External Review of ASH Scotland 2014

6 Use of Resources

Effectiveness and completeness of financial instructions and controls

6.1 There is good governance for financial decision making, with a comprehensive set of financial procedures within the organisation. ASH Scotland uses a regular cycle of financial reporting against annual budgets to the Finance Fundraising and General Purpose (FFGP) sub-committee and then the Board. The SMT meetings review budgets in detail, compare actual spend against budgets, and highlight variances for follow up with managers. The soundness of the financial systems is confirmed by external auditor reports which have consistently found ASH Scotland financial management arrangements to be satisfactory for the last ten years.

6.2 ASH Scotland has a well-structured and comprehensive approach to financial controls. Budgets are prepared by the Finance Team and submitted for approval by the FFGP sub-committee. Any significant variations are taken to the FFGP and Board for approval; in practice these are rare, as costs are largely fixed costs of salaries, rent and negotiated services contracts. Budgets are reviewed monthly and reported to the Director of Business and to a nominated person from the FFGP. A full set of papers including bank recommendations, aged debtors and creditors, control account analysis, balance sheet and income and expenditure accounts by funding stream are prepared and reviewed by the Director of Business. In addition, quarterly budget meetings are held with budget holders and financial statements are prepared for the FFGP and Board meetings.

6.3 Financial authorisation is restricted appropriately. Five staff signatories and three Board signatories are registered. All payments require two people to authorise them (where possible the Director of Business is always one of them) whether signing cheques or authorising on-line through BACS payments. Cheques over £1,500 require a Board member to be one of the signatories.

6.4 Financial controls are designed to ensure that ASH Scotland gets good value for money. A rolling programme of review of services (including gas, electricity, telephones, cleaning, IT, security, photocopying, stationery and supplies) was implemented a number of years ago. This means that these costs are regularly reviewed, and comparative quotes are sought to ensure best value and to keep costs as low as possible. A minimum of three quotes from different suppliers will be sourced and compared for cost and quality of service. A similar approach is applied to one-off expenditure such as printing reports, consultancy, furniture and equipment. Staff are encouraged to book travel and accommodation as early as possible to get best value and use tele-conferencing when feasible to minimise travel costs. ASH Scotland always negotiates to get good value for meeting and event costs. The organisation also works with partners to get in-kind support such as meeting rooms and facilities to keep overall expenditure low.

6.5 There have been a number of recent improvements in the financial management of ASH Scotland, partly due to the upgrading of the Finance Officer post (from a Finance Assistant) a year ago which has brought in a higher level of capacity. This has also enabled the Director of Business to take a more strategic role in overseeing finance. Financial instructions are now updated at least annually; there is now a formal month end procedure. A new process has been introduced to ask budget holding managers to sign off credit card expenditure, to ensure that they can assess if it was necessary. Increasing intelligent accountability in this way strengthens the overall effectiveness of the organisation. This new initiative contributes to the wider understanding of staff that controlling budgets is a shared responsibility, which has been consciously developed by the senior leadership over the last 4-5 years.

6.6 A critical test of good use of resources is whether they are spent effectively on the right areas of activity. ASH Scotland scrutinises expenditure carefully, to ensure that it is well focused on its strategic aims, and reviews its expenditure at Board to ensure good alignment with these as well as cost efficiencies, which together contribute to good value. Funders receive regular reports to assure them of good value for money in terms of their specific grant requirements. There are regular stakeholder and user surveys of specific services (such as the survey of users of the enquiry and library service in 2012) and the more general stakeholder surveys which are used to improve services. Together these different forms of scrutiny help provide assurance that ASH Scotland makes good use of resources.

Staffing capacity, development and deployment in relation to objectives

6.7 Staff are the strength of ASH Scotland and also its main area of cost. Ensuring staff are deployed efficaciously, and continue to have the right skills to be effective, is key to achieving good value for money. External stakeholders currently view ASH Scotland staff as being of high calibre, highly professional, and all staff are seen to have a very high commitment to their work. However, there are increased financial pressures, and, with the development of a new strategic plan which possibly includes new agendas, it will be important to ensure that staffing capacity and deployment continue to be appropriate to future requirements.

6.8 The SMT and Board ensure that staff are deployed well in relation to ASH Scotland objectives and contracts held through regularly reviewing staffing structures and numbers. The organisation does not view posts as fixed, and when vacancies arise, there is not an automatic 'like for like' replacement but an assessment is made of current and future needs so that human resources are used to deliver good value collectively. As an example, when a director left recently, the post was not filled but the opportunity taken to consolidate his areas of responsibility with those of the two remaining directors and to restructure internally to support this change. Additional staff capacity can also be brought in where this aids effectiveness, as in the example of upgrading the Finance Assistant post to a more senior role to improve financial management. Some posts are effectively dependent on particular contracts (such as the PATH project) and these are reviewed if the contract is not renewed or changes substantially. To date, changes in staffing have been managed without compulsory redundancies.

6.9 The main area of capacity which ASH Scotland perceives to be lacking is funding to support local alliances. Since the funding for the alliances support post came to an end, other teams have stretched to cover some of the work. Developing additional capacity in this area is seen by the organisation to be important to help it achieve its strategic aims of reducing inequalities and increasing the effectiveness of its local activity. ASH Scotland staff note that while they can and do work with local communities, current capacity feels like a "drop in the ocean" compared to how many groups they could be working with.

6.10 ASH Scotland's information and research capacity is highly respected and seen as a major strength by external stakeholders. Stakeholders from all sectors spoke of how much they use and rely on the information briefings and research updates to support their own work on tobacco control, and inform policy and practice. Academics were complimentary about the high quality of the publications produced. Stakeholders expressed concern at the possibility of this capacity being diminished with the anticipated departure of a current staff member; clearly this is still a priority area to continue to resource. This capacity is seen to be particularly important given the challenges ASH Scotland faces from the tobacco industry and pro-smoking lobby; and the need for its work to be robust and evidence based.

6.11 Performance management of staff is well aligned to the wider aims of ASH Scotland. Staff all have individual work plans which are closely related to the organisation's and each section's work plan for the year. These are reviewed with line managers approximately monthly to assess performance against planned outputs and outcomes. This helps ensure that staff are being effectively deployed to deliver organisational objectives. As part of setting annual objectives, staff and managers are asked to consider what, if any, training or development is necessary to help the individual achieve their objectives.

Using resources to deliver the Scottish Government objectives

6.12 ASH Scotland receives funding from five main funders, the largest of which is the Scottish Government, which provided in total 74% of income in 2012/13. This includes core funding, which is not tied to any specific activity and accounted for 22% of income in 2013/14, and project funding for the Information Service, and PATH (covering Youth, Inequalities and Training) which accounted for a further 52% of income. Other major funders have included NHS Health Scotland, the British Heart Foundation, Cancer Research UK, and The BIG Lottery Fund. Recent funding has been received from the Robertson Trust, matched by the Scottish Government, for further work on second hand smoke following on from the REFRESH project. Each funder supports different activities, for example Cancer Research UK supports policy and advocacy activity, the British Heart Foundation part funds the information service with the Scottish Government, and The BIG Lottery Fund funded the REFRESH project. For the purposes of this report we focus on the use of Scottish Government funding.

6.13 The Information and Research Service is highly valued by all stakeholders. It is very productive, producing daily and weekly bulletins, publications and fact sheets, as well as longer research publications such as the work for REFRESH and papers on the effectiveness of different interventions on reducing smoking amongst deprived groups and on e-cigarettes. The service also hosts a large library of resources on tobacco and provides a free public inquiry service on research questions. As well as its value to the wider sector, the service ensures that policy work and responses to the tobacco industry are very well evidenced. The production and publication of evidence and research have also played a significant role in informing the general public and the expert tobacco control sector, including the Scottish Government. ASH Scotland publications, such as the annual Smoking in Scotland report and regular bulletins support the organisation in its independent influencing role, as well as informing the ambition of the national Strategy and national policy debates. Performance reports on the Information Service submitted to the Scottish Government show that it performs very well in relation to its set indicators. The British Heart Foundation provides over half the information service costs.

6.14 The Inequalities work (which was originally combined with the PATH heading but has since become a separate funding stream) covers a wide range of activities. These have included working with poorer and disadvantaged groups, for instance through work on smoking and intention to quit in deprived areas of Glasgow; support to the Smoking in Pregnancy summit in 2013; and developing and project managing the REFRESH project with academic partners. In 2013, the organisation organised a BME and tobacco focussed summit as a part of the 40^th anniversary ASH Scotland conference, which resulted in a publication and the establishment of a Tobacco and Ethnicity Network. ASH Scotland has also targeted the third sector and community groups working with a range of inequalities groups to promote the uptake of Tobacco Awareness Raising Sessions (e.g. with homeless people, young people, women, children and family centres, people with HIV/AIDS, carers, and people with mental health problems). Support is given to mental health focused prevention and cessation work nationally and locally to reduce smoking prevalence and to support smoke free NHS buildings and grounds. ASH Scotland is seen as being effective in these areas, although it is seen to be most effective when it works with and through local organisations, as it is not a frontline service. The specification of the tasks and output measures is less clear for inequalities activities than for the information and research work, and so it is harder to make a clear judgment on performance. This also reflects the nature of the work; tackling health inequalities and influencing local groups is a less precise activity, and is not solely within the control of ASH Scotland as it requires the engagement of local organisations.

6.15 Preventing and reducing tobacco use by young people is vitally important for reducing overall use and changing attitudes. A wide range of work is undertaken in partnership with many voluntary organisations and, in particular, through the youth group of the STCA. Recent achievements include the establishment of the youth and tobacco forum; engaging with the Youth Tobacco Commission; running the Crofton and Dynamic Youth awards; assisting partners to effectively embed tobacco education in schools; identifying and reviewing existing resources suitable for those working with young people and making them more available; working with relevant partners and young people to campaign for outdoor music and sporting venues and events to adopt and implement smoke-free policies. Where possible young people are engaged in the activities. These activities use a variety of approaches to embedding and promoting information and policies on tobacco control in relation to young people. Performance reports on the Youth Project submitted to the Scottish Government show that it performs well in relation to the agreed output measures.

6.16 The training provision (a part of the PATH contract) includes work on cessation and on raising the issue of smoking. PATH was a partnership between ASH Scotland, the Scottish Government and NHS Health Scotland, and was funded by both for the work. The PATH partnership ended in 2013/14, but was a substantial part of ASH Scotland work before that. The Scottish Government has set up a comprehensive review of specialist smoking cessation provision, including consideration of future provision and training needs, to inform decisions on future training models and contracts. Although the training service is therefore not currently provided by ASH Scotland, its provision falls within the period of review. Under PATH, specialist stop smoking support was provided by the organisation using accredited training modules, developed in 2006 and revised and revalidated in 2009/10. These modules continued to be updated for accuracy but were seen to be in need of revision in recent years in order to address changes in approaches to cessation training, and reduced demand for staff training since many local staff have now been trained. Plans for revising the modules have been put on hold pending the forthcoming review.

6.17 Cessation training provided to practitioners using the accredited modules has been positively experienced and effective from a sample of course evaluations in the last two years and feedback from the 2014 stakeholder survey. The performance reports to the Scottish Government, however, show a slight underperformance in numbers of participants and in local health board engagement in relation to output measures in 2013, although numbers increased later that year and in 2014. Lower take up may also have been a function of past success in that many practitioners are now trained and there is a finite pool of practitioners. It may also reflect the fact that some larger NHS Boards now manage their own training and that there has been an increase in e-training. In addition to the accredited training modules, ASH Scotland also provides wider health behaviour change training, often in partnership with NHS Health Scotland.

6.18 Core funding from the Scottish Government is used to part support overhead costs (such as governance, office space, administration, ICT) and to support the STCA work. Funding is apportioned to activity costs where possible. Every effort is made to keep expenditure low and deliver good value. However, the Scottish Government core funding has no requirements specified for what ASH Scotland should achieve or deliver, beyond that it should be compatible with the priorities of Scottish ministers and in particular any priorities identified as a consequence of the new tobacco control strategy^[9] which ASH Scotland certainly achieves. From reviewing the work undertaken, expenditure in relation to activities, and reports to the Scottish Government, ASH Scotland is achieving what it has been asked to do, and in some cases surpasses output requirements in relation to grant and project funding.

6.19 It is, however, important to take a wider view than grant or contract compliance. From reviewing its activities and achievements over recent years and the feedback of stakeholders, ASH Scotland is clearly effective in leading and influencing policy on tobacco control, and engaging and supporting a wide range of national and local organisations. In so far as ASH Scotland's work contributes to a reduction in tobacco use, which will have an associated positive effect on costs to health services, the economy and society, it is making a valuable contribution to national objectives. While it may be difficult to put a monetary value on its impact, ASH Scotland's impact is larger than the sum of activities it undertakes itself.