3.1 Saving lives:
our healthier nation set targets in 4 areas: cancer, CHD and
stroke, accidents and mental health.
3.1a How does the Department intend to
monitor individual health authorities' progress towards the targets
set in Saving lives? What assessment is being made of the
effectiveness of any additional spending committed in response
to these targets?
1. Under "Shifting the Balance of Power",
HAs are being abolished from 2002 and most of their functions
will be devolved to Primary Care Trusts (PCTs). In future, PCTs
will be the focus for partnership working, particularly with local
authorities, and for developing HIMPs.
2. HIMPs are overarching strategic plans
for local health systems which articulate national priorities
within the local setting. HIMPs set out the vision, objectives,
targets, milestones and outcomes alongside key activity for improving
the health of the local communities and reducing inequalities
and modernising NHS service delivery. The national targets were
set out in the NHS Plan; in Saving Lives: Our Healthier Nation
(ie Coronary Heart Disease & Stroke, Accidents, Mental Health
and Cancer); are reflected in the goals of the NHS Modernisation
Fund; and in the National Service Frameworks (NSFs).
3. It is for local health communities, led
by PCTs to determine how best to use their funds to meet national
and local priorities for improving health, tackling health inequalities
and modernising services.
4. Performance management of HIMPs, including
the HIMP Performance Scheme, will in future be undertaken by strategic
health authorities, whose functions will be different from those
of existing health authorities, and which will cover a wider geographical
area.
SUMMARY OF
ANSWER
5. PCTs will include action plans for tackling
the four national OHN targets in their HIMPs. Strategic health
authorities will in future be performance managing PCTs.
3.1b Could the Department provide summary
details of the investment plans of all HAZs, as they relate to
the four main targets in Saving Lives? Please provide details
of spending, targets and evaluation.
OVERVIEW
6. Health Action Zones (HAZs) are multi-agency
programmes between the NHS, local government, the voluntary and
private sectors and community groups. The principal aim of HAZs
is to tackle inequalities in health in the most deprived areas
of England through health and social care service modernisation
programmes with opportunities to address other interdependent
and wider determinants of health such as housing, education and
employment.
7. Twenty-six HAZs were selected across
England in 1998 and 1999 having passed a needs threshold based
on a basket of health, healthcare and deprivation indicators.
Table 3.1.4 presents HAZs' age standardised mortality rates for
Our Healthier Nation Indicators. HAZs cover more than 50 per cent
of the population living in deprived areas in England and over
13 million people. Within each HAZ different health as well as
service priorities are addressed.
8. HAZs have acted as trailblazers for new
ways of working and integrating the services and approaches being
developed into mainstream activity, including the use of flexibilities
such as pooled budgets between health and local authorities. HAZs
have been the leading edge of the Health Improvement and Modernisation
Plan for the local area, trying out new approaches, using the
additional resources to change the way services are delivered,
and contributing to the overall performance of the local health
economy. The value of HAZs is that they have gone through the
process of partnership building to action local change and are
now in a position to pass their learning on to Primary Care Trusts
(PCTs), Local Strategic Partnerships (LSPs) and others.
9. HAZs have a strong focus on prevention
and working with partners to address the wider determinants of
health. This work, alongside improving services, is also crucial
to achieving Saving Lives: Our Healthier Nation targets. HAZs'
involvement in leading edge partnership work also leaves them
well placed to take forward the National Strategy for Neighbourhood
Renewal. All HAZs are actively supporting the development of Local
Strategic Partnerships under the national strategy. There is also
the potential for HAZs to integrate with LSPs, subject to the
local pace of LSP development.
HAZ STRATEGY AND
TARGETS
10. HAZs were initially a bottom up initiative
with each HAZ choosing what areas (geographical or client group)
to focus on. This was subsequently supplemented by Ministers'
desire for HAZs to focus on CHD, Cancer and Mental Health and
the Department's priorities as a whole. This is reflected in the
increase in percentage terms of expenditure on these areas. Expenditure
on CHD, Cancer and Mental Health has increased from 17.7 per cent
to 35.4 per cent and £10.2 million to £52.5 million
and this was partially achieved by the HAZs receiving £30
million to increase activity in these areas in 2000-01. In 2001-02
this funding was subsumed into the health inequalities adjustment
and HAs in HAZs received £102 million of the £130 million
available. Details are in the Table 3.1.1 below. The HAZs are
working towards implementation of the NSFs for Mental Health and
CHD and the Cancer Plan. Activities across the HAZs are varied
and reflect a whole systems approach. Examples are in Table 3.1.2
below.
Table 3.1.1
PERCENTAGE OF HAZ EXPENDITURE ON DH PROGRAMME
AREAS
Table 3.1.2
EXAMPLE ACTIVITIES ON CHD, CANCER AND MENTAL
HEALTH
HAZ PROGRESS
11. All HAZs continue to make good progress
in improving health and in modernising services. All HAZs are
working through partnerships and a whole systems approach, community
and staff involvement. All HAZs have representatives from PCG/Ts
and Acute Trusts on their partnership boards. Most HAZs have devolved
some funding to PCG/Ts and in most HAZs the PCG/Ts lead on specific
projects. In all HAZs acute trusts are engaged and lead on specific
pieces of work.
12. The latest report from the independent
national evaluation of HAZs suggested that a number of HAZs have
made progress in mainstreaming their activities and shown good
progress in involving local communities in the planning, implementation
and delivery of HAZ programmes. The Health Select Committee of
the House of Commons' recent report on Public Health emphasises
that the learning emerging from the national evaluation of HAZs
is taken on board in the development of LSPs.
13. HAZs were given permission to carry
£29 million into 2000-01 and also received allocations totalling
£120 million during the year. The high carry forward figure
was part of the reason that HAZs received less funding than they
expected in 2000-01. In a number of cases additional funding was
allocated to the HAZ by their HA to fund specific pieces of work.
The cumulative effect is an overspend of £30k. The figures
are also provisional because HA Accounts will not be finalised
until September.
HAZ EVALUATION
14. The national independent evaluation
of the HAZ initiative began in January 1999 and is due to report
in December 2003. The evaluation is being carried out by a team
led by Professor Ken Judge from Glasgow University. The evaluation
aims to identify and review how HAZ agendas for change are developed
and implemented, and to assess achievements. It involves an overview
of developments in all 26 HAZs in England, including a more detailed
investigation of developments in eight of those HAZs. In addition
to the national evaluation, HAZs are required to evaluate their
programmes locally.
HAZ INNOVATIONS FUND,
EMPLOYMENT PILOTS
AND FELLOWSHIP
SCHEME
15. As part of the initiative the Department
of Health has funded the HAZ Innovation scheme and 9 HAZ Employment
pilots. The 59 trailblazing projects funded by the HAZ Innovations
Fund are tackling the causes of ill-health for thousands of people
across England. The schemes, which began their work in Spring
2000, are aiming to reduce health inequalities by directly addressing
problems of education, employment, drug misuse, housing and health.
The 9 Employment Pilots are of testing innovative or flexible
approaches in a key thematic area linking health and employment.
They are centrally funded for two or three years. All the schemes
have devised innovative ways of targeting particular health concerns,
and it is envisaged that successful projects will be replicable
elsewhere in the country.
16. HAZ Fellowships were first introduced
in November 1999. Their aim is to give front line staff the time
and the opportunity to research and test new ideas in order to
improve services. The 1st wave ran from Spring to Winter 2000
and included 29 1st wave Fellows. 24 HAZ Fellowships were awarded
in the 2nd wave of the HAZ Fellowship scheme starting in April
2001. The 2nd wave focuses mainly on Mental Health and CHD. A
3rd wave is currently being selected.
HAZ FINANCE
17. HAZ funding is helping to bring about
change in the more substantial mainstream budgets of health and
local authorities. HAZs are also expected to link up with other
initiatives and help secure other sources of funding for their
areas, such as through the New Deal Initiative. In 2001-02 HAZs
receive funding as follows:
— Programme & development funding
from the HAZ budget;
— Innovations and Employment Pilot
funding from the HAZ budget;
— Smoking cessation funding, and;
— Drugs prevention funding.
18. In 1999-2000 and 2000-01 HAs in HAZs
received £30 million in their Initial Cash Limits to spend
in support of the HAZ programme and in the geographical area of
the HAZ as deprivation funding. In 2000-01 a further £30
million was targeted at CHD, Cancer and Mental Health. In 2001-02
this funding was subsumed into the health inequalities adjustment
and HAs in HAZs received £102 million of the £130 million
available. The HAs in HAZs received the same level of deprivation
funding (£60 million) plus the top 47 HAs with HAZs in the
Years of Life Lost index received £70 million between them.
19. Table 3.1.3 shows the total funding
each HAZ received in 2001-02. Table 3.1.5 shows the total funding
for HAZs from 1999-2000 to 2001-02.
Table 3.1.3
HAZ FUNDING 2001-02
3.1c How much funding has been made available
for methodological research to underpin the application of Health
Impact Assessments in 2001-02? How will the Health Impact Assessment
process be evaluated?
20. Funds totalling £198,000 are available
in 2001-02 to allow the conclusion of i) a contractual three-year
study by University College London into Health Impact Assessment
(HIA) and Environmental Planning ; ii) the conclusion of
a contractual two-year initiative by Liverpool University on Capacity-building
for HIA; and iii) further development—including an IT-based
version—of the screening checklist for HIA.
21. Development of HIA methodologies is
ongoing. Progress continues to be monitored by the cross-Government
Interdepartmental Group on Health Impact Assessment (IG-HIA) which
meets quarterly. Further, the IG-HIA can, if it wishes, commission
specific evaluative studies of HIA activity.
3.1d Can the Department update the information
given in tables 3.1.1 and 3.1.2?
22. Updated tables are set out below. Tables
3.1.1 and 3.1.2 have been re-numbered to 3.1.4 and 3.1.5 respectively.
Table 3.1.4
AGE STANDARDISED MORTALITY RATES FOR OUR
HEALTHIER NATION INDICATORS, 1997-99
Table 3.1.5
TOTAL FUNDING FOR HAZs FROM 1999-2000 to
2001-02
