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CHAPTER FOUR RESEARCH FINDINGS: VALUE FOR MONEY

Summary

ASH Scotland's performance in providing value for money in relation to the funding made available by the Scottish Government was examined by considering:

• the potential economic benefits of the Smoking, Health and Social Care (Scotland) Act 2005
• the impact and effectiveness of specific initiatives and projects
• the effectiveness and value for money of ASH Scotland's external communications
• the added value gained through partnership working
• the internal effectiveness of ASH Scotland

ASH Scotland's specific role in contributing to the development and implementation of tobacco control policy in Scotland, and in particular the Tobacco Action Plan, is considered in Chapter 5. Since a number of organisations and individuals were involved in taking forward tobacco control policy, it is difficult to establish evidence which isolates ASH Scotland's distinct contribution. The review team therefore made use of stakeholder views.

Notwithstanding these caveats, the outcome from the review's interviews allowed the team to conclude that ASH Scotland provided VFM in respect of financial support from the Scottish Government in the 3 year funding period 2004-07, in terms of delivery of the objectives and priorities set out in ASH Scotland's strategic plan.

Introduction

4.1 The Scottish Government's funding of ASH Scotland - both core funding and that for specific projects and initiatives - was not tied to detailed specific expected measurable outcomes. Rather, it was a contribution towards ASH Scotland's work in areas which took forward the Scottish Government's policy objectives. The core grant, which was the main focus of this review, is awarded under Section 16B of the NHS (Scotland) Act 1978, as amended, to national voluntary organisations engaged in health initiatives in Scotland, complementary to those required by statute. These grants can contribute towards the administrative costs of running organisations' headquarters and, occasionally, fund specific innovative projects and capital needs. One of the main criteria by which applications for grants under Section 16B are assessed is the degree to which the applicant's aims and objectives relate to, and complement, current policies in the provision of health care, and in improving the overall health of the country.

4.2 Paragraphs 6.10 - 6.13 in Chapter 6 explain how the Scottish Government's grant funding to ASH Scotland was linked to pre-agreed performance outputs and outcomes, and the systems for performance reporting which were in place.

4.3 ASH Scotland's specific role in contributing to the development and implementation of tobacco control policy in Scotland, and in particular the Tobacco Action Plan, is considered in Chapter 5. Since a number of organisations and individuals were involved in taking forward tobacco control policy, it is difficult to establish evidence which isolates ASH Scotland's distinct contribution. The review team therefore made use of stakeholder views, elicited through the stakeholder survey.

4.4 In order to assess ASH Scotland's performance in providing value for money in relation to the funding made available by the Scottish Government, the review team has considered a number of factors. These inform a view on its contribution to improving the overall health of the country and how effectively it has operated:

• potential economic benefits of the SHSC (Scotland) Act 2005
• impact and effectiveness of specific initiatives and projects
• effectiveness and value for money of ASH Scotland's external communications
• added value gained through partnership working
• internal effectiveness of ASH Scotland

The potential economic benefits of the ban on smoking in public places

4.5 Several stakeholders, in particular those from public health and the voluntary sectors, mentioned the potential economic gains, especially for the health service, of the ban on smoking in public places. Others mentioned the cost benefits to employers through the reduction in sickness absence from smoking-related illnesses. As one voluntary sector stakeholder put it, "in the long run, we are, after all, saving money to the NHS and we shouldn't forget that".

4.6 Another public health stakeholder said: "We don't yet know what the real cost benefits to the health service will be, but there certainly will be savings".

4.7 It has not been possible to be exact about the extent of ASH Scotland's contribution to the passing of legislation to ban smoking in public places. However, the review team considered it valid to include some data on the predicted economic gains of the ban in order to reflect the potential savings to which ASH have undoubtedly contributed through their work. This data is derived from the report "International Review of the Health and Economic Impact of the Regulation of Smoking in Public Places" (Ludbrook et al, 2005) ¹⁴.

4.8 The report estimates between £5,318,000 and £11,525,000 in NHS treatment cost savings (at 2003 prices) in Scotland in respect of lung cancer, coronary heart disease ( CHD), stroke and respiratory disease. These figures have an inbuilt assumption that the gains may take 10 - 30 years to realise.

4.9 In relation to productivity losses due to sickness absence, the report gives estimated losses for asthma and CHD. For heart disease, the highest estimated loss is £4,126,000. The figure for asthma was estimated as £1,039,000, giving a total for the high estimate of £5,165,000. The report once again assumes that it may be between 10 and 30 years before the benefits are realised.

The impact and effectiveness of specific initiatives and projects

4.10 This section considers the ASH Scotland Information Service, the Scottish Tobacco Control Alliance ( STCA), the Tobacco and Inequalities Project, Partnership Action on Tobacco and Health ( PATH) and the Local Tobacco Alliances Project.

The ASH Scotland Information Service

4.11 The ASH Scotland Information Service exists to provide expert information and advice on all aspects of tobacco in Scotland. It provides:

• an information database
• a library collection, categorised according to ASH Scotland's own specialist classification scheme
• an enquiry service - which aims to provide an answer within 3 days and normally does so in one day
• briefings
• statistics
• policy papers and reports
• research articles
• daily or weekly round-up ASH Scotland bulletins
• monthly library update bulletin

4.12 The ASH Scotland Information Service is moving away from print copies and aims to provide most of its information online; however it will provide a single print copy of any of its web-based factsheets or briefing papers to anyone in Scotland, free of charge.

4.13 The ASH Scotland Information Service is regarded as being at the heart of ASH Scotland: it has built up and developed an evidence base and research to underpin policy. This view is validated by responses in the stakeholder survey, such as "a huge resource" and "the foundation of ASH Scotland".

4.14 The case study on the SHSC (Scotland) Act (See Table 5-2) demonstrates the views of political stakeholders on the important role of the evidence base. Other stakeholders also commented on the way in which the evidence provided ballast to the campaign, for instance, one political stakeholder said:

" ASH Scotland provided the voice of reason behind the ban. To anyone who was posing the questions about why, the nanny state, damaging business etc - whether a

supporter or a detractor - ASH Scotland was the authoritative voice on why we were doing it and sought to get that message across wherever possible."

4.15 ASH Scotland's evidence to the Scottish Parliament Health Committee during its examination of the Bill was quoted approvingly 3 times in the Committee's report ¹⁵.

4.16 In the run-up to implementation of the Act, ASH Scotland took the lead in producing joint sector-specific guidance for the NHS and local authorities; it also covered the non-statutory care sector.

4.17 The quality of the report "Reducing Smoking and Tobacco-related Harm" ( NHS Health Scotland & ASH Scotland, 2004) produced jointly by ASH Scotland and NHS Health Scotland was cited by a number of stakeholders as a critical foundation in moving forward tobacco control in general and the campaign for smoke free public places in particular. A public health stakeholder commented that it was " a treasure trove of material for anyone saying anything on tobacco in Scotland". The report was informed by literature searches and specific enquiries carried out by the ASH Scotland Information Service.

4.18 Examples of the use of the ASH Scotland Information Service by other stakeholders are given below, using comments given in the stakeholder survey.

4.19 One public health stakeholder commented of the ASH Scotland Information Service: "Anything specific, I would ask them directly and generally they'd be able to provide it".

4.20 Another stakeholder in the academic/research community said:

"Yes, they provide me with the information that I need for my work. I take it for granted… if I need statistics or to answer a query, ASH Scotland is one of my first

ports of call. They're an excellent source and can come up with stuff in a hurry if it's needed."

4.21 A third stakeholder within a professional/trade union/umbrella body had used the ASH Scotland Information Service when writing briefings or speeches which touched on tobacco control issues: "They could always give me statistics to back up the argument, or point me in the right direction".

4.22 Enquiries to the ASH Scotland Information Service are received from the Scottish Government: 15 enquiries were recorded in 2006 and 7 in the first 8 months of 2007; however this is thought to reflect significant under-recording since they can be routed via ASH Scotland staff outwith the ASH Scotland Information Service and thus recorded as internal enquiries. It would be useful for ASH Scotland to implement a system to capture the true extent of the use of the service by the Scottish Government and other statutory agencies.

4.23 Examples of the use of the ASH Scotland Information Service by the Scottish Government are:

• an update on the economic impact of the Scottish legislation using reports from media and business sources
• a short briefing detailing the differences between the Scottish and English legislation on smoke-free public places, produced at the suggestion of the Scottish Government stakeholders group on implementation; such briefings are typically 2-4 pages in length and referenced

4.24 The ASH Scotland weekly bulletin is customised by the Alliances Manager to produce the STCA bulletin. This involves the addition of reports from STCA meetings, relevant planning documents etc, plus any updates submitted by STCA members.

4.25 The STCA bulletin appears to be a particularly valued product. Two public health stakeholders separately described the STCA bulletin as follows:

"The STCA Bulletin is brilliant and contains a mine of information. It makes you feel you are up to date - it must be an enormous piece of work but the content is great and it is invaluable."

" The STCA Bulletin is brilliant. I always go through it when it arrives and it keeps me up to date generally as well as informing me of things I might want to do."

4.26 Another said: "The STCA Bulletin is very useful and it's impressive that it's produced weekly; though I can't always do it justice, because of time constraints".

4.27 The ASH Scotland Information Service periodically surveys recipients of the ASH Scotland bulletin in order to ensure that it is meeting the needs of users.

4.28 The ASH Scotland Information Service is also responsible for the content of the ASH Scotland website. The "Resources for Young People" section of the website gathers links to interactive sites targeting this group.

4.29 The Tobacco Information Service is a separate website that was designed in order to develop new audiences by providing the best possible gateway to smoking and tobacco-related information in Scotland. It is a partnership comprising ASH Scotland, Information Services Division ( ISD) Scotland (part of NHS National Services Scotland), NHS Scotland e-library, NHS Health Scotland, The Centre for Tobacco Control Research at the Institute for Social Marketing and the British Medical Association ( BMA) Tobacco Control Resource Centre. The BMA was a founding member of the partnership.

4.30 The funding for the ASH Scotland Information Service comes 50% from the British Heart Foundation and 50% from the Scottish Government. It is staffed by two Information Officers who both hold professional library & information science qualifications. This is reflected in the professionalism of the service which both underpins ASH Scotland's work and also provides a beacon service of national tobacco information.

Synergy between Information and Communications

4.31 There is an important synergy between the work of the ASH Scotland Information Service and the organisation's campaigning work; indeed there is a substantial overlap between communications and evidence in the task of seeking to influence the development of government policy (whether at Scottish, United Kingdom ( UK) or European Union ( EU) levels). Responding to consultations, for example, combines the provision of information with making the case for the efficacy of a particular policy approach or instrument. Two recent illustrations are the work of the Senior Policy and Research Officer on producing a detailed briefing and a draft consultation document for discussion in mid September, regarding a positive licensing scheme for tobacco; and the Research and Evaluation Officer has been currently working on compiling a response to the EU consultation on smokeless tobacco ¹⁶.

Scottish Tobacco Control Alliance ( STCA)

4.32 The STCA brings together representatives from most local authorities, health boards and universities, royal colleges and other professional bodies, government agencies, healthy living centres and health improvement projects, drug action teams, health charities and organisations tackling inequalities.

4.33 The STCA's current strategic plan gives as its aims:

• to engage in efforts to influence tobacco policies and the strategy for tobacco control in Scotland
• to support and encourage the formation of local tobacco control alliances and provide encouragement and support to existing local tobacco control alliances
• to provide ongoing opportunities for information exchange at a national level and provide educational events that help to skill the membership
• to support a range of STCA topic groups to meet the needs of the membership
• to increase awareness of STCA activity within the Scottish Tobacco Control Community, recruit, broaden the membership and involve new members in the STCA
• to ensure that STCA members have ongoing opportunities to influence STCA structure, activities, policy priorities, and other organisational concerns
• to evaluate the activities and functioning of the STCA

Feedback from stakeholders regarding STCA

4.34 Two senior public health sector stakeholders gave the following opinions on STCA.

One reflecting on the major successes of ASH Scotland:

"The central role that they take in the coordination of tobacco related activity. It drives forward the activity. STCA as a structure has been incredibly successful - information sharing and networking."

4.35 Another stated: " STCA is very important - its bulletin and communications maintain everyone informed [sic] ".

4.36 A further stakeholder highlighted the importance of the consultation exercise which was conducted prior to STCA being set up:

"An important factor was that relevant people were consulted about the need for an alliance and what it would look like. So, the alliance was built on what key players felt was needed and what they felt it should do."

4.37 From the point of view of Scottish Government: "We needed to be able to say with evidence that this was the view of people in the tobacco field and hence the need for an alliance - the STCA".

The Tobacco and Inequalities Project

4.38 Work on tobacco and inequalities has been an ongoing core activity for ASH Scotland dating back to the Women, Low Income and Smoking Project which began in 1996.

4.39 The more recent Tobacco and Inequalities (T&I) Project was a national community development project that aimed to develop capacity and sustainability, as well as challenging and changing practice and policy. The three initial target areas for the project were:

• mental health and well-being
• black and minority ethnic communities
• older adults

4.40 The aims of the third phase of the T&I Project (2003-07) were:

• to raise awareness of the issues and inequalities some communities across Scotland face in relation to tobacco and health
• to establish good practice that can be disseminated and implemented across Scotland
• to raise awareness, challenge preconceptions, and stimulate positive change in policy and practice
• to form partnerships that will increase capacity, maximise sustainability and keep tobacco and inequalities issues high on local and national agendas

4.41 Specific recommendations and objectives, identified through previous inequalities work led by ASH Scotland and a needs assessment, were set for each of the 3 target areas.

4.42 The Tobacco and Inequalities Needs Assessment was undertaken between 2003 and 2004 and helped to inform the current phase of the Tobacco and Inequalities Initiative. The aim of the tobacco and inequalities needs assessment was to "investigate and facilitate service development and delivery appropriate to black and minority ethnic communities, older adults and people with mental health difficulties"^iv.

4.43 To help build a profile of the 3 target areas information was gathered on existing evidence, research, service provision and resources as well as the beliefs, perceptions and attitudes to smoking and stopping smoking of the target groups and service providers.

4.44 The needs assessment identified a series of gaps, and recommendations were made for future work to target the three themes across areas such as:

• service provision
• training
• resources
• information
• awareness raising
• development of culturally attuned and sensitive services

4.45 The T&I Project was also responsible for the dissemination of a Small Grant Fund of around £220,000. The grant led to the allocation of 25 grants to 21 organisations with a wide geographical spread.

4.46 External stakeholders whose organisations have been involved in the T&I projects reported successes (some relative) and pointed to some challenges. One commented:

"We felt that [our users] were one area of the population that had been traditionally ignored. Smoking was used as a reward or a punishment. Physical illnesses were high as a result, as were the financial costs. We needed the support mechanisms to be in place and we could provide these."

4.47 Another, remarking on the successes of their T&I project said:

"The number of people who gave up. The number of people who cut down. The key factors were creating the right environment at the right time because of smoking in public places."

4.48 A Scottish Prison Service stakeholder commented that the delivery of smoking cessation through trained peers in prisons "was a huge success and offered careers opportunities to prisoners".

4.49 One stakeholder, on the subject of the T&I Small Grants funded projects, said:

"Giving small amounts of money to organisations doesn't work. Only organisations which receive larger sums can achieve something."

4.50 An internal stakeholder reported that the T&I pilot projects "in reality had just scratched the surface because they were one year projects" and that "mental health moved along but for BME communities, it was more difficult to engage with partners".

4.51 On the other hand, an ASH Scotland stakeholder felt it important to recognise that, whilst "people probably wanted to see higher cessation rates [from the T&I projects], dependency is a complex issue".

4.52 ASH Scotland recognises that there have been some issues around its T&I work, such as, for instance, the continuity and impact of its work in respect of young people, in part because of the turnover of staff who have occupied the Youth Development post in the organisation. However, the Youth Forum has met 3 times since the appointment of the current postholder and has a growing membership.

4.53 Although the third phase of the T&I Project has now ended, ASH Scotland has begun work to future plan its inequalities work. Such work is seen by both itself and external stakeholders as an important aspect of future development. They report that they already have plans to further develop work on mental health and explore opportunities with migrant workers and the Lesbian, Gay, Bisexual and Transgendered ( LGBT) communities. The recent evaluation of the T&I Small Grants Funded Projects will also inform future developments.

Partnership Action on Tobacco and Health ( PATH)

4.54 PATH is managed by ASH Scotland and has as its aim to reduce the number of people in Scotland who smoke.

4.55 As has been noted in the introduction, PATH is the subject of separate external review and, therefore, this review has not focussed on its performance. However, it was felt important to include here the most significant points emerging from this research, gathered from the stakeholder survey. These relate to the training standards for smoking cessation and the training modules arising from these. The detail of this is contained in Section 5 of the report, paragraphs 5.34 - 5.35.

4.56 The issues raised in respect of the accredited training modules do pose questions about value for money. Health Board stakeholders reported that:

• training took too long to complete
• they still sent staff outside Scotland to undertake what they considered to be a more cost-effective training, whereby a course to qualify to undertake group cessation work could be completed in one day
• they still bought in (expensive) training from elsewhere to achieve staff training targets

4.57 Notwithstanding those criticisms, stakeholders' feedback was that better coordination with Health Boards and a working group to look at future planning of training may well resolve these issues. This feedback was shared with the team undertaking the full evaluation of PATH.

4.58 The establishment of training standards, the accreditation of the training, the evidence base of PATH and the professional calibre of its staff were cited by stakeholders as strengths.

The Local Tobacco Control Alliances Project

4.59 The Local Tobacco Control Alliances Project has been developed by ASH Scotland to support the development and activities of local alliances working on or with a strong interest in tobacco control in Scotland. Its aim is to facilitate information sharing and good practice on communication and implementation of Scotland's Tobacco Control Action Plan "A Breath of Fresh Air for Scotland" (Scottish Executive, 2004) ¹⁷.

4.60 It was the view of stakeholders that the alliances clearly had the potential to bring added value to delivery at a local level by bringing together key players and avoiding duplication of resources and effort, as well as facilitating a focus on hard to reach groups, such as young people, through existing services that the communities already accessed. As one public health stakeholder put it:

"The alliances can give us the capacity to plan well at a local level, to make sure that we are working together and not all trying to do the same thing separately. They can help us learn from each other and from good practice and work out effective ways of targeting the most difficult groups to reach."

4.61 In respect of young people, who were, throughout the research, consistently highlighted as a key target group, an internal stakeholder said:

"Every Local Tobacco Alliance Plan should have a young people's section in it…We want to develop guidelines for developing services for young people."

4.62 In October 2007, NHS Health Scotland and ASH Scotland produced a briefing paper "Designing and Delivering Smoking Cessation Services to Young People: Lessons from the Pilot Programme in Scotland" ( NHS Scotland & ASH Scotland, 2007) ¹⁸ on designing and delivering smoking cessation services to young people which summarises the key lessons from the Young People and Smoking Cessation Pilot Programme. This briefing will be available to assist local alliances in their work.

The effectiveness and value for money of ASH Scotland's external communications

4.63 Notwithstanding the value of ASH Scotland's evidence base, effective communications are an essential ingredient in achieving external impact. They also affect the sustainability and internal effectiveness of the organisation, for example its capacity to make a case for receiving and continuing to receive funding and support, its ability to develop a strong membership base, and its functioning as a corporate team.

Communications Evaluation Tool

4.64 The analysis of ASH Scotland's communications function was facilitated by the Communications Evaluation Tool, compiled by The Saren Dixon Partnership for the purposes of this research, which is attached as Annex 4. In general it indicated that ASH Scotland is operating very effectively in relation to external communications; the majority of stakeholder opinion validated this conclusion.

4.65 Some particular points of interest which emerged from the use of the evaluation tool are:

Target audiences - the Tobacco Information Service website was designed specifically to develop new audiences and has demonstrated success in doing so. There is a continual need for any organisation to review its definition of target audiences and to ensure that it is "thinking out of the box" about who these are.

Key messages - There is some tension between the precision of the traditional language of research/academia and the imperative of communications to derive a simplified, clear message. The detail and caveats which provide evidence of accuracy in the former can look like a muddying of the message in the latter. It is important for ASH Scotland to recognise this inherent tension and to continue to produce materials which are tailored for their specific audience and specific purpose.

Evaluation measures - whilst there was a lack of baselines and measures to facilitate an evaluation of impact in ASH Scotland's communications strategy, one should acknowledge that for a small organisation there is a balance to be struck between the effort required to put these in place and the value of the results. In respect of media monitoring, for example, a conscious decision had been taken to maintain an in-house database logging media coverage, but not to go to the expense of commissioning external monitoring of impact measures (which are in themselves imperfect). This is entirely reasonable.

Communications methods - ASH Scotland had recognised that it is not currently making best use of its website and this was under review. The strength of the ASH Scotland brand and profile means that the website may well attract users who believe that it is a direct service provider/adviser to smokers and the public. It therefore provides an important opportunity for signposting and links and its front page should be designed to avoid being off-putting to such potential users.

Communications Budget

4.66 There is no dedicated communications budget within ASH Scotland and the vast bulk of resource input is staff time. There is a publications budget within the Information Service - hence 50% funded by the British Heart Foundation ( BHF) - which covers items such as publicity for conferences, leaflets etc. The supporters' newsletter and bulletins are produced in-house, in both design and content terms. There are budget headings for the AGM and Annual Report which can carry external costs such as a photographer. Media monitoring is done in-house by the Information Service.

4.67 ASH Scotland argues convincingly that its work through coalitions and partnerships has enabled it to implement an effective communications strategy by attracting resources from elsewhere, and hence enhancing VFM. It is recommended that ASH Scotland considers the costs of the communications requirements of the fundraising strategy and makes any necessary budgetary provision.

Public and Media Relations

4.68 As stated in paragraph 4.65 above, target audiences is an area that needs to be under continual review. ASH Scotland will need to consider its range of audiences once the strategic priorities in the 2007-10 Strategic Plan are finalised. For example, it is recommended that ASH Scotland specifically review its target audiences to ensure that they fit with the fundraising strategy.

4.69 A database is maintained to collect the extent of media coverage. The decision not to attempt to measure or collect local media coverage is a reasonable decision on resource grounds (see section on evaluation measures in paragraph 4.65).

4.70 ASH Scotland is in the process of extending the distribution of Unfiltered News, making greater use of e-mail, and reviewing frequency. The publication has been redesigned for greater visual impact.

Corporate Image

4.71 In response to feedback gathered during the consultation on the 2004-09 Strategic Plan, ASH Scotland decided it required an updated branding which would:

• give ASH Scotland a clear and recognisable corporate identity
• clarify the relationship between ASH Scotland and the various projects/initiatives that are managed or co-ordinated through the organisation

4.72 This was one of the main development areas identified in the strategic review of the organisation. ASH Scotland brought in designers to assist with this task, which included the ASH Scotland logo, templates to enable combinations producing a consistent corporate image, the Annual Report, published Strategic Plan, website and stationery.

4.73 Since then, ASH Scotland has also simplified the relationship with partners by rebranding the Scottish Cancer Coalition on Tobacco ( SCCOT^v) as the Scottish Coalition on Tobacco ( SCOT) in November 2004; and amalgamating it with Scotland CAN! into one umbrella coalition. This united body has the broader focus of raising public awareness of the links between smoking and a range of diseases, including for example heart disease as well as cancer. Scotland CAN! is a subsidiary structure, serving as a media arm and public profile for the smoke-free public places legislation and its implementation.

The added value gained through partnership working

4.74 ASH Scotland has a wide network of relationships with external organisations. It has also formed, promoted and serviced a number of alliances of different organisations, ranging from temporary alliances over specific issues, such as that with children's charities over test purchasing arrangements, to permanent standing alliances such as the STCA and the Cross Party Group.

4.75 One of ASH Scotland's stated objectives is partnership working:

"We cannot deliver our work in isolation. We believe that the most effective way to take forward the tobacco control agenda in Scotland is to work in partnership with key stakeholders, including:

• Parliament and governments (local, Scottish, UK, EU and international levels)

• Alliances and coalition partners
• National Health Service Scotland
• Trade unions
• The media
• Charities and voluntary sector organisations" ( ASH Scotland, 2004)¹⁹

4.76 Since 1999, ASH Scotland has established or been involved in establishing:

• Scottish Cancer Coalition on Tobacco ( SCCOT)
• Scotland CAN!
• SCOT (bringing together SCCOT and Scotland CAN!)
• Cross Party Group on Tobacco Control
• Scottish Tobacco Control Alliance ( STCA)

4.77 Annex 5 contains more information about the above alliances, including their aims and objectives and their membership.

4.78 In addition to national alliances, ASH Scotland is active in the creation and building of local tobacco control alliances and has dedicated pages on its website which are designed to provide information and support for Local Tobacco Control Alliances across Scotland. They have a local alliances officer who works to develop and support them.

4.79 Stakeholders surveyed have resoundingly emphasised the importance of these alliances and groups at different stages in time. They have pointed to the lack of coordination before the groups came in to place and the benefits which they have derived from them. Importantly, they have highlighted as a strength that, not only did ASH Scotland identify the need for alliances and act on that, but also, in the case of the STCA, undertook a consultation that explored the need for a tobacco control alliance and the role(s) that it might have.

Stakeholders reflected that this gave added strength to the STCA.

4.80 The STCA has some 120 members from a variety of fields and its members have access to the weekly STCA Bulletin, seminars, conferences, and other opportunities for information exchange. The STCA hosts a number of topic groups including: Researchers Group, Tobacco Control Issues Group, Cessation in Pregnancy and Youth and Tobacco Forum. The STCA was particularly highlighted by stakeholders in their comments.

The internal effectiveness of ASH Scotland

4.81 ASH Scotland currently has a staff team of 27 people. The organisation was established as an autonomous body in 1993 with 5 members of staff; since then it has expanded significantly both its number of employees and the range of activities it undertakes.

4.82 During the process of strategic review commenced in late 2003, ASH Scotland identified a number of organisational issues which needed to be addressed. Many of these related to the increased size and complexity of the organisation. There were also governance aspects, such as the need to expand the capacity and expertise of the Board of Directors, and the requirement to modernise the constitution to reflect best practice and changes in company and charity law.

4.83 The organisation was restructured in 2003, creating the existing three sections each headed by a member of the Senior Management Team. The Organisation Chart current at the time of the review research (November 2007) is attached as Annex 6.

4.84 Taking account of the growth in the size and complexity of ASH Scotland, and changes in the external environment, a number of other organisational policies were reviewed in 2004:

• new financial and accounting structures and procedures were put in place
• the Advisory, Conciliation and Arbitration Service was commissioned to undertake a job evaluation and a policies and procedures manual was developed
• personnel policies were reviewed, including appraisal and support procedures, staff development and training

4.85 These changes were an appropriate response to the new internal and external environment.

Conclusion

4.86 ASH Scotland has achieved much in respect of its external impact and effectiveness to date. The overwhelming stakeholder view is that ASH Scotland contributed to the set of conditions which enabled the passage of the SHSC (Scotland) Act 2005. A summary of the data on the substantial anticipated health gain impact of this legislation in economic terms is included above. Notwithstanding the caveats expressed in this report about attribution of causation, the review team regarded it as reasonable to state that ASH Scotland had delivered value for money in respect of financial support received from the Scottish Government in the 3 year funding period 2004-07.

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