Impacts and Evidence: can integrated impact assessment improve policy making? Margaret Douglas, Susie Palmer, Kay Barton, Alastair Pringle - Scottish Government Cath Denholm - Health Scotland

Equally Well (June 2008) “Integrated impact assessment processes….should be developed and implemented at national and local levels… Impact on health inequalities should be a clear component… The Government should ensure that there is guidance and support…”

The case for and against an integrated approach Potential benefits Impact assessment fatigue Similar issues covered in different forms of assessment Simplifies and reduces work Champions for different issues can work together Potential problems Health (or whatever your favourite issue is!) will not receive adequate attention Potential for superficial treatment of issues Involving a wide range of stakeholders could create additional work

Health Inequalities Impact Assessment (HIIA) HEALTH & WELLBEING HUMAN RIGHTS EQUALITY

HEALTH & WELLBEING HUMAN RIGHTS EQUALITY Health Inequalities Impact Assessment Project Populations women carers people with low literacy staff older people homeless people minority ethnic people LGB transgender disabled people children /young people people with different religions / beliefs people living in poverty/ low income people with long term medical conditions

HEALTH & WELLBEING HUMAN RIGHTS Community capacity building Promoting good relations Discrimination Social environment Equality of opportunity Tackling harassment Promoting positive attitudes Physical environment Lifestyles Access to and quality of services Human rights Communication of information Health Inequalities Impact Assessment Project Impacts EQUALITY

The Process Scoping (Facilitated Workshop) Appraisal (Evidence Gathering) Final HIIA Report Process evaluation & outcome evaluation Scoping Report 10 Projects Stakeholder Feedback

Guidance & Support Scoping Tool Guidance Documents –The Process –Issues for Consideration: health & equalities –Issues for Consideration: human rights –Participant Information Sheet – key publications, web resources, help lines etc Training workshop - ‘Trialling the Tool’ General support from HIIA Project Team SHRC involvement & support Scottish Government support - ASD

Process Evaluation: scoping workshops Overwhelmingly positive: all said it added value and most said it raised new issues Stage of policy is important Mix of stakeholders allows wider perspectives Participants must be well informed ahead of workshop Importance of facilitation to challenge/ draw out different views Structured but informal discussion allowed open discussion of range of issues Large number of impacts and associated research questions identified for most policies Some raised issues wider than policy being assessed All scoping reports included tentative recommendations

Process evaluation: Appraisal stage Most said increased understanding of health and equality, but not human rights Concern about assessing human rights issues Commonly appropriate evidence was lacking Most struggled to complete in the timescale Was a pilot so not required for policy development or approval In many reports recommendations were same as identified at scoping Most felt appraisal stage added value

Outcomes Most stated plans to use the findings in policy development or related work Main benefits stated were: Involvement of stakeholders allowed broader perspective on issues Time to reflect on priority impacts Consideration of wider population groups Human rights based approach Better information for policy making Creative process Most said confident to do another HIIA

Next Steps Revise HIIA guidance to address comments Outcome evaluation (end 2011) Interest particularly in adopting workshop approach to EQIA All examples so far in Health Directorates and NHS Boards Need wider commitment to use as way to address inter-sectoral health determinants