Strengthening Strengthening partnerships to partnerships to improve alcohol improve alcohol

servicesservicesEast of England Regional Alcohol East of England Regional Alcohol Conference, 19Conference, 19thth May 2010 May 2010

Rachel Herring, School of Health Rachel Herring, School of Health and Social Sciences, Middlesex and Social Sciences, Middlesex University, London. University, London. r.herring@mdx.ac.uk r.herring@mdx.ac.uk

Policy context (New Policy context (New Labour)Labour)

Alcohol a new priority compared to drugsAlcohol a new priority compared to drugs Focus has been on:Focus has been on:

o alcohol related crime and disorder alcohol related crime and disorder o public spacespublic spaceso youth (‘binge’ drinking)youth (‘binge’ drinking)o acute health harms e.g. accidents/injuries, hangovers acute health harms e.g. accidents/injuries, hangovers

etcetc More recently: More recently:

o Home drinkingHome drinkingo Middle-aged (middle class) hazardous/harmful drinkersMiddle-aged (middle class) hazardous/harmful drinkerso Broader health harms e.g. heart disease, cancer, liver Broader health harms e.g. heart disease, cancer, liver

diseasedisease

NEW GOVERNMENT –NEW DIRECTION?NEW GOVERNMENT –NEW DIRECTION?

Policy context (New Policy context (New Labour): Labour):

Reducing alcohol-related Reducing alcohol-related harm harm • Devolution of the responsibility to local areas Devolution of the responsibility to local areas

for action to address alcohol-related harm and for action to address alcohol-related harm and help achieve national targets.help achieve national targets.

• Use of partnerships as a mechanism for Use of partnerships as a mechanism for developing and implementing local alcohol developing and implementing local alcohol policies e.g. CSPs, DA(A)Ts, PCTs, LSPs (and policies e.g. CSPs, DA(A)Ts, PCTs, LSPs (and LAAs).LAAs).

• High Impact Changes High Impact Changes • GORs have a supporting role.GORs have a supporting role.• Alcohol as a cross cutting issue – health, Alcohol as a cross cutting issue – health,

criminal justice, community safety, commerce.criminal justice, community safety, commerce.

PartnershipPartnership

What is partnership?What is partnership?

““An agreement between two or more independent An agreement between two or more independent bodies to work collectively to achieve an bodies to work collectively to achieve an objective” (Audit Commission , 1998, 2005)objective” (Audit Commission , 1998, 2005)

Why work in partnership?Why work in partnership? Perceived failure of separately defined and run Perceived failure of separately defined and run

servicesservices International evidence: multi-component approachInternational evidence: multi-component approach FundingFunding Statutory requirement e.g. CSPs (formerly Statutory requirement e.g. CSPs (formerly

CDRPs)CDRPs)

A MULTI-COMPONENT APPROACH:A MULTI-COMPONENT APPROACH:

Co-ordinated ActionCo-ordinated Action

a programme of co-ordinated action based on a programme of co-ordinated action based on an integrative programme design where an integrative programme design where singular interventions (or stand alone projects) singular interventions (or stand alone projects) run in combination with each other and / or run in combination with each other and / or sequenced together over time.sequenced together over time.

THE WHOLE IS GREATER THAN THE SUM OF THE THE WHOLE IS GREATER THAN THE SUM OF THE PARTSPARTS

Appreciation that alcohol is a complex, Appreciation that alcohol is a complex, cross- cutting issue that requires complex cross- cutting issue that requires complex solutionssolutions

Identification, mobilisation and co-Identification, mobilisation and co-ordination of appropriate agencies, ordination of appropriate agencies, stakeholders and local communitiesstakeholders and local communities

An understanding that the whole is greater An understanding that the whole is greater than the sum of the partsthan the sum of the parts

Change in professional behaviour Change in professional behaviour

Alcohol partnerships Alcohol partnerships require:require:

The whole is greater than the The whole is greater than the sum of the parts: sum of the parts:

Agreed common overarching goalAgreed common overarching goal Understanding the ‘bigger picture’ Understanding the ‘bigger picture’ Planning and delivering interventions/services that take Planning and delivering interventions/services that take

account of the ‘bigger picture’account of the ‘bigger picture’ Identify what each player contributes/gains from Identify what each player contributes/gains from

participation in the partnershipparticipation in the partnership

High Impact ChangesHigh Impact Changes

Work in partnershipWork in partnership Develop activities to control the impact of Develop activities to control the impact of

alcohol misuse in the communityalcohol misuse in the community Influence change through advocacyInfluence change through advocacy Improve the effectiveness and capacity of Improve the effectiveness and capacity of

specialist treatment specialist treatment Appoint an Alcohol Health WorkerAppoint an Alcohol Health Worker IBA – provide more help to encourage people IBA – provide more help to encourage people

to drink lessto drink less Amplify national social marketing prioritiesAmplify national social marketing priorities

Alcohol partnership: a Alcohol partnership: a VisionVision

http://www.alcohollearningcentre.org.ukhttp://www.alcohollearningcentre.org.uk// “ “to work effectively in partnerships, to work effectively in partnerships,

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

Factors that drive Factors that drive partnership working partnership working

IndividualsIndividualsChampionsChampionsEngagement of senior managementEngagement of senior management ‘‘Buy in’ at all levelsBuy in’ at all levelsClarity: purpose, goals, rolesClarity: purpose, goals, rolesHistory of partnership workingHistory of partnership workingSharing information and best practiceSharing information and best practiceBuilding in sustainabilityBuilding in sustainability

Barriers to partnership Barriers to partnership workingworking

Lack of engagement of senior management Lack of engagement of senior management Silos: working and thinkingSilos: working and thinkingProfessional ‘tribes’Professional ‘tribes’Inadequate resources: human and financialInadequate resources: human and financialTime pressures: ‘quick wins’ and workload Time pressures: ‘quick wins’ and workload Complexity of the policy context Complexity of the policy context Non coterminous boundariesNon coterminous boundaries

Professional changeProfessional change

Professional tribalismProfessional tribalismReconfiguration of professional Reconfiguration of professional

boundariesboundariesEmbedded identities can be disturbed Embedded identities can be disturbed

by a change in work ‘culture’by a change in work ‘culture’Fixed work ideals Fixed work ideals Identity and belongingIdentity and belongingTrust and responsibilityTrust and responsibility..

Local communitiesLocal communities

KnowingKnowingAssessingAssessingEngagingEngaging

Changing behaviours Changing behaviours Changing culturesChanging cultures

Early findings: achievements in Early findings: achievements in past yearpast 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 groups Alcohol 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 What would help partnerships?partnerships?

FUNDINGFUNDING

STABILITYSTABILITY

TIMETIME

ALCOHOLALCOHOL

A COMPLEX PROBLEM

Needs Partnership

working

Needs Multi-component

programme approach

Key playersHealth

Criminal justiceEducation

PublicTrade & industryCulture & media

Further readingFurther reading• Mistral, W., Velleman, R., Maastache, C. & Templeton, L. Mistral, W., Velleman, R., Maastache, C. & Templeton, L.

(2007) (2007) UKCAPP: Evaluation of 3 UK Community Alcohol UKCAPP: Evaluation of 3 UK Community Alcohol Prevention Programmes. Prevention Programmes. London: AERC. Available at: London: AERC. Available at: http://www.aerc.org.uk/documents/pdfs/finalReports/AEhttp://www.aerc.org.uk/documents/pdfs/finalReports/AERC_FinalReport_0039.pdf or summary RC_FinalReport_0039.pdf or summary http://www.aerc.org.uk/insightPages/libraryIns0050.html http://www.aerc.org.uk/insightPages/libraryIns0050.html

• Perkins, N., Smith, K., Hunter, D. Perkins, N., Smith, K., Hunter, D. et al et al (2010) ‘What (2010) ‘What counts is what works’? New Labour and partnerships in counts is what works’? New Labour and partnerships in public health. public health. Policy & Politics Policy & Politics 38(1): 101-117.38(1): 101-117.

• Thom, B. & Bayley, M. (2007) Thom, B. & Bayley, M. (2007) Multi-component Multi-component programmes: An approach to prevent and reduce programmes: An approach to prevent and reduce alcohol-related harm. alcohol-related harm. York: JRF Available at : York: JRF Available at : www.jrf.org.uk/publications/new-approach-prevent-and-www.jrf.org.uk/publications/new-approach-prevent-and-reduce-alcohol-related-harmreduce-alcohol-related-harm