Healthy Living Centres Evaluation

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Healthy Living Centres Evaluation
OVERVIEW OF PROGRAMME AND ITS EVALUATION
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The HLC Programme

• A large and diverse programme
• 300 million, started 1999, final grant awarded
  2002
• Most projects funded for 3-5 years
• Final project ends 2009.
• 350 projects
• 257 in England
• 46 in Scotland
• 28 in Wales
• 19 in Northern Ireland

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Integral to health policy

• Healthy living centres heralded as
• 'local flagships for health in the community,
  reaching out to people who have until now been
  excluded from opportunities for better health and
  being powerful catalyses for change in their
  neighbourhoods'
• (Our Healthier Nation, a Contract for Health, DoH
  1997)

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Evaluation the challenge

• Size and diversity of the programme
• The nature of community based health projects
  broad aims, complex organisations, flexible and
  responsive programmes
• Multiple programmes and initiatives taking place
  in HLC areas
• Difficulties in measuring outcomes particularly
  in short term
• Several different evaluations taking place
  Programme evaluation, National evaluations in
  England, Scotland and Wales, local evaluation
• Other demands for provision of information
  Annual Monitoring Reports, Development and
  support programme surveys

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The Bridge Consortium

• The Tavistock Institute
• University of Edinburgh
• Cardiff University
• Lancaster University
• The Institute of Public Health in Ireland,
  Belfast
• London School of Economics
• Glasgow University

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Evaluation Objectives

• to evaluate HLC programme success in terms of the
  aims of NOF and Healthy Living Centres
  themselves
• to contribute to the evidence-base regarding the
  successful strategies to improve health and
  reduce health inequalities
• to assist HLCs and their partners to learn from
  overall programme experience in order to develop
  their capacity and improve their practice and
• to help NOF with the management and development
  of the programme as well as with future programme
  and policy development

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Main Activities of the Evaluation

• Health Monitoring System survey of HLC users
• 40 case studies
• Policy analysis
• Workshops with HLCs and local evaluators
• Survey of all centres (2006)
• Use of information from parallel evaluations
• Database of intentions and baseline info on all
  HLCs (DoH evaluation)
• Annual monitoring data
• Data from development and support activities
• Local evaluations

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Common elements within HLCs

• Broad based approach to health to improve
  health and wellbeing and address wider
  determinants to health
• Aim to promote innovation and responsiveness to
  local situation
• Targeting of disadvantaged areas and groups
• Intention to reflect and complement national and
  local public health plans and priorities
• Partnership working
• Community engagement
• Sustainability

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Key variations in programme delivery

• Lead agency NHS 24, LA 23, partnerships 10,
  vol and community sector 33
• General vision of health whether targeting
  life style, service development, community
  capacity building or wider health determinants
  (poverty, unemployment etc.
• Structure whether a physical centre, a network
  or hub and spoke model
• Focus whether a geographical neighbourhood, a
  particular group (older or young people, ethnic
  group) or particular issue (mental health,
  physical exercise, diet and nutrition).
• Level of involvement with statutory sector (NHS,
  local authority)
• Approach to community involvement

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Locally identified theory of change cluster Health inequalities cluster
1. Focus on specific health issues A behavioural explanation
2. Lack of access to information 3. Lack of interest and confidence A service accessibility explanation
4. Lack of uptake of conventional services A service appropriateness explanation
5. Social isolation and social exclusion A social exclusion/social capital explanation A community participation/involvement explanation
6. Underlying poverty and unemployment A poverty and income explanation An environmental explanation
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Activities all in one location Activities all in one location SR1
Most activities run by one organisation Most activities run by one organisation on one site Multiple partners running activities on one site Activities run by number of partners
Most activities run by one organisation Most activities run by one organisation on number of sites Multiple partners operating activities on a number of sites Activities run by number of partners
Activities in multiple locations Activities in multiple locations
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Wide range of HLC activities

• Addressing health behaviour e.g. health
  information and advice, physical activities,
  healthy eating activities, stop smoking projects
• Addressing lack of services health care and
  screening, support and counselling, services for
  children and families, older and disabled people
• Social activities (addressing social isolation
  and social exclusion)
• Addressing poverty and unemployment (training,
  work experience, credit unions, benefits advice)

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Activities embedded in broad approach

• Broad programmes of HLCs often include
• social opportunities and emotional support,
  activities to encourage self help and mutual
  support
• Activities to address some of the causes of
  poverty - poor literacy skills, and lack of
  information about benefits and services which
  might provide assistance.
• Engagement of individuals in the work of the
  centre through consultation structure,
  volunteering, joining the staff, or developing
  and running groups and activities of their own.
• Building close working relationships with other
  local groups and organisations, including local
  statutory sector.

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A broad approach to tackling health and health
inequalities

• HLCs successful in targeting sections of the
  community with high levels of need (HMS data)
• Successful in generating programmes of activities
  at a local level often large and varied.
• Broad health agenda provides flexibility for
  adjusting programmes to meet local needs, and
  developing activities that encourage access and
  engagement
• However, activities alone insufficient to engage
  some sections of the community, particularly
  where other factors (social isolation, poverty,
  lack of other services) remain a major obstacle
  to health and wellbeing.

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Interim findings on HMS survey

• Longitudinal survey delivered via 154 HLCs
• 4500 returned initial questionnaires
• 987 returned 18 month follow up questionnaires
• Analysis of physical and mental functioning and
  self assessment of health and wellbeing
• Useful comparison between regular (monthly) and
  non regular users
• Regular user health remaining stable while non
  regular user health declines
• Indicates protective effect of HLCs

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Participants in activities

• 75 of service users are women
• 44 are aged 55 and over - and 34 are retired
• 11 of respondents are from Black and ethnic
  minority groups
• 23 are employed, 6 are unemployed
• 11 are permanently unable to work due to illness
  or disability
• 24 of respondents hold educational
  qualifications at degree level or above
• 43 have no car, 8 have no phone, 9 have no
  central heating

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Health and wellbeing

• 69 say that their health is good, very good
  or excellent
• 40 say that they are limited to some extent in
  moderate activities such as moving a table or
  pushing a vacuum cleaner
• 34 of respondents say that physical health or
  emotional problems affect their social activities
  some, most or all of the time
• 35 had done some physical activity (e.g.
  walking, swimming) on sixteen or more days of the
  previous month

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Changes in health status at 18 months

• Overall decline in SF36 score on mental health
  (46.6-45.3) for non regular users, less for
  regular users (49.7-49.1)
• Decline in SF36 score on physical health for non
  regular users (46.1- 44.9), less for regular
  users (45.2-45.1)
• General health rating in 21 non regular users
  changed from good to poor health compared to 10
  regular users
• General health rating in of 26 non regular users
  changed from poor to good, compared to 33
  regular users
• Results sig. even when age, sex taken into account

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Changes in health behaviour

• 24 of regular users quit smoking compared to 19
  non regular users numbers of regulars returning
  to smoking also lower
• 25 of regulars had increased consumption of
  fruit and vegetables compared to 17 non regular
• Less significant results on exercise and drinking
  behaviour althoug
• 24 of non regular increased, and then reduced
  intensity of exercise compared to 17 regular
  users

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The Changing policy context

• Initial policy context Our Healthier Nation and
  Saving Lives
• Since then
• Changes in structure and roles of Local
  Authorities and NHS (LSPs, PCTs)
• Less interest in area based interventions
• New public health policy Wanless II and Choosing
  Health White Paper (new priority areas)
• New policy relating to voluntary and community
  sector, civil engagement and community capacity
  building. (ODPM, Home Office Civil Renewal Unit)

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Relevance of programme to current policy debates

• Much learning relevant to the delivery of the
  fully engaged scenario of Wanless, and the
  implementation of the Choosing health agenda.
• Learning about the skills, experience and
  resources required to develop local, embedded,
  projects
• Provide evidence of value of a broad health
  agenda in enabling projects to respond to
  changes in community, local services and wider
  policy agendas
• Their work at a community level can also
  contribute to policy debates around the need for
  better infrastructure for community capacity
  building.

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Current concerns

• Sustainability future funding for most centres
  uncertain although some activities likely to be
  taken up by partners.
• Some centres looking to social enterprise models,
  others to mainstream funding.
• Harder to find funding for general activities -
  partnership working, community involvement,
  social activities
• Programme not mentioned in recent policy
  documents
• Lack of voice at national level but HLC
  alliance now formed