MONITORING AND EVALUATION
Equally Well identified significant gaps in the data available to support local performance management and reporting. Forthcoming improvements have been described previously within NHSScotland, where health data on diversity are inadequate.
Equally Well described health inequalities based on health outcomes for individuals, rather than the areas in which they live. However, most of the information currently available to describe health inequalities based on socioeconomic status is area-based. Recommendation 76 is about developing better data. The Government will therefore examine whether options for linkage of individual records of health status with individual records of socioeconomic status should be pursued. For example:
- Linkage to income records, such as: The inclusion of a question on income in the 2011 Census; tax records from the Inland Revenue linked to mortality data (work ongoing by Leyland et al); investigation of the feasibility of linking incapacity benefit data with health datasets (work ongoing by Glasgow University).
- Within survey linkage of individual income information with health variables such as self-assessed health, long-standing limiting illness, GHQ12 and in the future WEMWBS (using large scale national surveys such as Scottish Health Survey or Scottish Household Survey).
- The new Scottish Health Survey results will become available during 2009 - these will be analysed, and linkage will be done to explore the possibility of developing new basis for assessing health inequalities.
- This new analysis will become possible in 2009-10 (Scottish Health Survey), and 2012-13 (2011 census).
How will we know it's working?
Integrated impact assessment is to be developed and supported under Equally Well recommendation 77. This will help national and local organisations to identify in advance how policies and programmes will affect health inequalities. The Scottish Government is taking the following action:
- The Government is currently reviewing its approach to policy appraisal. The first stage of this review involves the development of an impact assessment framework based on the Government's Purpose and National Outcomes. A Scottish impact assessment framework will be piloted within Scottish Government. The second stage will assess the potential to develop an integrated impact assessment model and examine the wider application of such an approach with community planning partners. It is expected that this second stage will require commissioning of external contractors, following some initial scoping with stakeholders within and outwith government.
- EQIA is part of the Scottish impact assessment framework, and will be included within the development of integrated impact assessment.
- Providing support for local impact assessment during 2009-10, through suitable tools and increasing local skills and capacity to use them effectively.
It will be vital for the future development of action on health inequalities to evaluate the effectiveness of policies and actions that Equally Well has recommended. Evaluation needs to:
- Be appropriate for both specific interventions and complex packages of actions (recommendation 73).
- Be properly resourced.
- Focus on areas where current evidence is weakest.
- Address the differential impacts of policies and actions on different subgroups (socioeconomic, gender, ethnicity, for example).
- Address cost-effectiveness.
- In order to achieve these recommendations, the Scottish Government will:
- Develop an evaluation framework, which builds on this implementation plan and the analysis of intermediate outcomes.
- Work with an external advisory group.
- Support local evaluation of and ensure that lessons are learned from the test sites as a whole.
- Enhance opportunities for practitioners, academics and evaluators to share learning and develop a wider range of approaches to evaluation appropriate for actions designed to reduce health inequalities. For example NHS Health Scotland will continue to run the Evaluation Summer School in collaboration with Scottish Government, academic units and public and Third Sector bodies. Scottish Government will sponsor and participate in the Scottish Evaluation Network.
The final recommendation in Equally Well is that the Ministerial Task Force should reconvene in 2010 to review progress with implementation.
- The Scottish Government will announce by the end of 2009 how the Ministerial Task Force's review of progress will be carried out in 2010. The review will draw on progress in the local test sites and on action being taken by community planning partnerships generally, and reflected in the 2009-10 Single Outcome Agreements with Government. The review will also identify progress made by NHSScotland and community planning partners with the relevant action set out in the Better Health, Better Care action plan (December 2007). The Ministerial Strategic Group for Health and Community Care includes representation from Government, local authorities and NHSScotland. The
Group will maintain an oversight of progress until the Task Force's formal review.
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