1. Wellbeing, Evaluation & Prevention Fraser Battye 22 nd October 2009

2. Presentation Structure PART A: Monitoring & Evaluation of Living Well 1.Challenges 2.Approaches 3.Results PART B: General Reflections – Investing in Prevention 1.Challenges 2.(how) can evaluation help? 3.What else might help?

3. MONITORING & EVALUATION OF LIVING WELL PART A:

4. We were commissioned to…  Provide monitoring & evaluation (M&E) services: o Regional level o Formative approach o But also focus on outcomes  Why is that difficult? o 30+ projects in 14 areas o Massive diversity: size (£), target groups, interventions, contexts, capacity etc. o Results need adding up o Plus ‘usual problems’

5. What did we do?  Briefly considered: o Decide what ‘wellbeing’ is; get a tool o Give tool to projects; add up results o …easier for us – but less use for projects  Instead, we: o Built from ‘projects up’ o Individual M&E plans o Some common tools (e.g. WEMWBS) o Backed by toolkit / training / support / project visits

6. WHAT HAVE WE FOUND?

7. Main focus: mental wellbeing A lot of PA / MH cross-over

8. £3.6 million worth of inputs ‘in-kind’ support very significant

9. Main outputs  3,080 physical activity sessions  1,500 mental wellbeing sessions  720 healthy eating sessions  770 professionals engaged in training activity  170 volunteers recruited and / or trained

10. Beneficiary numbers Total: 16,000 Introduced guidance Av. cost per beneficiary: £160 (range: £5 - £1,200)

11. Outcomes  Measure annually…will know next month! (sorry)  Last year we found: o Improvements in knowledge, enjoyment, awareness o Positive changes in behaviour / condition: Improved diet Increased levels of activity Improved mental wellbeing  Needed around 10 beneficiaries for one positive outcome

12. REFLECTIONS ON PREVENTATIVE INVESTMENT PART B:

13. Challenges  General problem: o Limited resources but unlimited competing claims – requires trade-offs E.g. Restorative or preventative?  More specific problems facing preventative services: o Professional acceptance / credibility o Diffuse costs….and diffuse benefits o Media / public (us) pressure o Political presure o Poor information for commissioners

14. Evidence and Prevention 1.Lack of investment in evaluation: o Especially relative to restorative interventions o Problem of diffuse benefits here too 2.Accepted standards of evidence: o Randomised Trials – can be great, but: Expensive, sometimes inappropriate Findings may not last or transfer 3.Lack of economic evaluation: o Prevention rests on ‘spend to save’ arguments – but health economics is under-developed here

15. Result of these Challenges Relatively low increases in preventative investments in ‘health’

16. What might change this?  This is not (just) a technocratic exercise  Other factors: o Leadership o Policy - Wanless, Darzi, New Horizons etc o ‘Burning platform’ of rising costs / expectations: ‘Do Nothing’ = bankrupt system o Opportunity of a crisis?  Also (perhaps naïve?) public debate / engagement

17. SHA / Ipsos MORI Data (1)

18. SHA / Ipsos MORI Data (2) Actual spend is around 2% across West Mids Note: no trade-off

19. Thank-you for listening Q&A