Community Development – Now More Than Ever

1. Community Development – Now More Than Ever The current challenge and the response we need Sandy Watson Chairman, NHS Tayside Board

2. The Current Context • Public expectations • Modernisation agenda • Outcomes-based approach • Commitment / leadership; responsiveness / consultation; sound governance; sound management of resources • Review and option appraisal • Partnership / accountability • Rationalisation and consolidation • Rights / standards / standardisation • Financial burdens

3. Current Financial Situation • Scottish budget has doubled over past decade • 2-year pay freeze south of the border • VAT increase – impact on supplies, medical equipment, drugs • Scotland deferred impact of £6bn saving – double impact in 2011/12

4. Scottish Block Finance & Demand 2009/10 – 2017/18 (% real terms)

5. “Fortunes are not made in boom times…that is merely the collection period. Fortunes are made in depressions or lean times when the wise man overhauls his mind, his methods, his resources and gets in training for the race to come.” George Bacon Wood (1797-1879)

6. “The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty, and we must rise with the occasion. As our case is new, so we must think anew and act anew.” Abraham Lincoln

7. Demographic Challenge • Large growth in over-65s • Tayside over-65s – increase of 18% over 10 years; over 85s by 45% • Additional 148 beds by 2016/ 517 by 2031

8. Three other important strands

9. Community Planning(formalised by Local Government in Scotland Act 2003) “The key agencies involved in promoting the well-being of the communities they serve should come together at council area level in a processanimated by the local authority, to develop a vision of the key issues facing the area and how they are collectively going to address them. In so doing, they should develop a “Community Plan”, which would set out the partners’ shared vision for meeting the needs of the area. The report also stresses the importance of engaging with and involving communities themselves in this process.” Donald Dewar

10. “Better Health, Better Care - Action Plan” • “…..This document sets out a new vision for the NHS. That vision is based on a shift from the current position where we see people as “patients” or “service users”, to a new ethos for health in Scotland that sees the Scottish people and the staff of the NHS as partners, or co-owners in the NHS. I want us to move to a more mutual NHS where partners have real involvement, representation and a voice that is heard”. • Nicola Sturgeon, MSP, Deputy First Minister and • Cabinet Secretary for Health and Wellbeing

11. Some very important changes: • Greater prominence to health improvement and health inequalities, including the health of very young children, which can have life-long implications for people’s health and wellbeing • Much stronger emphasis on working with people – population, patients, carers, and NHS staff – both in changing and delivering services • Evident increase in the scale of the strategic agenda for the NHS and an explicit indication that the pace of change should increase • Much stronger emphasis on the health agenda being the preserve not just of the NHS, but involving other organisations • An indication of a wider strategic horizon for the NHS beyond the health agenda – position reinforced by the Concordat between the Scottish Government and local government, which emphasises a simplified approach to performance management through Single Outcome Agreements

12. Independent Commission on Good Governance in Public Services: Langlands Report The governing body should decide how the quality of service for users is to be measured and make sure that it has the information it needs to review service quality effectively and regularly. As part of this, it should ensure that it has processes in place to hear the views of users and non-users from all backgrounds and communities about their needs, and the views of service users from all backgrounds about the suitability and quality of services. The governing body should use this information when making decisions about service planning and improvement.

13. CommunityEngagement “…. The process of involving communities in the planning, development and management of services. ………Community engagement takes many shapes and forms. It can involve simple exercises in consultation through to the formation of multi-agency partnerships with community representation at the centre. Underlying community engagement is the commitment of the service providers and planners to listen to those for whom the services are planned”. Communities Scotland (“Community Engagement – How to Guide” )

14. Buzz Words • Empowerment – increasing the ability of individuals and groups to influence issues that affect them and their communities • Participation – supporting people to take part in decision-making • Inclusion, equality of opportunity and anti-discrimination – recognising that some people may need additional support to overcome the barriers they face • Self-determination – supporting the right of people to make their own choices • Partnership – recognising that many agencies can contribute to ensure that resources are used effectively. • Co-production – active relationship between staff and service users as co-workers

15. ADD: • Social marketing • Co-production

16. Social Marketing What is it? “putting people at the heart of policy, communications and delivery to encourage behaviour change”

17. A few thoughts • Provision of services for people > culture of dependency • Partnership with users • Get better at explaining > ownership • Training (interagency) + community capacity building • Involvement in building the boat as well as steering and rowing it

18. Not just another initiative • Changing the way we do business • Review vigorously • Measure progress • Be honest about where we’ve got to

19. The Process Requires: • Honest analysis of strengths and weaknesses. (Does this organisation really know where it is?) • Vision • Development of a powerful top team • Importance of communication • Maintaining progress

20. A way forward? • List current successful developments • Identify key factors for success • Operational plan/ template? • How can we build on what works well?

21. Go with the people Live among them Start with where they are Begin with what they know Of the best leaders When their task is accomplished Their work done The people all remark “We have done it ourselves”