As you arrive….

Please make yourself comfortable and write a little description of your expectations for today onto a post-it and add to the wall

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Creative Practice

IRISS and Shetland workshopsJanuary 2015

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Hello3

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Facilitation

Working together today

• A climate for discovery• Suspend premature judgment• Explore underlying assumptions and beliefs• Listen for connections between ideas• Encourage and honour diverse perspectives

and contributions• Articulate shared understanding• Harvest and share collective discoveries

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Programme10.00 Introductions10.15 Scene setting (Peter MacLeod)11.15 Scene setting – what’s driving

change in Shetland (Robert Rae)12.30 Lunch13.00 What’s our vision? 14.00 Strategies for engagement (Lisa Pattoni)14.45 Realising our ambitions15.30 Coffee15.45 Group reflection and planning16.30 Close

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Ice breaker

In pairs, discuss:

1.What’s important to you about integration? And why do you care?2.What opportunities do you see in locality working? What do we still need to learn about locality working?

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What’s driving change in Shetland?

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What’s our vision?

1. Ability to see the larger system

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2. Fostering reflection and generative conversations

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3. Shift from problem solving to co-creating the future

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An overview from Edna Mary…

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Mindful of 10 principles for locality arrangements:1.They are co-produced with communities, users and carers2.They are an integral part of Health and Social Care partnerships and will be held to account for delivery of local priorities3.They are based on trust and respect between all partners4.They are multidisciplinary and multisector

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5. They have common purpose through an agreed scope and local outcomes for the population

6. There is a clear understanding of the measurable outcomes for both services and service users that will be delivered

7. They have a level of devolved financial and operational responsibility to make decisions on the use of resources

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8. They make a central contribution to the development and delivery of joint strategic commissioning plans

9. They have a focus on creating health and tackling inequality through service planning, coproduction, support for self management and asset based approaches

10.They embody non-competitive direct engagement in the commissioning of support and services.

(Strang, F (2013) All Hands on Deck)

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Making headlines….

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Key actions1. Develop ‘Primary Health and Care’ Teams2. Implement a multidisciplinary approach to assessment

& review of individuals with health & care needs3. Review the current service model to address needs

within each of the individual neighbourhoods4. Implement a service model which maintains the

importance of high quality service user experience, that is based on assessment of need and which is planned and delivered by staff at a neighbourhood level

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Strategies for engagement

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“involvement results in better information on which to base commissioning decisions, better quality services and better outcomes for people”

(Hough, 2008)

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Coproduction ladder

Why do it and what does it look like?

• dynamic and iterative;•recognises assets and builds on local resources;•applies local insight and data;•builds collaboration;•opens up opportunities for innovation, and•takes a longer term view.

(NEF, 2012)

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Where should we involve people?

Throughout!

1.Understanding assets and needs2.Shaping and delivering services3.Reviewing service performance

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Example 1: More power to their elbow(Wistow, 2011)

• Focus tended to be on process• Local people felt that their involvement was

worthwhile and had showed results. • There were concerns about the mix of older

people• Should older people be viewed as citizens or

consumers?

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Example 2: older people with high support needs (NDTi, 2014)

• Involved local communities to help develop a new commissioning strategy for older people with high support needs

• Design team of older people – the face of the exercise

• Visited people, rather than expecting them to come to them

• Started with the question ‘what supports help you have a good life?’

• Series of events over 4 months25

Example 3: Transforming services for young people

(Governance International) • From deliverer of services to commissioner of

outcomes (focus on wellbeing)• Decommissioned 4 historical services• Began with a comprehensive needs assessment

in partnership with young people• Young people as co-commissioners of local

services through decision making panels• Crucial involvement and buy-in from front-line

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Critical success factors• Why are you involving people?• It takes time and is a process• It can require independent facilitation• Build relationships - the focus has to be on

outcomes – not processes

(Schehrer and Sexton, 2010)

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…and some more

• Requires diverse views• Recognise that these are issues for all• Make operating context overt• Don’t over specify

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How can we practically apply co-production in commissioning?

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Co-producingCommissioningCo-producing

CommissioningCommissioningCo-productionCommissioningCo-productionINSIGHTINSIGHT

Some questions• Is this actually about a transfer of power or about

power residing within the partnership while being open to the influence of users?

• Do users want to have the responsibility for strategic decisions?

• Is there a tension between current and future service users; actual or perceived; between identified need and aspiration?

• To what level at each point can people realistically be involved in shaping services for the future?

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“service user involvement is not an end in itself, but a means of effective change, both in the outcomes of services and the behaviour of workers”

(Davies, Finlay and Bullman, 2000)

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Realising these ambitions

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Prompt

Practically, what will people in the community/who use your services see, hear, think and feel differently based on the realisation of your vision?

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Group reflection and planning

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