Linking Health Outcomes to Other Community Planning Priorities

Avril Blamey Senior Public Health Advisor

Policy Evaluation and Appraisal team

NHS HS

Outline • Previous limitations in the planning process• What would better plans look like?• Starting with ”badged” health outcomes• Making the links to other CPP priorities• Identifying contributions for partners• Underlying values and rationales• Do-ability and testability• What does and doesn’t matter?

Indicators

Previous limitations in the planning process

InterventionsExpectedConsequences

Problem

s

Goal

s

Interventions Targets

What would better plans look like?

• Provide clarity about what you hope to achieve at start of intervention

• Focuses activity on what must be done to achieve the outcome• Shows plausible links between inputs, activities and outcomes• Develops plausible, testable and do-able plans • Tools for outcome focussed planning (Logic models, RE-AIM

Framework)

• Does health need to be the primary or secondary outcome?

Why have we traditionally started with badged/topic outcomes?

• It’s easier?• Partly organisational/professional boundaries (NHS led)• Individual rather than structural interventions easier to

evaluate/research • Evidence/monitoring structures developed that way in

health • Funding streams often support topic, disease

approaches• Easier to control and predict?• Not necessarily more important • Not necessarily more effective

Making the links

Alcohol

Employability /economy

Less short and long term absence Rehabilitation

Environment Safer environmentsLess litter due to underage drinking

Community Safety

Perceptions of safetyReduced violence

Transport Increased use due to aboveTaxi schemes

Theme

Topic

Partner contributions

Alcohol

Community Diversionary activitiesEducation schemesParental involvement

NHS Treatment servicesBrief interventions Workplace polices

Local authority School educationCommunity education (diversionary)OverprovisionEnforcing legislation

Police Test purchasingASBOs/parental reporting

Partner

Role

Underlying values and rationales

• Targeting is clear and appropriate (e.g ROA and reduced inequalities as target) and linked to clarity of equity outcome

• Access to and experience of services/ interventions are appropriate to target groups re inequalities ( inequalities sensitive practices)

• Commitments and successes are shared• Plans are plausible, testable and doable

Is it plausible?Consider some key assumptions being made • Will proof of age/test purchasing reduce underage drinking?

– Do underage people buy their drink from on/off-sales?– If so will these venues implement proof of age as

intended?

– Do/will young people get their alcohol from parents/ older friends?

– Will access from parents/ older adults increase?

Plausibility

• Current alcohol plans focus on curbing binge and underage drinking not on price and general availability

– Without such measure will overall consumption be addressed?

– Overall consumption is strongest indicator of liver damage so will this outcome be achieved?

Do ability and Testability• Staff, resources, timescales, skills

• SMART objectives• Programme monitoring • Use of existing data• New primary data• Prioritised and focused evaluation plans

Should health be the primary or secondary

outcome?• Does the staring point matter if;

• Outcomes are explicit, shared and specific (e.g. inequalities or population health)

• Values and targeting is overt and appropriate• Interventions sensitive to excluded groups• Plans are plausible, testable and doable