How local authority services are designed and delivered
The Sexual Health and Blood Bourne Virus Framework states that a multi-agency, collaborative approach to the prevention, testing, treatment and care of HIV - and the provision of support services - is essential. It makes clear that there should be strong links between multi-agency sexual health strategy groups; blood borne virus managed care networks; alcohol and drug partnerships; and community health partnerships; which, in turn, should feed into community planning processes.
Managed Care Networks
When asked about the formal mechanisms they use to provide services to people living with or at risk of HIV during research for the HIV Scotland report 'Making the Vision a Reality' (2015), local authorities gave a range of different responses. Some referred to community health partnerships, and many talked about the establishment of managed care networks (MCNs).
Managed care networks are described by local authorities as having a key role in the integration and co-ordination of services relevant to HIV - bringing together staff from across the health and local authority sectors to assess local needs and plan services. There is some geographical variation in the type of managed care networks which have been established, with some focusing solely on blood borne viruses and others also incorporating sexual health. Local authority staff highlight that while some services relevant to HIV are jointly commissioned, this is certainly not the case in all areas, as these quotes from staff highlight:
“We have an integrated Community Health & Care Partnership which covers community health and social work services.”
“We work jointly with the NHS to plan/deliver services for those with blood borne viruses, which includes HIV. There is a social work representative on the managed care network for blood borne viruses… who contributes to assessment of local need, service planning and service monitoring across health and social care services.”
“The work around HIV has developed in partnership with NHS and will be enhanced by the re-establishment of the managed care network.”
“At the moment there are no jointly commissioned services for people living with or at risk of contracting HIV. However, there is local authority representation on the blood borne virus MCN and all associated working groups.”
Alcohol and Drug Partnerships
Staff in some local authorities also see the development of drug and alcohol partnerships as helping promote joint working by establishing shared outcomes which can be applied across the statutory and third sectors. There are 30 alcohol and drug partnerships (ADPs) in Scotland, which bring together local authorities, health boards and other local partners to plan and commission evidence-based, person-centred and recovery-focused treatment services. For more information, see the relevant page on the Scottish Government website.
“Via the Alcohol and Drug Partnership we commission services on an outcomes focussed basis to assist in prevention, treatment, support and peer support... we have refocused funding allocation to reflect outcomes so that all recipients of funding from the independent, voluntary and statutory sector are required to report on how the strategic aims of the partnership are being met.”
- Local authority staff member
Informal mechanisms for service delivery
Local authority staff also gave examples of less formal joint working arrangements which have been developed with health boards and the third sector, such as through the establishment of integrated referral pathways, staff training and the co-location of staff and services.
Staff in several local authorities commented that closer working relationships had been established with the third sector over recent years. This included through the development of 'step-up/step-down care' services for people living with HIV, whereby people were able to receive more support than was available to them at home (step-up) and to leave hospital and get ready to return home (step-down).
The way in which local authority staff describe trends in the design and delivery of services relevant to HIV is consistent with a move to an outcomes-based approach. While the way in which countries apply an outcomes-based approach depends on local circumstances and priorities, it is possible to point to some common characteristics. They often promote localism, in the form of greater devolution of power and decision-making to local government and local partnerships. This enables services to better reflect local priorities and distinctive needs and circumstances. They also focus on improving the effectiveness of partnership working, where agencies co-ordinate their policies and services towards the joint pursuit of shared outcomes.