Food & Health Alliance

Back in 2006 the panel of the Review of the Scottish Diet Action Plan (SDAP) expressed concern that although considerable progress had been made in implementing the SDAP recommendations there had been little apparent impact on overall food consumption and the nutrient intakes of the Scottish population. The panel suggested a range of plausible explanations for this including the possibility that resources and initiatives may have been ‘spread too thinly across a broad range of actions rather than focusing population-level impact within a few priority areas.’

The SDAP Review has helped focus minds on what needs to be achieved to begin to have a real impact at a population level. In particular it has helped to concentrate our efforts where they will have the biggest effect. But that raises another question: how do we know if we are making a difference? And that underlines the increasingly critical role of evaluation in the food and health agenda.

What are we collectively trying to achieve in food and health? 

Through a focused range of actions and prioritised food and health work we want to help make the nation’s diet healthier. This in turn will improve people’s health and reduce health inequalities. To achieve maximum impact at a population health level there is a need for shared priorities and an agreed accountability for delivering these.

How do we prioritise our efforts to ensure we make an impact in health improvement and reducing health inequalities?

The National Performance Framework (NPF), launched by Finance Secretary John Swinney in November 2007 in the Scottish Budget Spending Review 2007,

sets out a framework which is outcome-focused and aligned with national priorities. It seeks to meet local needs and circumstances and encourage joint working, while acknowledging different accountability arrangements.

How do we link our work into the National Performance Framework?

Working with the Scottish Government, NHS Health Scotland has developed an outcomes-focused performance framework for health improvement that is aligned with the National Performance Framework and a set of related tools for community planning partners to use in the context of Single Outcome Agreements (SOAs).

These can be accessed at: www.improvementservice.org.uk/health-improvement/health/tools-for-soa-processes/

We are at the early stages of applying this approach to the area of food and health. The framework will identify the National Outcomes and Indicators in the National Performance Framework related to diet and use logic models to identify the key contributions of different community planning partners to achieving these shared outcomes, together with potential performance indicators for managing these contributions.

What are logic models?

Logic modelling is a tool that can be useful in:

• identifying short, medium and long-term outcomes of a programme or strategy

• identifying the key activities that evidence suggests will help achieve these outcomes

• setting out the different partners involved in delivering these activities

• developing performance measures of key outcomes

• informing the development of monitoring and evaluation plans to assess whether the intended outcomes are achieved.

Examples of logic models can be found on the NHS Health Scotland website:  www.healthscotland.com/scotlands-health/evaluation/support/logic-models.aspx

Why are NHS Health Scotland and partners using these food and health logic models?

The National Performance Framework contains a number of outcomes that relate to diet such as healthy weight for children or reduced mortality from Coronary Heart Disease (CHD). It is important that partners work together to identify these outcomes and the most effective services for achieving them, delivered either singly or in partnership. Logic modelling can help this process.

How do you develop these logic models?

Logic models are built up using available evidence. Where evidence is not available we use information on the potential impact of different interventions and the likelihood they will address key policy goals, such as reducing health inequalities.

The next stage is to discuss the model with key stakeholders to ensure it addresses the areas of greatest importance and that it makes sense. It is fundamental that the model is validated with the correct stakeholders and has the right policy and evidence included within.

How do we know these actions will have the desired outcomes?

They will be based on available evidence and current understanding of what works to change people’s diets. They could also form the basis of local performance management processes and monitoring and evaluation work. Over time we can build up a picture of whether services deliver their intended outcomes and whether these lead to longer term dietary changes in the wider population.

When can we use this outcome framework?

A draft will be available late spring/early summer. We’ll keep you posted on progress.

How do we use this outcome framework?

The framework is not prescriptive. It is being developed for people to use or adapt in planning the services they deliver that contribute to health improvement, as well as developing measures to assess their performance in delivering these services. Planning partners can use it in a number of ways:

• as a basis for dialogue with planning partners, for example, in community planning and the development SOAs

• to identify effective, evidence-based interventions that they can deliver to make a contribution to shared outcomes in the NPF

• to demonstrate to key stakeholders the contribution their services can make to shared outcomes in the NPF

• as a basis for developing the information and processes they use to manage their performance in delivering these services

• to target evaluation work on key outcomes and the services put in place to achieve them.

What does this mean for me working in local government?

Local government has an important role to play in supporting dietary change.

SOAs mean that local government, along with its community planning partners, agree outcomes. This includes health improvement outcomes that they will be expected to achieve. The framework will help to identify and demonstrate the contribution that service providers in local government can make to these outcomes.

What does this mean for me as an NHS employee?

Like local government, the NHS has an important role to play in supporting dietary change. This is reflected in the HEAT target for child healthy weight but it also requires effective joint working with other partners across a range of services. This outcome framework will help identify how the services you provide as an NHS employee fit into this wider strategy for improving the population’s diet.

As a community and voluntary worker, what does all of this mean for me?

The Third Sector is a key partner of health and local government. The outcome framework will provide a basis for dialogue between Third Sector organisations and their partners about the contribution they make to SOAs.