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Sunday, March 15, 2009

Value for money

The Sunday Times reports on a report by the House of Commons' health select committee, which has accused Ministers of spending vast sums of money on "ineffective and possibly damaging" interventions which they hope will force lifestyle changes on the public, without carrying out elementary research to see if the programmes make any difference.

The paper quotes Labour committee chairman Kevin Barron as saying that MPs were shocked by the Government's failure to collect any meaningful evidence about whether dozens of schemes to promote healthy habits made any difference before they were introduced across the nation:

The inquiry says projects were designed so badly that it was impossible for them to be properly evaluated, reporting the views of one expert that documents which passed for research often amounted to "little more than propaganda".

It concludes that ministers have "spent large sums of money on social experiments to reduce health inequalities – but we do not know whether these experiments have worked or whether the money has been well spent."

The Committee goes on to list these failed experiments at length:

Dozens of schemes were critiqued in the report. They include the £3bn Sure Start project launched in 1998 to provide one-stop childcare, educational, medical and social help for the poorest young families, and later expanded to all social groups, despite doubts about whether the initiative was effective.

Other projects include Healthy Schools, a multi-billion initiative to promote healthy eating and exercise to children, an 'expert patient' programme to teach people how to manage chronic illnesses, and most recently, £30 million pumped into creating "Healthy Towns" which promote exercise.

More than 10 years since many of the projects were introduced, there is little proof they are working, the report says.

The MPs warn: "More public money must not be wasted on ineffective and possibly damaging interventions" but say one of the latest Government initiatives, Healthy Towns, already appears to be repeating the same mistakes.

In November, ten areas were promised millions to develop cycling, walking, healthy eating and green spaces as part of an anti-obesity drive.

Their experiments will include a "loyalty card" which rewards people for going to keep-fit classes, weight-loss clubs or going for a run.

The scheme being tried in Manchester will give people points which could be redeemed for food, sports equipment or gym sessions.

Because the money was given to 10 areas which drew up the most impressive bids, rather than a random selection of towns, it will never be possible to determine whether the £30 million scheme works, or whether the areas were already more likely than others to succeed in efforts to combat obesity, the report warns.

Nevertheless, if the pilots appear to succeed, they are likely to form the basis of a national programme.

MPs also accuse the Government of "appalling" failures to take actions which it says would improve the health of most Britons.

The report attacks ministers for "continuing to procrastinate" about whether or not to introduce traffic light labelling to inform consumers about how healthy each product is, and criticises the NHS for paying GPs for simply identifying their patients as smokers, regardless of whether they do anything to persuade them to give up.

Despite a Government target set in 2002 to reduce health inequalities by 10 per cent by 2010 the gap has widened – by 4 per cent for men and 11 per cent for women.

I suspect that the Welsh Assembly has similar problems. What evaluation is being carried out for example to determine whether the money being spent on free swimming, free school breakfasts and free prescriptions is having the desired effect? Can we be certain that the hundreds of millions of pounds spent over the last few years on the Communities First programme has had the desired effect of lifting communities out of poverty?

Important as the Home Energy Efficiency Scheme is, it was determined as long ago as 2006 that only one in three of those being helped were actually fuel poor and yet nothing has been done to restructure the scheme.

Government Ministers in both administrations are keen to keep repeating that they are 'evidence-led'. Alas, the evidence points to a contrary conclusion.
with a general election in June now a very strong possibility, we can discuss these matters at the hustings:)
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