Scottish Government

CHAPTER 1: BACKGROUND TO THE REVIEW

Summary

Introduction

1.1 The Scottish Government's Public Health and Wellbeing Directorate commissioned York Health Economics Consortium ( YHEC) to undertake an external review of 'Partnership Action on Tobacco and Health' ( PATH) during the autumn of 2007. PATH is a national initiative involving 5 key partners:

• The Scottish Executive (subsequently renamed The Scottish Government); ¹
• NHS Scotland;
• NHS Health Scotland;
• ASH (Action in Smoking and Health) Scotland;
• COSLA (Convention of Scottish Local Authorities).

1.2 The review of PATH is part of the rolling programme of external reviews of agencies and organisations in receipt of major recurring grants of £100,000 or more at 6-year intervals. Such reviews are required under the Scottish Compact of Good Practice Guide Advice on SE relations with the voluntary sector. ²

1.3 PATH is funded by the Scottish Government and based within, and managed by, ASH Scotland. ASH Scotland is the leading voluntary organisation in tobacco control in Scotland. ³ It became an autonomous national organisation in 1993, with the purpose of enhancing "the quality of life for all by having a tobacco free Scotland". This stand-alone review is closely linked to the simultaneous external review of ASH Scotland which was commissioned separately. ⁴

What is PATH?

1.4 Set up in June 2002, PATH's central aim is to reduce the number of people that smoke in Scotland. Now entering the latter stages of its second phase of funding and work (i.e. from April 2005 to September 2008), PATH is at the forefront of a nationally co-ordinated, evidence-based and consistent approach to tobacco control in Scotland and supports the implementation of national and local tobacco control activity.

1.5 PATH has taken a lead in a number of key developments to roll out and enhance evidence of good practice for Smoking Cessation Services across areas of training, data collection, evaluation, prevention and cessation. Its remit is to maximise the impact of significantly increased investment in smoking cessation and prevention in Scotland by leading a number of key developments, including:

• Designing and delivering a standards-based national tobacco training strategy, including delivery of a programme of academically-accredited courses to smoking cessation counsellors, health professionals and staff working with tobacco control issues;
• Developing and supporting a national system for monitoring, evaluating and researching the effectiveness, quality and reach of smoking cessation work and facilitating data collection and supporting performance assessment arrangements on tobacco control work;
• Managing the distribution and evaluation of a £1m national Support Fund to explore new approaches to tobacco work amongst priority groups, disseminating and building upon the findings;
• Promoting best practice in smoking cessation and prevention work with disadvantaged groups through a programme of development and dissemination aimed at identifying needs, communicating the evidence-base and strengthening capacity;
• Promoting best practice in smoking cessation and prevention work with young people through a programme of development and dissemination aimed at identifying needs, communicating the evidence-base and strengthening capacity. ⁵

1.6 This work falls into three broad areas:

• Training and development;
• Data collection and monitoring;
• Supporting research to explore new approaches to identifying and promoting best practice in smoking cessation and prevention work with identified priority groups.

1.7 The key proposed outcomes for Phase 2, which comprise short-term outcomes to be achieved by mid 2006 and selected longer-term outcomes for mid-2008, are presented in Annex A. These are taken from an annex in a document prepared by the Tobacco Control Division of

the Scottish Executive Health Department ( SEHD) in June 2005 which was sent to Ministers to secure the funding for Phase 2. ⁶ The SEHD annex concludes with some outline options for the period after this phase of funding; these are also included in Annex A.

1.8 The SEHD annex also states that the high level outcome for Phase 2 of PATH ("Building on Success") is:

"To increase the existing cost-effectiveness of smoking cessation by providing centralised, co-ordinated, evidence-based support".

1.9 PATH developed an Action Plan to March 2008 (see footnote 5). This document identifies the strategic objectives for each of PATH's five workstreams (see paragraph 1.5) and describes what had already been done to date to meet these objectives. It then presents an Action Plan, with approximate timescales for achievement, for each of these workstreams. Further details are provided in Annex B.

1.10 Key partners, experts and professionals in the health and tobacco control field help to inform PATH's work through Working Groups and extensive consultations. PATH also has a multi-agency Advisory Group drawn from the five partnership organisations (see paragraph 1.1) and representatives from the Scottish Tobacco Control Alliance ( STCA) ⁷ and the Scottish Health Promotion Managers Group to provide support and guidance as work evolves.

Aims and objectives of the PATH review

1.11 The aims and objectives of the PATH review are to:

• Take stock of the key achievements made to date by PATH and the contribution made by the key partnership organisations represented on its Advisory Group, including with key stakeholders in the tobacco control and wider health improvement field;
• Assess PATH's performance in providing value for money in delivering the key outcomes ⁸ agreed in June 2005;
• Make recommendations about the future direction of the activities supported under PATH, including exploring exit strategies; the scope for integration of key aspects within ASH Scotland or other appropriate agencies; and the issue of sustainability when Phase 2 comes to an end in 2008.

Structure of the report

1.12 This report comprises ten sections. This chapter (Chapter 1) provides some background to the review. An outline of the methodology used to carry out the review is presented in Chapter 2, and Chapter 3 places PATH in context by considering Scottish smoking rates and national policy documents.

1.13 The next four Chapters consider different aspects of PATH's remit, namely:

• Training and development - accredited courses ( Chapter 4);
• Training and development - approved courses ( Chapter 5);
• Data collection and monitoring ( Chapter 6);
• Supported projects ( Chapter 7).

1.14 Other feedback from stakeholders on PATH and the future delivery of its work are presented in Chapter 8. Chapter 9 considers whether PATH provides value for money and Chapter 10 summarises PATH's performance against its three broad aims and objectives, presents the recommendations from the review, and closes with some overall conclusions.