as enablers of the partnership process. Sustainability in the POPP project was defined as the application of the learning generated within the pilot and/or the inclusion of the service re-designed in the mainstream.

Challenges

Challenges were faced concerning the short amount of time of the projects, the consequential sustainability, and the amount of resources and time for creating the partnership. Difficulties in overcoming a culture based on competition instead of collaboration were also faced alongside organisational differences in terms of structure and arrangements ( e.g. salaries, pension systems, and holidays).

Although 85% of the projects secured funding to continue after the pilot period through the local Primary Care Trust or the Social Care Form, an early attention to the issues of sustainability was necessary. When early agreements were made among public sector agencies regarding their responsibilities for sustaining projects and these agreements were written into initial bids, it was easier to continue the projects.

Challenges were also faced to determine the ways in which budgets could be pooled between different organisations and different public sector departments. Although the monies were moved within organisations, no budgets were pooled among different agencies of the system. Thus, in the evaluation report, identification of mechanisms for incentivising pooling budgets in the early days of the partnership was suggested to support long-term sustainability. Finally, although the project was evaluated, it was suggested, for ensuring effective programme evaluation, to identify monitoring and measurement systems at the start (and not at the end) of the project .

Bounce Back Project [31]

BounceBack is a project run as a partnership between AIW Health, a Third Sector organisation, and Liverpool University. GPs practices were involved to explore how to mainstream the intervention. It aimed to challenge and change current thinking about how to assess and manage mental health and well-being in a primary care setting. The goal of the partnership was to identify and address the causes of mental distress, working collaboratively to recognise disruptions to daily living and to explore how to address this area. Aligning theoretical knowledge from the University and practical knowledge of the charity, the project was awarded by the Department of Health Innovation Excellence and Strategic Development to support the introduction of the model of care in primary care settings.

The process of partnership and integration of the services in primary care was analysed and explored by the University of Liverpool. In the first phase of the project, challenges in understanding the differences between BounceBack and the current primary health care practice were faced by primary care staff and patients. The service was seen as an extension of the existing care rather than a new model of services. Also in the scaling up of the partnership, AIW Health staff were struggling to understand how to explain how the model was different from current practice but also from other Third Sector organisations. For overcoming these challenges, the project was refocused on a specific practice, working for co-defining and describing both the core and variable components of the intervention. A communication strategy for implementing the services was developed and regular feedback within the BounceBack team, practice and patients was created.

Outcomes

An evaluation of the project was also conducted by Reeve et al. (2016). The evaluation showed that only few practices, although expressing ongoing interests, were referring people to the service. Some factors were analysed as influencing this result. First, primary care was facing problems in terms of capacity. Second, it was difficult to support the patients in changing their belief that only medical intervention could affect their health and concerns. The patients involved highlighted that the service helped them by providing support and offering practical solutions, diminishing their distress. For overcoming this barrier, a key person within the practice team was identified to drive forward the service.

Challenges

The introduction of a new service needs to be managed as an entire system change, aligning visions and blurring boundaries between evaluation and delivery (Reeve et al. 2016). High level of resources for delivering the services and flexibility of reshaping the complex intervention should be taken into consideration. Finally, generation of knowledge, adaptability and change should be at the base of the co-production process alongside an evaluation of the process. Every partner should then be involved in a process of continuous learning (ibid).

Connected Care Model [32]

The Connected Care model involves an intensive programme of community capacity building led by Turning Point, a Third Sector organisation. Community Researchers explore the needs and the services in a specific community, organising engagement events with citizens, public sector officials and civil society. This research process leads to recommendations being formulated about how local people think local services could be commissioned and delivered differently. Community members and commissioners then work together to turn these recommendations into reality through the establishment of partnerships, new services and community collaborations. Different partnership processes have then been established through the Connected Care Model. One of these is reported below.

In 2009, Turning Point was commissioned by NHS South West Essex and Essex County Council to carry out a Connected Care pilot project in South East Pitsea and Vange in Basildon for sixteen months. More than 900 people were involved and based upon the recommendations developed by the Community Researchers, a new service model aimed at developing a more community based approach to the service was launched jointly with the local council. The Basildon Experts by Experience Model is a hybrid service that employs a mix of local people and volunteers, with knowledge of their community, experience of using health, housing and social care services, and a vision for co-creating a new type of service embedded in the local community that builds the capacity and resilience of local people. The model aims at co-producing in the community a service to provide housing support, debts and benefit advices and time banking. The Experts by Experience Model was tested as a pilot project in the community. The navigators were the first point of contact, support and onward referral, helping people to understand the resources available and representing an interface between service users and public services.

Outcomes

The new service was evaluated in terms of cost-benefit analysis by external researchers (Bauer et al., 2010). From a governmental perspective, the researchers claimed the service was associated with an average net benefit per client between £1,047 and £3,319. It was calculated that a total net benefit between £550,000 (not including quality of life benefits) and £1,750,000 and an average rate of return between £4.44 (not including quality of life benefits) and £14.07 for every pound invested were achieved.

Challenges

In exploring the Connected Care case, although a cost-benefit analysis of the partnership was conducted, Bauer et al. (2010) did not explore the process of the partnership and how the service was sustained in the long term. Thus, it is not possible to analyse what challenges were faced in collecting community needs, piloting additional projects and including or reshaping services.

Recovery College [33]

The Recovery College is a project developed between a voluntary sector organisation Activ8 and Sussex Partnership NHS Foundation Trust ( SPFT). Recovery Colleges use an educational approach to enable people to realise their aspirations; take control of their recovery and improve their well-being. All courses are mental health and recovery related; co-produced and co-facilitated by peer and professional trainers; and open to people who use services, their relatives, friends and carers, and NHS and voluntary sector staff.

Outcomes

Hastings Recovery College differs from many of the initial UK Recovery Colleges as it represents an equal partnership between the voluntary sector and the NHS (Meddings et al. (2014). SPFT has commissioned peer training since 2009, employing peer support workers, training all staff in recovery oriented practice, supporting self-help groups and the use of personal recovery plans. Alongside the role of SPFT, Activ8 has successfully sought external funds, developing a genuine 'balance of power' within the partnership, with the Third Sector organisation holding the budget for new funds for the pilot. Moreover, different meetings have been organised for planning the design of the Recovery College, developing a shared vision and discussing what each organisation could do. Only two lead partners were involved in the core redesign, engaging other organisations in case they had particular expertise. Starting with a small pilot was recognised as useful for overcoming possible barriers in terms of structure, cultures and knowledge. While building upon the strengths of the two partners, some challenges were also faced such as time, resources, bureaucratic constraints but also different target beneficiaries.

Challenges

Overall, making the partnership work is time and resource consuming. This should be acknowledged from the outset. It has also been noted that learning should be shared from the outset to support the growth of the partnership.

Appendix 3 - Expected Outcomes and Objectives Achieved

Strategic PSP Name

Objectives/Outcomes

SPT

Bringing co-ordination, enhanced quality and better use of resources to the CT sector

Delivery of Community and Demand Responsive Transport ( DRT) Services

CT Capability & Capacity - Growth and IT Development

Co-Identification of three workstreams for increasing capacity of the community sector. Improvement of standard and quality of community transport (following the procedure of SPT)

7 pilot programs were designed. 3 pilots were conducted and they were confirmed to continue as services. 2 services were started but not reconfirmed after the pilot phase. 2 services are going to start in the next months

25 people (of 47 referred) completed the D1 training with a success rate of 100%. IT Scheduling process was tested and shared in two areas

East Renfrewshire

To review the existing Supported Living services (in-house and externally provided services)

Involve stakeholders and partners in the design and piloting of new service models

To test the models developed and to implement the changes through a procurement process

Mapping exercise and production of a paper that collects the evidence behind the services

6 pilot redesign services tested

A move away from traditional time and task costs based on an hourly rate, to seeing an emphasis on an overall yearly budget of resources, and a move to defining the levels of support required based on an individual's stated outcomes

NHS Lothian

Designing services which are of the highest quality, and both effective and efficient

Strengthening existing relationships and building new robust relationships with Third Sector organisations and, essentially, with service users

Building knowledge of a co-production approach to designing services which could be utilised and enhanced in later stages of the redevelopment and in other service areas

The first PSP (Wayfinder) is at the stage of scaling up the services and exploring how to become mainstreamed. The other PSPs are in different stage of development but they are designing, piloting and testing different services in different communities of Lothian

Some of the PSPs have involved Third Sector organisations they were not expecting to be involved (development of new partnerships). The strengthening of existing and new relationship has been ongoing. Service users were involved mainly through Third Sector organisations or open events in the community

The experience of the first PSP has been used for developing the other four PSPs promoted by the same PSP lead


Strategic PSP Name

Objectives/Outcomes

Low Moss

The Strategic PSP set out to develop and test a new approach to improve the throughcare support provided to short-term offenders

New throughcare support model for short term prisoners has been developed and 653 beneficiaries were supported. Positive results in terms of reduction of re-offending and improvement of health and well-being

Elevate

To increase employability opportunities for people in recovery

To reduce the number of people in recovery who are unemployed

To make a positive impact on the health and well-being of local people and communities

Work placements and accredited qualifications, skills training course, Erasmus placements (Year 1: 35 achieved qualification, 17 secured jobs; Year 2 (as of 2 nd quarter) 108 and 19)

Started in May 2017 with a six week personal development programme

Still to work on

The Life I Want

Improving health for people with learning disabilities

Improving relationship

Improving transition

50 NHS GGC staff trained so far (in the last year - change of objectives from the first year), 56 people have attended Health work stream meetings with people with learning difficulties representing 41% of attendees

Identified some of the main barriers which prevent people from having good and positive relationships.
Identified the need for three sub-groups and some members of the work stream have already volunteered to sit on each group. In all the workstreams people with learning disabilities are the key actors in designing, piloting and testing the services and documents developed

Good Practice Guidelines on planning with young people delivered to the GIRFEC Board; Funding secured by GCIL for the development of an SDS App. SDS Book and Digital Stories circulated among the Strategic PSP Partners and beyond; Promotion and awareness raising of an Independent Travel Pilot with GCIL and VIAS


3 young people in contact with the ABCD work in the East End of the City

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