Wellbeing, Evaluation & Prevention

1. Wellbeing, Evaluation &Prevention Fraser Battye 22nd October 2009

2. Presentation Structure PART A: Monitoring & Evaluation of Living Well • Challenges • Approaches • Results PART B: General Reflections – Investing in Prevention • Challenges • (how) can evaluation help? • What else might help?

3. PART A: monitoring & EVALUATION OF Living Well

4. We were commissioned to… • Provide monitoring & evaluation (M&E) services: • Regional level • Formative approach • But also focus on outcomes • Why is that difficult? • 30+ projects in 14 areas • Massive diversity: size (£), target groups, interventions, contexts, capacity etc. • Results need adding up • Plus ‘usual problems’

5. What did we do? • Briefly considered: • Decide what ‘wellbeing’ is; get a tool • Give tool to projects; add up results • …easier for us – but less use for projects • Instead, we: • Built from ‘projects up’ • Individual M&E plans • Some common tools (e.g. WEMWBS) • Backed by toolkit / training / support / project visits

6. What have we found?

7. Main focus: mental wellbeing A lot of PA / MH cross-over

8. £3.6 million worth of inputs ‘in-kind’ support very significant

9. Main outputs • 3,080 physical activity sessions • 1,500 mental wellbeing sessions • 720 healthy eating sessions • 770 professionals engaged in training activity • 170 volunteers recruited and / or trained

10. Beneficiary numbers Total: 16,000 Introduced guidance Av. cost per beneficiary: £160 (range: £5 - £1,200)

11. Outcomes • Measure annually…will know next month! (sorry) • Last year we found: • Improvements in knowledge, enjoyment, awareness • Positive changes in behaviour / condition: • Improved diet • Increased levels of activity • Improved mental wellbeing • Needed around 10 beneficiaries for one positive outcome

12. PART B: Reflections on preventative investment

13. Challenges • General problem: • Limited resources but unlimited competing claims – requires trade-offs • E.g. Restorative or preventative? • More specific problems facing preventative services: • Professional acceptance / credibility • Diffuse costs….anddiffuse benefits • Media / public (us) pressure • Political presure • Poor information for commissioners

14. Evidence and Prevention • Lack of investment in evaluation: • Especially relative to restorative interventions • Problem of diffuse benefits here too • Accepted standards of evidence: • Randomised Trials – can be great, but: • Expensive, sometimes inappropriate • Findings may not last or transfer • Lack of economic evaluation: • Prevention rests on ‘spend to save’ arguments – but health economics is under-developed here

15. Result of these Challenges Relatively low increases in preventative investments in ‘health’

16. What might change this? • This is not (just) a technocratic exercise • Other factors: • Leadership • Policy - Wanless, Darzi, New Horizons etc • ‘Burning platform’ of rising costs / expectations: • ‘Do Nothing’ = bankrupt system • Opportunity of a crisis? • Also (perhaps naïve?) public debate / engagement

17. SHA / Ipsos MORI Data (1)

18. SHA / Ipsos MORI Data (2) Note: no trade-off Actual spend is around 2% across West Mids

19. Thank-you for listening Q&A