Strengthening partnerships to improve alcohol services East of England Regional Alcohol Conference, 19 th May 2010 Rachel Herring, School of Health and Social Sciences, Middlesex University, London. Rachel Herring, School of Health and Social Sciences, Middlesex University, London.

Policy context (New Labour)  Alcohol a new priority compared to drugs  Focus has been on: o alcohol related crime and disorder o public spaces o youth (‘binge’ drinking) o acute health harms e.g. accidents/injuries, hangovers etc  More recently: o Home drinking o Middle-aged (middle class) hazardous/harmful drinkers o Broader health harms e.g. heart disease, cancer, liver disease NEW GOVERNMENT –NEW DIRECTION?

Policy context (New Labour): Reducing alcohol-related harm Devolution of the responsibility to local areas for action to address alcohol-related harm and help achieve national targets.Devolution of the responsibility to local areas for action to address alcohol-related harm and help achieve national targets. Use of partnerships as a mechanism for developing and implementing local alcohol policies e.g. CSPs, DA(A)Ts, PCTs, LSPs (and LAAs).Use of partnerships as a mechanism for developing and implementing local alcohol policies e.g. CSPs, DA(A)Ts, PCTs, LSPs (and LAAs). High Impact ChangesHigh Impact Changes GORs have a supporting role.GORs have a supporting role. Alcohol as a cross cutting issue – health, criminal justice, community safety, commerce.Alcohol as a cross cutting issue – health, criminal justice, community safety, commerce.

Partnership What is partnership? What is partnership? “An agreement between two or more independent bodies to work collectively to achieve an objective” (Audit Commission, 1998, 2005) Why work in partnership? Why work in partnership?  Perceived failure of separately defined and run services  International evidence: multi-component approach  Funding  Statutory requirement e.g. CSPs (formerly CDRPs)

A MULTI-COMPONENT APPROACH: Co-ordinated Action a programme of co-ordinated action based on an integrative programme design where singular interventions (or stand alone projects) run in combination with each other and / or sequenced together over time. a programme of co-ordinated action based on an integrative programme design where singular interventions (or stand alone projects) run in combination with each other and / or sequenced together over time. THE WHOLE IS GREATER THAN THE SUM OF THE PARTS

 Appreciation that alcohol is a complex, cross- cutting issue that requires complex solutions  Identification, mobilisation and co-ordination of appropriate agencies, stakeholders and local communities  An understanding that the whole is greater than the sum of the parts  Change in professional behaviour Alcohol partnerships require:

The whole is greater than the sum of the parts:  Agreed common overarching goal  Understanding the ‘bigger picture’  Planning and delivering interventions/services that take account of the ‘bigger picture’  Identify what each player contributes/gains from participation in the partnership

High Impact Changes  Work in partnership  Develop activities to control the impact of alcohol misuse in the community  Influence change through advocacy  Improve the effectiveness and capacity of specialist treatment  Appoint an Alcohol Health Worker  IBA – provide more help to encourage people to drink less  Amplify national social marketing priorities

Alcohol partnership: a Vision / “ to work effectively in partnerships, partners must be agreed on a vision for the area. It is not enough for a vision to simply record the things that partners want less of …..Partners should be able to describe what an area will look like at the end of their endeavours so that they can maximise the potential to work collaboratively and reduce the risk of becoming target-focussed and working in silos.” “ to work effectively in partnerships, partners must be agreed on a vision for the area. It is not enough for a vision to simply record the things that partners want less of …..Partners should be able to describe what an area will look like at the end of their endeavours so that they can maximise the potential to work collaboratively and reduce the risk of becoming target-focussed and working in silos.”

Factors that drive partnership working  Individuals  Champions  Engagement of senior management  ‘Buy in’ at all levels  Clarity: purpose, goals, roles  History of partnership working  Sharing information and best practice  Building in sustainability

Barriers to partnership working  Lack of engagement of senior management  Silos: working and thinking  Professional ‘tribes’  Inadequate resources: human and financial  Time pressures: ‘quick wins’ and workload  Complexity of the policy context  Non coterminous boundaries

Professional change  Professional tribalism  Reconfiguration of professional boundaries  Embedded identities can be disturbed by a change in work ‘culture’  Fixed work ideals  Identity and belonging  Trust and responsibility.

Local communities  Knowing  Assessing  Engaging  Changing behaviours  Changing cultures

Early findings: achievements in past year Joint agreement on priorities and resource allocationJoint agreement on priorities and resource allocation Getting alcohol on the agenda at CEO and LSP levelGetting alcohol on the agenda at CEO and LSP level Alcohol as key priority for PCT strategic plan 2010/11Alcohol as key priority for PCT strategic plan 2010/11 Alcohol embedded in joint commissioning groupsAlcohol embedded in joint commissioning groups Development of county wide strategyDevelopment of county wide strategy Development of new services e.g. IBA, AHWDevelopment of new services e.g. IBA, AHW Retendering of specialist servicesRetendering of specialist services Developing user voice in the development of servicesDeveloping user voice in the development of services Reduction in alcohol related admissionsReduction in alcohol related admissions Reduction in alcohol related crimeReduction in alcohol related crime

What would help partnerships? FUNDINGSTABILITYTIME

ALCOHOL A COMPLEX PROBLEM Needs Partnership working Needs Multi-component programme approach Key players Health Criminal justice Education Public Trade & industry Culture & media

Further reading Mistral, W., Velleman, R., Maastache, C. & Templeton, L. (2007) UKCAPP: Evaluation of 3 UK Community Alcohol Prevention Programmes. London: AERC. Available at: FinalReport_0039.pdf or summary W., Velleman, R., Maastache, C. & Templeton, L. (2007) UKCAPP: Evaluation of 3 UK Community Alcohol Prevention Programmes. London: AERC. Available at: FinalReport_0039.pdf or summary FinalReport_0039.pdf FinalReport_0039.pdf Perkins, N., Smith, K., Hunter, D. et al (2010) ‘What counts is what works’? New Labour and partnerships in public health. Policy & Politics 38(1): Perkins, N., Smith, K., Hunter, D. et al (2010) ‘What counts is what works’? New Labour and partnerships in public health. Policy & Politics 38(1): Thom, B. & Bayley, M. (2007) Multi-component programmes: An approach to prevent and reduce alcohol-related harm. York: JRF Available at : prevent-and-reduce-alcohol-related-harmThom, B. & Bayley, M. (2007) Multi-component programmes: An approach to prevent and reduce alcohol-related harm. York: JRF Available at : prevent-and-reduce-alcohol-related-harmwww.jrf.org.uk/publications/new-approach- prevent-and-reduce-alcohol-related-harmwww.jrf.org.uk/publications/new-approach- prevent-and-reduce-alcohol-related-harm