Andy Bruce

1
Andy Bruce

• Health Improvement Strategy
• Scottish Government

2
Ill cover

• 1. Policy Context
• 2. Partnership and Performance
• 3. Current Performance Developments

3
We have made tackling health inequalities our
top priority
1. Policy Context

• Nicola Sturgeon
• Cabinet Secretary for Health Wellbeing

4
(No Transcript)
5
Upstream/downstream reducing inequalities in
health depends on reducing inequalities in life
chances and life circumstances
6
The most significant inequalities

• Childrens very early years, which influence the
  rest of their lives.
• The high economic, social and health burden
  imposed by mental illness, and the requirement to
  improve mental wellbeing.
• The Big Killers including cardio-vascular
  disease and cancer. Risk factors for these, such
  as smoking, are strongly linked to deprivation.
• Drug and alcohol problems and links to violence
  that affect younger men in particular and where
  inequalities are widening.

7
Task Forces Recommendations

• Support for families and young people
• Mental health and wellbeing
• Poverty and employment
• Physical environments
• Alcohol, drugs, violence

8
Delivering Change

• Cross-cutting agenda
• Public services and client pathways
• Test sites and learning networks
• Third Sector roles
• Using resources effectively
• Clear outcomes, performance reporting and
  performance management
• Short and long timescales
• Evaluation challenges

9
2. Partnership and Performance

• Single Outcome Agreements
• National and local priorities
• Governments economic purpose
• 15 National outcomes
• HEAT targets

10
Relevant National Outcomes

• Our children have the best start in life and are
  ready to succeed
• We live longer, healthier lives
• We have tackled the significant inequalities in
  Scottish society

11
SOAs Key Points

• Outcome focus
• High-level, strategic
• Limited and manageable number of priorities
  local and national
• Outcomes shared by partners
• Underlying service planning and performance
  management arrangements

12
HEAT - Health Improvement and Health Inequalities

• H2 80 of all 3-5 yr old children registered
  with dentist by 2010/11
• H3 Deliver child healthy weight intervention
  programme by 2010/11
• H4 Deliver alcohol brief interventions (SIGN
  74) by 2010/11
• H5 50 of key frontline staff trained in
  suicide prevention by 2010.
• H6 Deliver agreed smoking cessation services
  (2008/9 2010/11).
• H7 33.3 of babies exclusively breastfed at
  6-8 weeks in 2010/11
• H8 Inequalities targeted cardiovascular Health
  Checks during 2009/10

13
3. Current Performance Developments

• Health improvement performance management review
• Equally Well developments

14
HIPM Review

• Aim
• to develop a performance framework for health
  improvement that is appropriate for cross-sector,
  partnership-based delivery
• The performance framework needs to be
• Outcome-focused
• Evidence-informed
• Aligned with partners reporting and performance
  management processes

15
HIPM framework
We live longer, healthier lives We have tackled
the significant inequalities in Scottish society
LONG-TERM HIGH LEVEL OUTCOMES
Government ReportingNational Performance
Framework SOAs
INTERMEDIATEOUTCOMES
Performance management
SHORT-TERM OUTCOMES
Outcomes related to service delivery
Outputs
Activities/ Processes
Inputs
16
Outcomes triangle - Alcohol
We live longer, healthier lives
We have tackled the significant inequalities in
Scottish society
We live our lives free from crime, disorder and
danger
We realise our full economic potential
Our children have the best start in life
NATIONAL OUTCOMES
Reduced inequalities in HLE, Improved Mental
Wellbeing, Reduced alcohol-related deaths
hospital admissions
HIGH LEVEL OUTCOMES
Less hidden harm to children Increased educ
attainment
Less work absenteeism incapacity
Reduced alcohol-related ASB crime
Reduced alcohol consumption beyond recommended
limits
INTERMEDIATEOUTCOMES
Sensible drinking culture
Safer drinking wider environments
Access to affordability of alcohol
Supportive environments for children of
alcohol-abusing families
SHORT-TERM OUTCOMES
Wealthier Fairer
Outcomes related to service delivery
Smarter
Healthier
Safer Stronger
Greener
17
Improved mental wellbeing Reduced inequalities in
HLE Reduced inequalities in CHD mortality Reduced
alcohol-related hospital admissions
National indicators
Reduced alcohol consumption
Reduced screening FAST positive at follow-up
Those drinking at harmful levels (key sub-groups)
Revised HEAT target
Brief interventions (SIGN 74) no. of screenings
What the NHS has to do to reach the target group
and deliver effective brief interventions in key
settings
H4Alcohol
Funding, trained workforce, evidence-based
guidance, data to manage and monitor the
delivery of interventions
18
Alcohol Partner Contributions to Outcomes
Improved mental wellbeingReduced inequalities in
healthy life expectancyReduced inequalities in
alcohol-related deaths and hospital admissions
BehaviourReduced alcohol consumption levelsLess
drunkenness less drink-driving
EnvironmentsPhysical Reduced exposure to
alcohol-related hazardsEconomic Reduced
availability/affordability of alcohol Social
Drunkenness less attractive sensible drinking
the norm
Service uptake engagement
Understanding risks, attitudes to drinking
Hazardous and harmful drinkers
General public - targeted
Preventive services
Sensible drinking messages
Media campaigns
Brief advice
Scottish Govt
NHS
19
Equally Well Long-term NationalInequalities
Indicators

• Healthy life expectancy
• Premature mortality
• Mental wellbeing
• Low birthweight

20
Medium-term Progress

• Intermediate outcomes
• Different agency contributions
• Use of indicators
• More development needed!

21
EQUALLY WELL OUTCOMES FRAMEWORK EARLY YEARS
YOUNG PEOPLE
22
EQUALLY WELL OUTCOMES FRAMEWORK MENTAL
WELLBEING
23
Further Information

• Equally Well
• http//www.scotland.gov.uk/Topics/Health/health/In
  equalities/inequalitiestaskforce
• HIPM outcomes tools
• http//www.improvementservice.org.uk/health-improv
  ement/health/tools-for-soa-processes