A new partnership framework has allowed Scotland to set clear objectives and measurement criteria for local authorities, giving the public a clearer idea of what to expect from their health services.
"What is needed is a much fuller framework of partnership between the executive and local government that enshrines mutual responsibilities between the two levels of elected government. Councils should recognise the rights of ministers to set national priorities that impact on local government, and ministers should recognise that councillors are elected on a manifesto with commitments for local areas."
In 2000, this was the position argued by the Society of Local Authority Chief Executives (Scotland) and the Convention of Scottish Local Authorities regarding the relationship between Scottish ministers and local government.
There was no robust framework for negotiating and agreeing priorities, which were often imposed by ministerial announcement with short lead times, often leading to disruption and distortion. The objection was not to ministers having priorities but to the absence of an efficient and effective framework when planning for them.
Local government advocated a focus on outcomes and the abandonment of ringfencing at that time, but to no avail. The Labour/Liberal Democrat coalition at the time showed little interest.
The new Scottish National Party government agreed a concordat with local government in November 2007. This set out the terms of a new relationship between the national and local government, based on mutual respect and partnership, and was intended to underpin the funding to be provided to local government between 2008-09 and 2010-11.
The concordat involved a package of measures, endorsed by the Scottish government and the Convention of Scottish Local Authorities, which both parties believed would lead, over time, to significant benefits for users of local government services. A significant component was establishing single outcome agreements between each of Scotland's 32 local authorities and the Scottish government.
These agreements were to be in place for every council by April 2008, based on an agreed set of 15 national outcomes, underpinned by national indicators, supported by streamlined external scrutiny and effective performance management.
Significantly, they were to be extended to be agreements between Scottish government and community planning partnerships at the earliest opportunity and by April 2009 at the latest.
The Scottish government set its main objectives, with the overarching aim of growing Scotland’s economy. These were to make Scotland wealthier, fairer, healthier, smarter, safer, stronger and greener.
In addition to these, it set 15 broad national outcomes and 45 national performance measures against which it expects community planning partnerships to produce single outcome agreements.
All territorial health boards in Scotland have been working to 30 targets covering health, efficiency, access and treatment. Each is measured on a standard basis nationally to provide an objective and comparative assessment of performance. For NHS Tayside staff, it clearly specifies what must be delivered. For the people of Tayside, it spells out exactly what they should expect from NHS Tayside.
Public sector commitment
The public sector agencies in Tayside have already demonstrated their commitment to this approach by ensuring the single outcome agreements submitted for Angus, Dundee and Perth and Kinross are submissions from the community planning partnerships, all three of which include NHS Tayside.
Fewer than half of the community planning partnerships in Scotland have got to this stage so far, with the cabinet secretary for finance and sustainability indicating that all should be involved by April 2009.
The fact that the various agencies in Tayside have already managed a community planning approach encapsulates for me the extent to which, through partnerships much closer and warmer than in many parts of Scotland, we are in a position to make a real difference to the public in the years ahead.
If we are serious about the direction of travel set out in Better Health, Better Care – Action Plan, where strong emphasis is laid on partnership working, it seems this model is worth working at. With robust baselines, clear measurable and time-bound milestones, and a rigorous means of monitoring and assessing progress, there can only be benefit to the public, whom we all serve.