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 1

Creative Practice IRISS and Shetland workshops January

Hello 3

4 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 5

Programme 10.00Introductions 10.15Scene setting (Peter MacLeod) 11.15Scene setting – what’s driving change in Shetland (Robert Rae) 12.30Lunch 13.00What’s our vision? 14.00Strategies for engagement (Lisa Pattoni) 14.45Realising our ambitions 15.30Coffee 15.45Group reflection and planning 16.30Close 6

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? 7

What’s driving change in Shetland? 8

9 What’s our vision?

1. Ability to see the larger system 10

2. Fostering reflection and generative conversations 11

3. Shift from problem solving to co- creating the future 12

An overview from Edna Mary… 13

Mindful of 10 principles for locality arrangements: 1.They are co-produced with communities, users and carers 2.They are an integral part of Health and Social Care partnerships and will be held to account for delivery of local priorities 3.They are based on trust and respect between all partners 4.They are multidisciplinary and multisector 14

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 15

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) 16

Making headlines…. 17

Key actions 1.Develop ‘Primary Health and Care’ Teams 2.Implement a multidisciplinary approach to assessment & review of individuals with health & care needs 3.Review the current service model to address needs within each of the individual neighbourhoods 4.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 18

Strategies for engagement 19

“involvement results in better information on which to base commissioning decisions, better quality services and better outcomes for people” (Hough, 2008) 20

21 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) 22

Where should we involve people? Throughout! 1.Understanding assets and needs 2.Shaping and delivering services 3.Reviewing service performance 23

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? 24

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 months 25

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 staff 26

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) 27

…and some more Requires diverse views Recognise that these are issues for all Make operating context overt Don’t over specify 28

How can we practically apply co-production in commissioning? 29 Co-producing Commissioning Co-producing Commissioning Co-production Commissioning Co-production INSIGHT

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? 30

“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) 31

Realising these ambitions 32

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? 33

Group reflection and planning 34