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CHAPTER SEVEN RESEARCH FINDINGS: KEY STRENGTHS AND WEAKNESSES

Summary

ASH Scotland has made a significant contribution to a period of remarkable progress on tobacco control in Scotland.

It is clearly an organisation which enjoys considerable strengths. The close working partnership between ASH Scotland and the Scottish Government in advancing tobacco control during the period of the review was regarded as a strength by the majority of stakeholders surveyed.

The organisation is now facing some challenges of success and maintaining momentum may be an issue.

There exist some issues which require addressing around internal communications, staff turnover and diversification of ASH Scotland's funding base.

Introduction

7.1 This chapter comments on strengths and weaknesses of ASH Scotland identified in the process of the review. These are examined under the headings:

• internal organisational strengths and weaknesses
• the challenges of success
• relationship between ASH Scotland and the Scottish Government
• external engagement: strengths & weaknesses
• external impact and effectiveness of ASH Scotland - impacting on the future

Internal organisational strengths and weaknesses

Human Resources

7.2 ASH Scotland offers flexible working, with flexi-time and time off in lieu ( TOIL) systems in place. A long hours working culture is not encouraged, indeed is said to be frowned upon.

7.3 As illustrated in Table 7-1, ASH Scotland experienced an atypically high rate of staff turnover in 2006-07. This was mentioned in a number of stakeholder interviews.

One public health stakeholder commented:

"We are aware of and comment on the high turnover of staff. A concern is that contacts are made and then broken. I don't know why … but people do comment about it. It must have been incredibly difficult to refocus after the legislation. How do you refocus and energise? I do know that people left on maternity leave, or to go travelling etc but it is still an issue."

7.4 Media stakeholders also mentioned the loss of established contacts due to staff turnover.

Internal communications

7.5 Internal communications were perceived by staff as an area that "didn't go so well" in their half day workshop held to feed into the strategic planning process for 2007-10 ²⁵. The issue was also mentioned by a couple of respondents in the stakeholder survey, in relation to the constraints imposed by the premises.

7.6 The Review Team is not in position to diagnose the nature of the issue - but would suggest that if is perceived as an issue by staff, then it does merit exploration.

7.7 Within the Senior Management Team, each Director has responsibility for communication about his or her own area of work, and communication within the organisation is also regarded as a responsibility of each and every staff member; however no Director has a lead role allocated for internal communications.

7.8 We recommend that the nature of the issue is scoped with the facilitation of an external consultant at a suitable opportunity; and a lead role on internal communications allocated to a member of the Senior Management Team.

Benchmark

7.9 Benchmarking is acknowledged as a useful tool in a range of areas including VFM, governance, Human Resources ( HR), training, marketing and communications, finance procedures and evaluation. It helps to identify areas where an organisation's costs are out of kilter with its peer group and enables attention to be focused on aspects where there is a significant variance from the norm. It can give new insights into best practice and how to achieve it, provide reassurance about what is working well, provide evidence to support change and help to determine priorities for action.

7.10 Since ASH Scotland is the only national voluntary organisation tackling tobacco control in Scotland, there is no immediately obvious peer organisation to use as a benchmark. Our criteria for selection were:

• Scottish voluntary organisation
• mission includes public education and the promotion of regulation/legislation in order to achieve individual and societal behaviour change
• works at both community and national levels
• probably health-related aim
• major focus on campaigning, lobbying and communications
• perceived as a well-run and effective organisation

7.11 Following discussion with the Review Steering Group, Scottish Drugs Forum was selected as a benchmark for the purposes of this review.

7.12 It proved to be impossible to carry out a comparative analysis of VFM in respect of outputs or external impact of the two organisations because of a) the lack of hard data; and b) the different policy contexts within which they are working.

7.13 The review team therefore decided to focus on three areas where data were available:

• sources of income - please see Annex 9 ^xi
• membership profile
• and a number of HR measures and indicators

Table 7-1 ASH Scotland and Scottish Drugs Forum Benchmark Information ^xii

Commentary

7.14 The staff turnover figures are of interest because this is a feature that has been commented upon in relation to ASH Scotland by stakeholders within the survey. The figures bear out the view that turnover has increased markedly since the passing of the SHSC (Scotland) Act in November 2005.

7.15 Percentages for sickness absence can be skewed in small organisations by long term sickness absence. The Scottish Drugs Forum reported that it had 2 members of staff on long term sickness absence in 2004-05 and 2 in 2005-06; without these, the figures drop to 2.5% and 2% respectively. ASH Scotland's rates of sickness absence are low: the average rate of employee absence in the non-profit sector was 3.6% of working time in 2006. ^xv.

7.16 The membership profile of the 2 organisations differs markedly in that ASH Scotland has 28 individual members and no organisations as members and SDF has 52 individual, 5 associate and 234 organisations affiliated.

7.17 This comparison leads to the following conclusions and recommendations:

• ASH Scotland's low rate of sickness absence is a strength and implies a high level of staff commitment
• ASH Scotland's atypically high level of staff turnover in 2006-07 may be a cause for concern; on the other hand it may be a natural response following a sustained period of achievement culminating in the implementation of the SHSC Act (Scotland) 2005. It could also be said that a high turnover at this stage could assist ASH Scotland to reposition itself for the new challenges ahead. It is recommended that ASH Scotland continues to monitor turnover on a quarterly basis; and continues to offer exit interviews to staff who leave the organisation and to analyse the feedback from these reviews. It may also be prudent to review opportunities for career progression within the organisation; and to be alert to any issues regarding staff morale
• ASH Scotland may also want to consider whether increasing its membership base would be a means of strengthening the organisation and capitalising on its recent high profile. For example, it could develop a strategy for increasing individual membership and explore the pros and cons of creating other membership categories, such as associate and organisational. It would of course need to weigh up the potential benefits of an increased membership base against the costs of developing and servicing it

Culture

7.18 Organisational culture can appear to be a somewhat amorphous concept but is regarded as a useful tool to analyse determinants of organisational strategies and the capacity to adapt to changes in the external environment. A strong culture is also regarded as a means of ensuring that the knowledge embedded in separate teams with discrete technical knowledge - as could be said of ASH Scotland's divisions - is shared "through substantial informal interaction among employees" with "...the idea of the strong culture as a pervasive, permeable essence that links people, both within and outside formal systems" (Jelinek and Schoonhoven, 1991) ²⁶ .

7.19 There were some interesting views expressed within the stakeholder surveys which related to different cultural paradigms. These took a number of forms. At one level, these related to the traditional clinical, evidence-based health approach, in contrast to the approaches of both social marketing and community development which seek more a more interactive process of engagement with their target group. Moves within the health service to a greater emphasis on co-production were also pointed out. Internally, 2 stakeholders mentioned the tension between the evidence-based approach to formulating messages in contrast to the communications approach.

7.20 These comments pointed to some potentially significant underlying shifts with a relevance to ASH Scotland's future strategy, and which might be expected to be expressed within the culture of the organisation.

The challenges of success

7.21 ASH Scotland appears to be facing some of the challenges of success (the external perception that smoking is now "sorted"; a reported internal dip in morale; and high staff turnover in 2006-07). It also now finds itself in a less expansive public spending environment.

7.22 The issue of momentum seems to be a common feature of both internal and external challenges:

"The lesson for the leaders of non-profits is that one has to grow with success. But one also has to make sure that one doesn't become unable to adjust. Sooner or later, growth slows down and the institution plateaus. Then it has to be able to maintain its momentum, its flexibility, its vitality and its vision. Otherwise, it becomes frozen." (Drucker, 1992) ²⁷

Further legislation and regulation?

7.23 Of the 12 political stakeholders who were interviewed, 9 expressed a view on whether there was a need for further tobacco control legislation and regulation; whether the priority was now consolidation of the culture change embodied in the Smoking, Health and Social Care (Scotland) 2005 Act by continued prevention and education alongside monitoring and enforcement of existing statutory controls; or whether both approaches should be pursued equally.

7.24 Of the 9 who expressed a view, 4 stakeholders said they saw a need for further legislation and regulation. Two of these supported further regulation of point of sale advertising and display.

7.25 Three of the 4 supported legislation to ban smoking in cars: one stakeholder on safety grounds, akin to the ban on the use of mobile phones whilst driving. The other 2 wanted a ban on smoking in cars where children are present. However both said that this was not an immediate imperative, but rather should be tackled in due course.

"I would support a ban on smoking in cars with young children; but we need a bit more time to let the effects of the ban [on smoking in public places] be gathered and bed down."

"The timing should be towards the end of the current Scottish Parliament session. That'll be about 5 years on from the ban on smoking in public places, which is a reasonable interval."

7.26 Taking into account these 2 last stakeholders, a total of 7 of the 9 political stakeholders who expressed a view did not favour further legislation/regulation in the short to medium term.

7.27 The 5 out of 9 political stakeholders who did not support further legislation and regulation tended to emphasise smoking prevention and cessation, plus the monitoring and enforcement of existing statutory controls. There was some nervousness about how seeking to go further might be perceived by the public: "it's much harder to resist the accusation of the nanny state if you do more legislating"; "you could cross the line where you get a backlash".

Relationship between ASH Scotland and the Scottish Government

7.28 ASH Scotland receives a large proportion (75-80%) of its funding from the Scottish Government and is one of three voluntary organisations which have received between £230k and £250k ^xvi under Section 16B of the National Health Service (Scotland) Act 1978. Given this situation, and the evidently very close working relationship which it has enjoyed with the Scottish Government at both a political and civil servant level, the question has been legitimately posed as to whether ASH Scotland can truly be regarded as an independent organisation.

7.29 Thirty-five of the stakeholders interviewed were from outside both ASH Scotland and the Scottish Government (including for the purposes of this analysis the Scottish Prison Service and Health Scotland as Scottish Government). Nineteen of these 35 stakeholders made comment on the relationship between ASH Scotland and the Scottish Government.

7.30 Eleven of those 19 stakeholders said that ASH Scotland was independent of the Scottish Government. 3 expressed views which were neutral on this specific point.

7.31 Five of those 19 stakeholders regarded ASH Scotland's independence as to some extent compromised. For example one public health stakeholder commented:

"It's really important that ASH has a degree of independence - that it's able to speak out and not necessarily toe the party line. I don't view ASH as totally independent, because it's funded by the Scottish Executive."

7.32 Some commentators have gone as far as to suggest that it has become an arm of the Government. A voluntary sector stakeholder said: " yes, it is an arm of the Scottish Government, but a positive arm". One stakeholder in the academic/research category stated: "Given that much of its funding comes from the taxpayer, it is difficult not to believe that ASH is little more than the executive's tobacco control agency".

7.33 A very small minority of stakeholders felt that the level of funding and close relationship lends itself to unacceptable tensions, in particular in respect of ASH Scotland's lobbying role. On the other hand, the Scottish Government has been clear that it does not fund ASH Scotland's lobbying function and, although it has described ASH Scotland as its delivery arm ^xvii sees this in the context of the Tobacco Control Plan in which ASH Scotland and PATH are designated particular roles.

7.34 The majority of stakeholders felt ASH Scotland had managed to maintain its independence and that, for instance, it worked well across all political parties. It has been pointed out by stakeholders in various fields that ASH Scotland had the advantage of being able to do what Government could not do and that it has been equally willing to challenge Government as it has been to work with it. One Scottish Government stakeholder commented: "The other side of the coin is that Government can legislate and ASH Scotland cannot".

7.35 One public health stakeholder put their view of the situation succinctly:

"We needed an organisation which was independent and which was able to take the debate away from the issue of the ban coming from the "nanny state". At the same time, ASH's independence has placed them in a position where they can argue for tobacco control whatever the political nature of the administration."

7.36 For many stakeholders, that combination of a legislator with an outside but close working partner was a benefit, not a detriment, in the period that is the subject of this research. Having said that, the climate is somewhat different for the future, and the nature of that relationship may well change as policy issues emerge on which ASH Scotland and Government diverge more significantly. Future Scottish Government funding decisions and the ability of ASH Scotland to diversify its funding base may also impinge on the relationship.

External engagement: strengths & weaknesses

7.37 Comments from half of the media stakeholders interviewed suggested that they had found the changes in their main contact within ASH Scotland (the Communications Officer) somewhat disruptive because it takes time to build up a relationship.

7.38 ASH Scotland is seen as efficient and well-organised by its media contacts and was praised for its ability to react to stories with a tobacco angle : "I can almost guarantee that if there's a story that relates to tobacco on any level, they'd comment - probably before you've even asked them".

Other relevant stakeholder views on general campaigning & lobbying

7.39 ASH Scotland could have a more sophisticated interaction with the political process of policy formation by researching and planning according to the timescales of the various political parties. One political stakeholder commented that ASH Scotland:

" followed the classic strategy of sending a letter at election time. But most progressive NGOs [Non Governmental Organisations] have come to terms with the timetable for the rolling policy process. They did a Manifesto - that's a publicity stunt rather than influencing policy."

7.40 A more complimentary view was expressed by another political stakeholder:

"Unlike some voluntary organisations, ASH Scotland understands that briefings should not be sent on the day of the debate. It engages more broadly with politicians than just on the day-to-day parliamentary business."

External impact and effectiveness of ASH Scotland - impacting on the future

An effective future direction for ASH Scotland

7.41 Stakeholders were very vocal indeed about the future direction of ASH Scotland and highlighted particularly the passing of the legislation on smoking in public places and the departure of the Chief Executive as setting a challenging scene, although not a negative one.

7.42 Stakeholders expressed concern that, with the legislation in place, the battle will be seen as having been won. This fear is not groundless; one political stakeholder, for example, said:

"The war is won in terms of what you can do with legislation. Therefore you've got to consider scaling back. As we take the big guns off the field, it's time for the sharpshooter - the more forensic approach."

7.43 Some stakeholders favoured the continuation of a whole population approach. One public health stakeholder commented:

"Only targeting inequalities is deeply conflictive. We still need a whole population approach. We need to keep our intervention going across all groups."

Another stated that:

"The evidence from Ireland is that, although smoking rates fell in the first period after the legislation there, they have begun to rise again. So we mustn't take our eye off the ball in relation to the whole population."

7.44 A stakeholder from a professional/trade union group believed: "There is still a lot to be done about almost everything to do with smoking".

7.45 The majority of stakeholders were much more inclined to favour investing funds to target the hardest to reach, even if they recognised that there remained issues to tackle in the whole population. The following were identified as the main inequalities groups to target:

• people living in the most deprived areas
• young people in general, and especially those in deprived areas where positive role models are less obvious and young women
• BME communities, some thinking in particular migrant workers
• people with mental health issues
• older people
• LGBT communities

These are largely in line with ASH Scotland's priorities for its Tobacco & Inequalities work.

7.46 One suggestion from a Scottish Government stakeholder was that consideration be given by ASH Scotland as to how the Equality Impact Assessment tool, which has been developed by the Scottish Government, might assist them in taking their inequalities work forward.

7.47 Some stakeholders working in the field with people in the above target groups felt there needed to be a word of caution about the approach. As one put it:

"We need to understand the context in which smoking takes place and not have a one size fits all approach. We need to maintain an element of choice for particular sectors of society along with support to stop which is tailor made. Consultation with [harder to reach groups] may have an educative function as well, in that consultees hear arguments which help them decide to give up."

"We need to focus on young people and look at different ways of getting the message across; we need a joined up approach of cutting off the supply (point of sale) and cessation with young people given that cessation rates amongst young people with a traditional cessation approach are so poor."

7.48 Stakeholders made a range of other points on the future work of ASH Scotland. A Scottish Government stakeholder commented:

"On smoke free, all the evidence existed. On some of the other issues which ASH want to pursue, the evidence base is not there, but we sometimes need someone to be in the forefront."

7.49 Stakeholders from the public health sector, the Scottish Government and the voluntary sector all mentioned the opportunity for ASH Scotland to become an international adviser on tobacco control issues and, thereby, possibly open up new funding opportunities.

7.50 A public health stakeholder said:

"The international agenda is now important - the tobacco companies have moved on. International sources of funding may be available for ASH Scotland to offer consultancy and expertise internationally."

7.51 In short, other points made which merit mention are:

• point of sale issues very important
• younger end of 50+ age group is important to target
• still have a huge issue of education to tackle
• need to stretch the legislation to protect professional staff who go into places where smoking is not banned through agreements with Local Authorities
• youth/community workers could be an ideal conduit for work with young people and deprived communities - need to think of new ways of getting the message across
• need to target home smokers in relation to the damage they do to others around them
• new measures need to be sensible and reasonable

Funding: the future

7.52 It has been noted in Chapter 6 that ASH Scotland is heavily reliant on the Scottish Government and to build an effective future direction, it will be necessary for it to secure funds from other sources both to generally diversify its funding base and to finance new initiatives. One suggestion has been for the organisation to seek international funding to support a potential role as an international adviser on tobacco control.

Corporate Profile

7.53 The evidence from the stakeholder survey is that the corporate profile of ASH Scotland is currently closely intertwined with the profile of the present Chief Executive (albeit that a number of stakeholders were at pains to say that they recognised that it was a team effort ^xviii).

7.54 The appointment of a new Chief Executive offers ASH Scotland an opportunity to consider whether this is the most effective way of maintaining and developing corporate profile, given the media, and perhaps general, preference for a figurehead; or whether it wants to consciously promote a number of ASH Scotland spokespeople and representatives, potentially including Board members and coalition partners as well as staff.

7.55 All in all, the stakeholder survey, the current external environment for ASH Scotland, the departure of a Chief Executive who was clearly widely respected and considered very effective, and the appointment of a new Chief Executive all point to a need for reconsideration about the organisation's future direction, whilst maintaining the evident strengths of ASH Scotland.

ASH Scotland's perception of its performance

7.56 ASH Scotland has undertaken an analysis of its recent performance in preparation for the development of its new strategic plan. It was felt appropriate to include some findings from this exercise and they are contained in Annex 10.

Conclusion

7.57 ASH Scotland has made a significant contribution to a period of remarkable progress on tobacco control in Scotland. It is clearly an organisation which enjoys considerable strengths.

7.58 At the same time, there are some challenges of success which the organisation now faces. Its staff turnover has increased substantially following the introduction of comprehensive smokefree public places legislation. There are questions raised by stakeholders about how the strength of its signature evidence base fits with the approaches required to advance work with ASH Scotland's priority target groups.

7.59 The review team has also highlighted some areas of possible weakness and sought to offer ways of addressing them. These include issues around internal communication, staff turnover and diversification of ASH Scotland's funding base.

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