HEALTHY START RAPID EVALUATION OF EARLY IMPACT ON BENEFICIARIES, HEALTH PROFESSIONALS, RETAILERS AND CONTRACTORS

Transcription

1 Tavistck Institute HEALTHY START RAPID EVALUATION OF EARLY IMPACT ON BENEFICIARIES, HEALTH PROFESSIONALS, RETAILERS AND CONTRACTORS EXECUTIVE SUMMARY This reprt presents the findings frm the rapid evaluatin f Phase 1 f Healthy Start and its early impact n beneficiaries, health prfessinals, retailers and cntractrs. It was cmmissined by the Department f Health in autumn 2005 and ran in tandem with the evaluatin f the training prvided t implement Phase 1 f Healthy Start, als undertaken by Symbia/Tavistck Institute. We include ur main recmmendatins at the end f this summary. A full set f recmmendatins is prvided at the end f the full reprt. The evaluatin strategy Overall the evaluatin strategy adpted fr Phase 1 f Healthy Start wrked well, and generated a wealth f useful data. We were able t gather qualitative feedback frm a large number f infrmants at bth a natinal (21) and lcal level (112). We develped, pilted and gathered quantitative data frm three pstal and telephne survey tls frm health prfessinals attending training activities (32), retailers (20) and beneficiaries (18). We experienced significant difficulties in undertaking the evaluatin strategy because: The absence f a lcal c-rdinatr in Devn and Crnwall made it difficult t understand the variatins in the lcal cntext, and t establish cntact with lcal health prfessinals and the relevant management structures. The difficulty with the LREC applicatin, especially in Plymuth had a great impact n the team in terms f bth time and resurces and delayed access t infrmants in the Plymuth area. There are few ethnic cmmunities in Devn and Crnwall; we have been able t gather nly limited data n the ptential cultural and linguistic issues that might arise in mre ethnically diverse areas.

2 Tavistck Institute Links t wider plicy The extent t which Healthy Start is cmplementary t many ther plicy develpments in bth health and children s services prvides strng backing fr managers f services t take a practive stance, bth in prmting the scheme, and in making links acrss services in develping innvative appraches t its delivery. These links were ften nt being made n the grund. Lcal health prfessinals appeared t have ften been left t implement the scheme with little supprt frm their management structure. This tended t encurage a fcus n the mechanics f the scheme, rather than expliting the pprtunities prvided by the scheme t prmte wider change. Health Prfessinals There has been cnsiderable success in implementing and delivering Healthy Start, especially given the tight timescales at the beginning f the scheme. While the cverage f training was patchy, in the main, by nw, mst health prfessinals are aware f the scheme and hw t apply it. When they d nt, they can ask clleagues fr infrmatin and supprt. Hwever, cncerns remain that knwledge abut sme elements f the scheme remains lw (sme eligibility rules) and that in sme areas certain team members have n knwledge at all. Healthy eating messages are prvided t beneficiaries thugh this tends t be in a rutine way. The wider applicatin by health prfessinals f Healthy Start is much mre limited links between frnt line staff and wider supprting structures are generally pr. This is nt entirely the respnsibility f frnt line staff. There has been an absence f leadership and supprt frm senir management, and n cherent strategy fr Healthy Start in any f the areas we visited. Health prfessinals at all levels cntinue t wrk in sils, with little crss wrking. This is less true where Sure Start r ther rganisatins are mbilised, r mbilise health prfessinals. Retailers The intrductin f Healthy Start in Devn and Crnwall was, n balance, a success: A gd number f retailers are participating, including sme that did nt previusly participate in the Welfare Fd Scheme. The infrmatin prvided abut the prgramme is generally regarded as adequate and useful. As a result, retailers tend t be well infrmed abut the prgramme and in particular the fds cvered by it.

3 Tavistck Institute The registratin and vucher reimbursement prcesses are regarded as smth by the retailers themselves, suggesting that the bjective f making them mre straightfrward was successful. The impact f participating n businesses tends t be either psitive r neutral, with ccasinal cmments that participatin has brught in new custmers r led custmers t spend abve the value f the vucher in the shp. At the same time, the first phase f the Healthy Start prgramme did experience sme snags : Sme retailers heard abut the beginning f the Healthy Start prgramme t late t register n time. Sme retailers felt this cst them custm. Nt all shps were directly invited t sign up and sme did nt respnd t the invitatin, which left significant gaps in sme areas. There was cnfusin amng sme retailers abut the need t register, particularly by thse retailers that were already accepting milk tkens. Infrmatin abut Healthy Start and the fds it cvers did nt always reach all staff and was smetimes pr. While sme retailers were enthusiastic abut the prgramme and the brader nutritinal messages it is trying t supprt, mst see it as just anther vucher system. Opprtunities fr linking in with 5 A DAY prgramme by drawing n 5 A DAY wrk t give families ideas abut using fruit and vegetables, as well as brader encuragement t eat healthily beynd Healthy Start are being lst. Beneficiaries Cmmunicatin frm EWA, frm benefits ffices t existing and new beneficiaries was gd. Health prfessinals such as midwives and health visitrs als prvided infrmatin abut Healthy Start. Cmmunicatin via the different rutes had been effective in creating awareness f Healthy Start as a change t an existing benefit and the applicatin frm was clear. It is nt pssible t cnfirm that there had been gd cverage f hard t reach grups as these may have been under represented in ur sample. We identified a lack f clarity amngst ptential beneficiaries interviewed arund eligibility. Beneficiaries were mstly aware that the vuchers culd be used in exchange fr fruit and vegetables as well as infant frmula and can be used in registered shps. The infrmatin received had been mainly written infrmatin with limited verbal discussin and the main purpse f the infrmatin was in terms f accessing the vuchers rather than health prmtin.

4 Tavistck Institute Retailers themselves were the main surce f infrmatin abut where the vuchers culd be exchanged. Beneficiaries mainly used multiple retailers (supermarkets) t exchange their vuchers. Althugh there were sme teething prblems reprted, exchange at retailers has generally wrked well, especially where there was n fuss r embarrassment. Almst all beneficiaries with children ver ne year used the vuchers t buy fruit and vegetables. Over half the beneficiaries surveyed said that they were buying mre fruit and vegetables since the vuchers were intrduced. Hwever, many health prfessinals in cntact with beneficiaries reprted pckets f the ppulatin with particularly pr diets, and a lack f fd preparatin skills. T achieve a shift in eating behaviur requires a targeted multi-layered apprach ver an extended timeframe. Other services In terms f the practical implementatin f Healthy Start, it was clear that there are a number f supprt wrkers and wrkers in parallel services wh culd play an imprtant rle in infrming ptential beneficiaries abut their entitlement t the scheme, and helping them t make their applicatins. Hwever, the level f infrmatin reaching these grups was ften patchy, and their understanding f the scheme pr, in spite f effrts made by health visitrs and midwives t cascade infrmatin received at training events. In terms f the use f Healthy Start as an pprtunity t influence health behaviurs, it was apparent that there were a large number f parallel initiatives taking place, t which beneficiaries culd have been referred. Many f these prvided hands n experience f cking and pprtunities t sample different fds, particularly imprtant given beneficiaries lack f knwledge and skills n hw t make best use f the pprtunity t buy fruit and vegetables, nted earlier. Thse wrking in such services culd ften think f a number f different ways in which they culd incrprate Healthy Start int these activities, nce infrmed abut it. Health visitrs and midwives ften had difficulty in making the links with such activities, because they had nt been encuraged by the line management, because f their wrk lad, and because cnnectins between different services were pr at a lcal level. Lack f cmmunicatin was cmpunded by the lack f links at a central level within sme PCTs, between midwifery and health visiting services, and thse respnsible fr ther relevant services, such as public health, pharmacy r children's services.

5 Tavistck Institute Recmmendatins Drawing n these findings we have made a number f recmmendatins fr the natinal rll ut f Healthy Start: That DH makes the links between Healthy Start and specific health plicy bjectives mre explicit in cmmunicatins t health prfessinals and parallel services, in particular bjectives in the Natinal Service Framewrk: children yung peple and maternity services, PSA besity targets and health inequality targets. That DH cmmunicates t relevant health service managers and parallel services the pprtunities that Healthy Start prvides in reaching key health plicy bjectives and thse relating t children and families. That Healthy Start be used by DH t encurage jined up wrking between different services in rder t achieve these key plicy bjectives at different levels (strategic and lcal). Cmmunicatins shuld incrprate examples f successful crss-service wrking. It is essential that the right managers are infrmed abut Healthy Start in Phase 2 in rder t ensure that the aims f the prgramme are fully realised. At a minimum the fllwing health prfessinals must be included in any cmmunicatin abut Healthy Start: Directr f Midwifery Directr f Operatinal Services Directr f Children and Family Directrate Prfessinal lead fr Children s Services Public Health - Prfessinal Lead Pharmaceutical Cmmittee These messages shuld be reinfrced by similar messages inserted in natinal and lcal prfessinal and media cmmunicatins. At a lcal level Infrmatin abut Healthy Start prvided t beneficiaries at bking interviews with midwives is an effective means f disseminatin and shuld be encuraged. Hwever, it needs t be supprted by ther means t ensure that ther ptential beneficiaries dn t fall thrugh the gaps. Eligibility criteria shuld be highlighted in infrmatin prvided s that specific grups are nt missed, fr example under 18s. Cmmunicatin with retailers T widen chice, especially in deprived and extremely rural areas, as many shps as pssible shuld be targeted. Cmmunicatin leaflets must be sent t retailers well befre the start f the natinal rll-ut t ensure maximum cverage.

6 Tavistck Institute Cmmunicatin with beneficiaries Health prfessinals in Phase 2 shuld systematically link up with lcal services t disseminate infrmatin abut Healthy Start and access beneficiaries t learn abut nutritin and diet. T reinfrce healthy eating messages health prfessinals must encurage beneficiaries t take part in relevant practical, experiential activities lcally. The rle f health prfessinals in encuraging beneficiaries t attend supprting activities needs t be reinfrced. DH t make it clearer n the frm where t send the applicatin frm back t. DH t ensure access and chice t retailers, prvide additinal infrmatin abut registered retailers. Fr example, refer t the website in the applicatin leaflet in the Where can I use the vuchers? sectin. The rle f ther services A targeted infrmatin and management strategy, fr example Sure Start and children's services, pharmaceutical services and schl health. A key message fr these grups is the eligibility f teenage mthers. Rutine cmmunicatin with public health leads, particularly thse c-rdinating natinal prgrammes such as 5 A DAY and healthy schls. A key message fr these is the significant benefit f incrprating Healthy Start in lcal initiatives, tgether with examples f gd practice. Prfessinals frm ther services must be targeted fr Healthy Start training r cascaded training. Specially designed training activities r infrmatin packs fr supprt staff, including receptinists, NNEB Nursery Nurses and Health Visitr Assistants. Evaluatin f natinal rll ut f the prgramme We strngly recmmend that a natinal evaluatin r quality assurance mechanism is develped fr the natinal rll ut f the prgramme, with supprt fr lcal evaluatin strategies at PCT level. This will: Strengthen the prgramme thrugh identifying gaps that need t be addressed Address the gaps in infrmatin cncerning the impact f the scheme in areas with large ethnic minrity cmmunities Prvide examples f gd practice in lcal areas which can be fed back t encurage lcal innvatin and cmmitment t the prgramme

7 Tavistck Institute We recmmend that the tls develped fr this evaluatin be used (appendix 1) fr gathering feedback frm health prfessinals attending training events, beneficiaries and retailers, as these have already been pilted and prved effective. Crss cutting recmmendatins Cnsideratin shuld be given t the crdinatin f implementatin and training at a lcal level, which wuld strengthen bth the crdinatin f training activities, and ensure gd cverage f cmmunicatin strategy at a lcal level. Such a rle culd be added n t anther crdinatin rle, fr example, the 5 A DAY crdinatr, r as part f the respnsibility f anther lcal crdinating grup which brings tgether relevant parties (midwifery, health visitrs, children s services, public health). The rll ut f the prgramme wuld be strengthened by setting up sme kind f learning netwrk between thse with a key rle in the prgramme at either lcal r reginal level. The netwrk culd als be supprted by regular cmmunicatins frm the central team, either via an discussin grup, website pstings r a newsletter. It culd be used fr the sharing f examples f gd practice in rder t encurage thers t pick up n creative uses f the pprtunities prvided by the prgramme.