Healthy Living Centres Evaluation
OVERVIEW OF PROGRAMME AND ITS
EVALUATION
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
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)
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
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
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
Main Activities of the Evaluation
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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
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
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
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
Most activities run
by one
organisation
Activities all in one location
[SR1]
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 on number
of sites
Multiple partners operating
activities on a number of
sites
Activities in multiple locations
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)
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.
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.
Interim findings on HMS survey
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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
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
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
Changes in health status at 18 months
• Overall decline in SF36 score on mental health (46.645.3) 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 (45.245.1)
• 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
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
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)
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’.
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