Health Scotland’s Role Mary Allison & Erica WimbushDelivery Plan Seminar with NHS Boards 22 Aug 2006
Outline • HI policies and structures • Health Scotland’s evolving role and relationships • Examples from recent work • Discussion – improving the fit
Towards A Healthier Scotland, 1999 Generated 7 strategies/action plans: Diet Smoking Drugs Alcohol Physical activity Mental health & well-being Sexual health 4 national demonstration projects Health Improvement Challenge, 2003 SE leadership for HI NHS Health Scotland (HEBS+PHIS) 4 additional themes for cross-cutting action Early Years Teenage transitions Healthy Working Lives Communities Health improvement policy in Scotland • Two main goals • Improving population health • Reducing inequalities in health • Delivering for Health, 2005 • Prevention 2010 • ????
Health Improvement Infrastructure in Scotland THE SCOTTISH PARLIAMENT Health & Social Care Committee NATIONAL THE SCOTTISH EXECUTIVE CMO + Health improvement + Health protection (SEHD) Enterprise&Lifelong Learning-Education—Development-Environment&Rural Affairs–Health-Justice- Transport - -etc NES Public health QIS SCDC CHEX SCVOVHS LTS SHPSU COSLA LGIS COMMUNITIES SCOTLAND FSAS HPS ISD Public health HEALTH SCOTLAND 14 NHS BOARDS Public health REGIONAL COMMUNITY PLANNING PARTNERSHIPS Community plan/JHIP/ROA LOCAL Community health projects Voluntary orgs 32 LOCAL AUTHORITIES Health Improvement Officers COMMUNITY HEALTH PARTNERSHIPS Health promotion + PH practitioners
Scottish Executive Health Dept Advance understanding of Scotland’s health and how to improve it Provide evidence inputs to HI policy and planning Supportdelivery of HI policy & programmes Disseminate evidence and learning for goodpractice Health Scotland’s role 14 NHS Boards Health Scotland £12.7m+£10m Other key partners
Health Scotland’s structure 14 NHS Boards Health Scotland 150 staff Scottish Executive Health Dept Other key partners Chief Executive’s Office Finance & Resources Public Health Science Public Health Observatory Evidence for Action Policy Evaluation & Appraisal Research Commissioning Library Programme Design & Delivery Children & Young People Topics Settings Learning & Workforce Development Publishing & e-Services
Policy development Policy review Stages in the policy cycle Policy implementation The simple story….
Policy development • Problem definition • Evidence based guidance • Programme theory - Logic modelling • Evaluation planning • Communications planning • Workforce development
Policy implementation • Coordination of national programmes • Social marketing (engagement) • Strengthening infrastructure • Workforce development • Planning, monitoring and evaluation
Policy Review • Policy review • Performance reporting for HI • Feedback and learning for practice development
But …reality is often • Complex system with multiple players and agendas • Constant change • Struggle to build learning from past when focused on the future • Timescales for delivery rarely allow desirable planning-delivery-evaluation sequence • Challenging conventional wisdom is uncomfortable – partnerships, participation, evidence-based practice
Political compromise Standards Guidance Experiment Dealing with uncertainty: Evidence and practice Low Innovation Creativity “Zone of Complexity” Trial & Error Agreement about how to do it High High Low Certainty about what works Source: Viv Speller, HDA
The ideal The common The undesirable Long term commitment Strong issue definition Strong evidence base Easily identifiable workforce Guidelines Standards Training Agreed intervention programmes Performance measures Lack of consensus Parts of issue unclear Uneven evidence base Dispersed workforce Some agreed interventions Some training, for some Some accountability, for parts Disagreement about issue Very weak evidence base No infrastructure No accountability Scenarios