A national health inequalities fund for Wales: concept, design and implementation

Abstract

Objectives: To evaluate the potential for a national innovation fund, in the context of devolved health policy, to stimulate local action to deliver national priorities, using as a case study the conception, design and implementation of the £30m Welsh Assembly Government's (WAG) Inequalities in Health Fund (IiHF) 2001-08.

Methods: Multi-method evaluation of the national and local conception, design and implementation of the Fund, using analysis of documentary evidence, interviews and focus groups with national (Wales) officials and more than 170 local managers and professionals. The field work was carried out between October 2004 and June 2007.

Results: Different approaches at the three stages (concept, design, implementation) can reduce or enhance the effectiveness of funds like this one as a tool for achieving national objectives, and these are described.

Conclusions: National funds can be a useful lever for change, if appropriately conceived, designed and implemented. However, in the context of competing healthcare and other policy priorities, 'good practice' is often difficult to achieve, and somewhat simplistic incentives are often subverted locally, diluting the original purpose of the initiative.