Health Improvement Performance Management (HIPM) Review Proposed Priority Outcomes Erica Wimbush, Health Scotland 26 October 2007

HIPM Review HIPM Steering Group – agree priority outcomes for HI that can be shared across the whole system; aligning high level SG outcomes for public reporting with outcomes for service delivery NHS Working Group – Review of current measures for ‘H’ in HEAT system; performance management focused on short-term outcomes related to effective NHS contributions to priority outcomes

LONG-TERM HIGH LEVEL OUTCOMES Tie-in with SE high level strategic obj Processes Outputs Inputs INTERMEDIATE OUTCOMES SHORT-TERM OUTCOMES The immediate impacts of service delivery on the community Scottish Government Outcomes Model

Healthier Scotland to help people to sustain and improve their health, especially in disadvantaged communities Well-being Population health Health inequalities Individual behaviours Social, economic, and physical environments LONG-TERM HIGH LEVEL OUTCOMES INTERMEDIATE OUTCOMES SHORT-TERM OUTCOMES Outputs Inputs Processes National level priorities Performance management Public Reporting Outcomes related to service delivery

Healthier Scotland to help people to sustain and improve their health, esp in disadvantaged communities ensuring better, local and faster access to health care. Well-being Population health Health inequalities Individual behaviours Social, economic, and physical environments LONG-TERM HIGH LEVEL OUTCOMES INTERMEDIATE OUTCOMES SHORT-TERM OUTCOMES Outputs Inputs Processes National level priorities Performance management Public Reporting Outcomes related to service delivery Access to health care

Proposed Priority Outcomes HIPM Steering Group Need to prioritise - to focus our resources and maximise coverage and impact Shared priorities across govt and delivery partners – focus our resources on a set of shared outcomes Selection criteria: –Importance –Potential to intervene effectively –Feasibility –Performance assessment

Inequalities and health Smoking Alcohol Obesity Early years Proposed Priority Outcomes

5 cross-Govt Strategic Objectives Wealthier & Fairer Enable businesses and people to increase their wealth and more people to share fairly in that wealth. Healthier Help people to sustain and improve their health, especially in disadvantaged communities, ensuring better, local and faster access to health care. Safer & Stronger Help local communities to flourish, becoming stronger, safer place to live, offering improved opportunities and a better quality of life. Smarter Expand opportunities for Scots to succeed from nurture through to life long learning ensuring higher and more widely shared achievements. Greener Improve Scotland's natural and built environment and the sustainable use and enjoyment of it.

Inequalities and health Reduced inequalities in the wider social, economic and environmental factors that help shape inequalities in health. Individual behaviours Educational achievement LONG-TERM HIGH LEVEL OUTCOMES INTERMEDIATE OUTCOMES SHORT-TERM OUTCOMES Outcomes related to service delivery Reduced inequalities in premature mortality Infants Accidents and cancers (2-15) Suicide, drug-related and assault (16-39) CVD, cancers and chronic LRD (40-65) Reduced inequalities in: Healthy life expectancy Mental well-being Income Poverty Work Employment Employability Environment Access to services Wealthier & Fairer Healthier Safer & Stronger Smarter Greener

Smoking Reduced burden of disease, disability and premature death due to tobacco Reduced inequalities in · Smoking prevalence · Uptake of smoking by young people Social norms LONG-TERM HIGH LEVEL OUTCOMES INTERMEDIATE OUTCOMES SHORT-TERM OUTCOMES Outcomes related to service delivery Reduced inequalities in premature mortality due to smoking-related diseases Reduced inequalities in Healthy Life Expectancy Smoke-free environments Access to SC services Accessibility of tobacco (YP) Wealthier & Fairer Healthier Safer & Stronger Smarter Greener

Alcohol The increasing burden of disease, harm, distress and premature death due to excessive alcohol consumption is stemmed. Reduced alcohol consumption beyond recommended limits Reduced drink-driving Sensible drinking culture LONG-TERM HIGH LEVEL OUTCOMES INTERMEDIATE OUTCOMES SHORT-TERM OUTCOMES Outcomes related to service delivery Reduced alcohol-related harm and inequalities in alcohol-related harm Improved Healthy Life Expectancy & Mental Wellbeing Premises & environment Access to services Accessibility of alcohol Wealthier & Fairer Healthier Safer & Stronger Smarter Greener

Obesity The increasing burden of disease, disability and premature death due to rising levels of overweight and obesity in children and adults is stemmed. Increased % of adults and children of healthy weight Awareness & social norms LONG-TERM HIGH LEVEL OUTCOMES INTERMEDIATE OUTCOMES SHORT-TERM OUTCOMES Outcomes related to service delivery Reduced inequalities in premature mortality due to obesity-related diseases Active environment Access to services Accessibility of EDF+D Improved Healthy Life Expectancy & Mental Wellbeing Increased PA levels among those overweight Reduced consumption of energy-dense processed foods + drinks Wealthier & Fairer Healthier Safer & Stronger Smarter Greener

Early Years The development of young children and their families, particularly those children most at risk, is healthier. Reduced inequalities in · Parental substance use · Smoking in pregnancy · Breastfeeding rate at 6 weeks · Dental caries · Post-weaning diet · Physical activity levels (ages 2-5) Social norms LONG-TERM HIGH LEVEL OUTCOMES INTERMEDIATE OUTCOMES SHORT-TERM OUTCOMES Outcomes related to service delivery Reduced inequalities in · Pre-school child development Child poverty Home & local environments Access to services for vuln families & LAAC Wealthier & Fairer Healthier Safer & Stronger Smarter Greener

Key questions – Proposed priority outcomes Shared priorities. Do they fit with local priorities? Do they provide a good basis for shared priorities? Accountability for delivering outcomes. What are the unique contributions of local authorities, NHS Boards, community and voluntary organisations to these outcomes? What needs to be delivered in partnership? Moving forward on joint planning and performance reporting. How can the forthcoming revised guidance on HI joint planning for CHPs and CPPs best support delivery? What capacity and support is required?

Next steps - Engagement Events 26 October – National event Regional events with CPPs 26 November, Perth 30 November, Edinburgh 3 December, Glasgow

Next steps Health & Wellbeing Action Plan, December –Priorities Moving to outcome-focused accountability –NHS Working Group –Local authority outcome agreements –Revised joint HI planning guidance for CHPs and CPPs HIPM Steering Group – whole system reporting and developing leadership and support