Terms of Reference (ToR)
Evidence Sub Group
Authors:Sara Thomas, Specialty Registrar and Judith Greenacre, Director of Health Intelligence
Owner: Judith Greenacre, Director of Health Intelligence
Date:29 August 2012 / Version:0.6
Publication/ Distribution:
- Evidence Sub Group
- Health Improvement Review Executive Delivery Team(EDT)
- Health Improvement Advisory Group members (HIAG)
- Public Health Wales website
Revision date / version / Summary of Changes / Changes marked
Review Date:
Purpose and Summary of Document:
To document the Terms of Reference (ToR) for the Evidence Sub Group. A formal task and finish group of the National Health Improvement Review.
Work Plan reference: National Health Improvement Review
1Background
At the request of the Minister for Health, Social Services and Children, Professor Sir Mansel Aylward completed a review of a number of key national health improvement programmes in 2011. One key recommendation was that consideration should be given more fully to the future direction for health improvement and the programmes across the board. The Minister has now asked Public Health Wales to undertake this work.
The purpose of the review is to fully consider the future direction for health improvement and health improvement programmes in Wales, ensuring sustainability, value for money and the delivery of priority outcomes across Wales, consistent with national policy.
The vision for and the importance given to health improvement is shown in a number of key national policy documents including “Programme for Government”, “Together for Health”, “Our Healthy Future” and “Fairer Outcomes for All”. The review will take account of these policies ensuring that they are reflected in its considerations and recommendations.
Public Health Wales’ five year strategy, NHS Wales Five Year Prevention and Promotion Programme and Local Public Health Strategic Frameworks set out more specific priorities for delivery in the short to medium term, all of which are also priorities within “Our Healthy Future”. All the frameworks highlight the following areas as key priorities:
- Physical activity
- Nutrition
- obesity
- Smoking/ tobacco
- Substance misuse (including alcohol and drugs)
- Teenage pregnancy
- Workplace health
- Accidents injuries and falls
Most frameworks also highlight:
- Vaccination and immunisation
- Mental health and wellbeing
“Our Healthy Future” also identifies six strategic themes including health and well being through the life-course and reducing inequities in health as priorities.
2Aim and objectives
The aim of the Evidence sub group of the National Health Improvement Review is, within available resources and timeframes, to provide readily available information to inform decisions to be made about the future direction of health improvement and health improvement programmes in Wales, in accordance with the requirements of the National Health Improvement Review.
The objectives of the Health Improvement Review Evidence Sub Group (HIRESG) may need to be revised once a clear method for the overall review is available.
The National Health Improvement Review Terms of Reference(version 1 27/6/2012) indicates that the review will be delivered in three phases: The objectives for the Evidence Sub Group are given in relation to these three phases
1. Scoping health improvement activity - by September 2012
The National Health Improvment Review requires this phase to develop:
• A comprehensive ‘map’ of existing programmes, interventions and
resources committed to health improvement and wellbeing activities
• A review of evidence relating to health improvement and the wider
policy context
• An economic analysis and the identification of gaps, duplication and
existing and potential capacity across the whole system
• A communications and engagement plan to ensure all stakeholders
are fully engaged and informed of developments as they evolve
Present objectives are to:
- Map relevant Welsh policy to the agreed priority areas for health improvement
- Map readily available evidence relating to health improvement for each of the public health strategic framework priority areas; identifying “effective approaches” (i.e. what has been shown to work) to improve health in these priority areas. This will also involve identifying ineffective approaches (shown not to work) and approaches where insufficient evidence of effectiveness exists.
- Align theHIR programmes to the evidence for health improvement in the priority areas. Undertake additional reviews of the evidence for specific programmes as necessary, within the resource and time available.
- Assess the programme’s approach against what is known to work and the outcomes achieved by the programme to informfuture Ministerial recommendations.
- Make the evidence obtained available to inform the health economic analysis (PBMA) of individual health improvement programmes identified.
- Flag evidence obtained in such a way that it can be easily identified to inform future strategic directions for the work across Wales e.g. life course approach, wider determinants of health.
- Advise or provide any further requests for evidence, as is possible within available time and resources
2. Development of recommendations - by December 2012
The National Health Improvment Review requires this phase to develop:
• Options for a strategic vision and delivery model
• Recommendations for the continuation, cessation or modification/
integration of individual programmes
• Recommendations on the implementation of health improvement
programmes. These will include how national
campaigns/programmes can develop more consistent and
straightforward information for the public and professionals;
clarifying the interface with UK level activity; and the effective use
of communications
Present objectives are to:
- Advise or provide any further requests for evidence, as is possible within available time and resources
3. Implementation of recommendations – by May 2013
The National Health Improvment Review requires this phase to develop:
Options for implementation setting out clear priorities, timescalesand any consultative requirements to support service transformation
• Clarification of roles and responsibilities for the commissioning anddelivery of health improvement activities in the future
• Identification of priorities for the research and knowledge agendasto ensure research and public health intelligence continue to informthe delivery of improvements in health and maximise resourcecapture into Wales from relevant funding bodies
• Proposal for a communications plan that ensures all stakeholders arefully informed of progress and that there are opportunities to continue to refine the approach in the light of experience
Present objectives are to:
- Advise or provide any further requests for evidence, as is possible within available time and resources
3Scope
The list of health improvement programmes to which the HIRESG will focus its attention will be agreed and defined by the HIR Executive Delivery Team (EDT).
The timescale and resource currently available for this review will not allow detailed literature searches or critical appraisal of published evidence for every priority area and programme. The work undertaken will therefore build on and use existing readily available evidence and reviews. Potential gaps in available evidence will be identified and addressed to the extent that available resources and competing work demands allow.
4Key Activities
Appendix A shows the revised flow diagram for providing information in relation to the first 4 objectives for the Evidence Sub Group in relation to phase 1 of the NHIR
Appendix B shows a colour coded key to give an overall grade for each programme, informed by available evidence of effectiveness of approaches.
Key tasks for the Evidence Sub Group for phase 1 of the NHIR are shown in the table below:
Task / Supporting info by / Decision by / ByAgree criteria for programme exclusion and inclusion in HIR / JW/ SAT/HH / EDT / 1 August 2012
Agree priority areas for the HIR / SAT / HH / EDT / 1 August 2012
Agree criteria to determine whether programme relates to priority area(s) / *(HI expert) / EDT
Determine which programmes fit which priority areas / SAT/HH/TK/MW / EDT / 1 August 2012
Decide how deal with programmes not linked to a priority area / SAT/HH
Agree proposed methods and evidence flow chart. Agree specific tasks for group members / ESG / EDT/ PB/JG / 8 August 2012
Test method and evidence flows through pilot (cooking bus relating to priority area of nutrition and refine method in light of lessons learned / ESG / 7/9/2012
Undertake sifting exercise to extract information on effectiveness of approaches for key priority areas / LKMS/MW / 7/9/2012
Identify those programmes for which information on approaches and methods used have been made available to ESG / LKMS /TK / MWd / ?other
Identify whether the high grade evidence initiatives identified above are currently in place in Wales? / SAT/?other
Map programmes to evidence for priority areas and identify gaps / TK / MWd /?other
Define specific , clearly focused questions to address the gaps / TK / MWd /?other
Prioritise questions to be answered by ATTRACT / * (HI expert) / JB
Undertake rapid review of evidence of wider literature / ATTRACT / MWb
Decision on how deal with programmes for which no evidence found / * (HI expert) / EDT
Assess how well programme follows what is considered an effective approach to improve health in the priority area / * (HI expert) / N/A
Assess how well the programme evaluates in terms of outcome measures (period/ output etc.) / * (HI expert) / N/A
Identify programmes for PBMA / * (HI expert) / EDT
5Timescales
The entire health improvement review must be completed by December 2012 in order that the Minister maybe advised on future funding arrangements regarding Health Improvement in Wales.
In order to deliver the review to these timescales the evidence sub group will need to make its work available to inform the health economic analysis(PBMA) at as early an opportunity as possible. Further evidence required by the HIR will need to be scoped and prioritised within available resources and competing demands for evidence. Whilst the Evidence sub group will make every effort to meet requests for further information from the economic sub group, the EDT may need to agree relative priorities where timescales cannot be met within existing resources
6Membership
Name / Role / OrganisationJudith Greenacre / Chair of Group and oversight of resource requirements / Public Health Wales
Sara Thomas / Support & liaison with health economic subgroup / Public Health Wales
Teri Knight / Health Improvement & evidence synthesis expertise / Public Health Wales
Dinah Roberts / Evidence mapping / LKMS
Mary Webb / Evidence mapping and rapid reviews / Public Health Wales
John Brassey / Rapid reviews / Attract, Public Health Wales
7Dependencies & Constraints
The objectives of the Health Improvement Review Evidence Sub Group (HIRESG) may need to be revised once a clear method for the overall review is available.
Outside of the Evidence Sub Group, the NHIR lead has also asked theHealth Promotion Library to look at some international comparisons - no additional details known.
The successful delivery of the Evidence sub group objectives is subject to the following dependencies and constraints:
- Resource/ skills constraints
- Agreement on the programmes to be reviewed
- Agreement on the overall review project structure, method and information requirements
- Timescale for delivery – full literature reviews for each programme will not be possible. Any changes proposed may require a phased approach.
- Continuity of political / policy context
8Governance Arrangements
As part of the overarching programme methodology being used to govern the Health Improvement review the sub group will adhere to the principles of Managing Successful Programmes (MSP) methodology.
The sub group lead shall report to the EDT on a monthly basis.
Public Health Wales Strategic Programme Director (Helen Howson) will be the overall operational lead for the Health Improvement review and will be supported by the Programme manager (Jonathan Watts) who collectively will ensure the ongoing integrity of review.
Dr Peter Bradley shall be the senior responsible owner (SRO) for the review.
Appendix A: key questions and evidence flow chart relating to phase 1 objectives 1 to 4
Appendix B: key to proposed evidence informed classification of programmes in relation to key questions
Date:30 August 2012 / Version:0.6 / Page: 1 of 11