Equally Well - Intermediate Outcomes

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What do we mean by intermediate outcomes?

Intermediate outcomes are about the underlying reasons for health inequalities e.g. poverty, lack of good employment, physical environments. All community planning partners are involved in influencing these outcomes; action is not exclusively for NHS Scotland.

Many of the intermediate outcomes also appear in other national strategies and frameworks. In particular, the outcomes identified are consistent with the early years and tackling poverty frameworks. Outcomes are also consistent with the drug and alcohol outcomes toolkit that was published in December 2008 and outcomes identified for criminal justice authorities.

Why is it useful to identify intermediate outcomes?

The analyses present a menu of intermediate outcomes and activities that can be planned and delivered by community planning partners (separately and jointly) to help reduce health inequalities. They will be useful for community planning partnerships that identify local problems with poor health that contribute to national health inequality, and/or that identify significant health inequalities within their partnership areas. The analyses should also be helpful in identifying local priorities for SOAs and for joint thinking between local partners on the actions that each should then pursue.

How do the analyses relate to the Health Improvement Performance Management (HIPM) Review?

The analyses follow some of the same formats as the HIPM package, with the intermediate outcomes grouped into environmental and behavioural determinants of health inequalities.

The outcomes are also time-sequenced - they indicate the intermediate outcomes that need to be achieved before we can reduce health inequalities, although the outcomes do not correspond to particular timeframes - some intermediate outcomes may take a long time to achieve.

The analyses do not, however, attempt to model the causes of health inequalities or the complex interrelationships between them. As Equally Well spells out, there is not enough good evidence yet of what works in reducing health inequalities and influencing underlying causes, so the analyses are not a complete, evidence-based guide to the best ways of reducing health inequalities.

Rather, they reflect the health inequalities outcomes described in Equally Well and the actions that Equally Well recommends based on our current understanding of the factors that influence health inequalities. Further work is required to identify intermediate outcomes relating to economic, social and physical environments that shape health inequalities and the effective actions for achieving these outcomes.

Nor do the analyses address the issue of who will benefit from the activities identified. Plans to achieve the intermediate outcomes need to consider the reach of the services provided to ensure that interventions (whether targeted or delivered to the population as a whole) improve the health of groups in greatest need.

Likewise, measures used in local performance management processes need to assess outcomes across a range of different groups. This will assist in indicating whether outcomes for the population as a whole have improved and whether health inequalities have been reduced.

How do the analyses relate to SOAs and the recent SOA Guidance?

The analyses are in the spirit of the 2009 SOA guidance. In particular, they distinguish between "above the line" outcomes suitable for inclusion in SOAs and also provide some "below the line" information for use in community planning partners´ own planning, performance management and reporting processes.

The analyses are not, however, specifically about "below the line" performance management within community planning partner organisations, for example, the HEAT targets for NHS boards. The Equally Well implementation plan indicates that further work will be required to identify shorter-term service delivery outcomes to form the basis of performance management of progress towards achieving the intermediate outcomes.

What happens next?

Scottish Government plans more work in 2009: to explore how HEAT can better reflect NHS action to reduce health inequalities, to identify local data or proxy data to measure progress against the long-term health inequalities outcomes and analyse further the potential activities and inputs of individual community planning partners that contribute to the intermediate outcomes.

The ´Equally Well´ implementation plan includes information about progress with Equally Well recommendations and support available for local activities and inputs.

Reviewed 28 July 2014

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