1. Delivering HI Outcomes in Partnership A Review of Performance Management for Health Improvement & Reducing Health Inequalities within the NHS Erica Wimbush

2. Purpose of the Review To advise the Scottish Executive Health Dept on key improvements to the performance management system for NHS Boards in delivering population level health improvement and reducing health inequalities.

3. Objectives To agree what are the main ways in which NHS organisations can effectively contribute to the delivery of health improvement outcomes To agree a set of meaningful indicators and measures of NHS performance that help track progress in these areas. Which of these are appropriate for the ‘H’ section of the HEAT targets? To advise on an approach to performance management and reporting appropriate for the wider system of health improvement

4. HS programme – Delivering HI Outcomes in Partnership SE Steering Group HI Governance Health Scotland Outcome planning & reporting CPPs Piloting an integrated outcome-focused approach to HI planning Local Government New outcome- based performance framework Community & Voluntary sector Outcome planning and evaluation NHS Performance management of HI CHPs

5. Some key principles Emphasis is on reducing inequalities in HI outcomes HEAT - No more than seven targets and KPIs in total Outcomes focus where possible – the immediate outcomes related to service/intervention delivery, not longer-term HI outcomes Focus PM on areas of NHS delivery where there is a strong evidence pathway between service/intervention delivery and longer-term HI outcome Focus PM on areas where NHS Boards have direct control and accountability

6. OUTCOMES INPUTSPROCESS OUTPUTS REACHOUTCOM ES Uusikylä & Valovirta – Three Spheres of Performance Governance

7. Increased quit rate Increased quit attempts Increased intention to quit Reduced consumption Reduced initiation to smoking Reduced susceptibility Shift social norms Reduced exposure to secondhand smoke Increased support for legislation Increased knowledge of health risks HI Outcomes Reduced access to tobacco (Compliance with regs) Increased service use Increased service provision (Compliance with SC Guidelines) (Compliance with legislation) HI Program/ Service Outcomes Health outcomes HI Outcomes Young people Smokers Public places Enforcement of Smoking Ban Schools Smoke-free schools School curriculum Local retail Underage sales Smoking Cessation services Deliver services, follow-up clients Reduce incidence and prevalence of smoking & passive smoking Gen public Local authorities Trading standards Environmental Health HP specialists (schools) NHS Boards CHPs SC Cooordinators Local authorities Environmental Health HI actions Reduced tobacco-related morbidity and mortality Tobacco strategy LocaL Delivery Partners

8. Stage 1 - Scoping 1.Discuss and agree specification for work with SE sponsors, Working Group and other key stakeholders 2.Establish infrastructure –Project team –Working Group –Analytical support 3.Initial nominations for PM focus –Seminar with area Boards, 17 April –Meetings with national policy/program leads for priority outcome areas

9. Stage 2 – Pathways to HI Outcomes Elaborate the case for each long-listed nominated area by mobilising existing public health evidence and information to define the pathways between the service/intervention areas nominated for PM focus and the longer-term HI outcomes Working Group (May) Agree selection criteria Develop long-list from nominations Identify potential areas for fast-tracking for 2008/09 Working Group (July/Aug) Develop short-list for consultation

10. Stage 3 - Consultation Aim To prioritise the short-listed areas through National consultation event Series of smaller meetings with key and other stakeholders (eg Medical Directors, MCNs, SE Divs)

11. Stage 4 – Data collection and reporting For each short-listed area: Identify appropriate performance indicators and measures Where data currently unavailable, determine how/whether to proceed - could the required data be collected and analysed? Interface with evaluations of the service/intervention area How will results be used and communicated (by SE, within Boards)? How will areas of improvement be identified and reviewed? Is a further smaller consultation exercise necessary at this stage?

12. Stage 5 - Recommendations Key features of the PM approach recommended Areas of health service delivery identified as making the greatest potential contribution to delivering HI outcomes Targets, performance indicators and measures Reporting and improvement process Contribution to wider performance reporting on delivering HI outcomes in partnership

13. Engagement Process - SEHD PH & HIS Divs (project sponsors) Performance Management Delivering for Health (Inequalities, Keep Well) Primary Care (QuOF) MH Delivery Plan (targets) C&YP Health Services (targets for LDP Guidance 08/09) And wider… Joint Outcomes for Community Care Local Govt Outcome Agreements

14. Engagement process – NHS Boards Working Group HS Partnership Managers Scottish PH Network Today’s scoping seminar (Stage 1) Consultation events (Stage 3) Seminars and workshops for wider DHIOP programme

15. Health Scotland Erica Wimbush, Coordinator of wider DHIOP Programme Julia Murphy, Project Lead Delivery support Lorna Renwick, HI within the NHS Miriam O’Connor, HS Partnership Managers (NHS Boards) Ann Connacher, Scottish PH Network (DsPH) Analytical Support Lynda Brown, PH Adviser, Evidence for Action Andrew Tannahill, Head of Evidence for Action David Gordon, Head of PH Observatory