www.hertsdirect.org

Jim McManus, OCDS, CPsychol, CSci, AFBPsS ,FFPH, FRSPH

Director of Public Health, Hertfordshire County Council

5th December 2014

East of England Commissioning for Culture and Sport event

Commissioning for Activity &

Sport in Hertfordshire: A work in progress

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Contents

• contextualize commissioning as a means of place shaping and affecting large scale culture change.

• cover how a countywide approach to commissioning exercise referral, exercise for older people and those with disabilities will contribute to the prevention of long-term disease.

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The key messages from Herts experience• We want a cultural shift in physical activity and sport access and

use for everyone

• Needs a whole system exercise

• Herts is already a big system with lots of players

• A commissioning approach has brought real benefits even in early stages so far

– Phasing it is the only way

– Clear shared strategic direction and governance needed

• Harness skills and energy through co-production

• One person’s messy is another’s inclusion

• This is a work in progress - £20m and counting investment in physical activity and sport

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Challenges

• Large County

• Distributed infrastructure for sports and physical activity, lots of energy and passion

• 70,000 + volunteers in sport and PA

• Some areas of inactivity

• 2,200 avoidable early deaths

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Premature

deaths in

Hertfordshire

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Some issues

• On the whole we do better than England

• Look below that though....

• 11 year gap in life expectancy between richest and poorest

• Significant avoidable disease, disability and death

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Obesity

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Where we want to get to

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But...

• Nothing less than a cultural shift to physical activity as mother nature’s way of keeping us healthy will resolve the challenges we face

• And nothing less than firm resolve to share the same strategy and vision, and work to deliver that, from every partner, will get us there

• How on earth do we get there?

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Problem -Solving Phase Early 2014

• Series of discussions and meetings and workshops, multiple stakeholders

– We are facing an epidemiological crisis with avoidable disability creating huge burdens

– We have a complex system with some inertia and some good things

– Need concerted whole system approach

• Major conference September 2014

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Assets• Sports partnership and many stakeholders

• Olympic legacy board – now Lifestyle Partnership

• Ten District Councils and County Council

• 70,000+ Volunteers

• Significant voluntary, private and public sector sports footprints

• University commitment in Sports

• Sports and activiy at every level

• Multi million point investment

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Problems and risks

• Not joined up between primary care and rest of sectors well enough

• Distribution of inactivity and disease and disability

• Facing multiple fronts

– Sports world

– Health world

– Public Sector world

• Distributed system

• Variable pathways in various places

• Could spend all resource system building not achieving

• Need to get things delivered

• Every partner has a contribution

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Value of CLOA advice to us

• Consultancy through CLOA

• Report and Mapping

– Steps to an at scale system

– Build a commissioning approach

– Public Health monies enable the existing system, don’t replace

– Improve and Build, don’t restart

– Very valuable recommendations and advice

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Answer

• Use a modified commissioning approach to start building a framework

• Build a framework which incorporates CLOA advice

• Shaping the market and landscapes will come in phased approach not overnight

– Massive input into the system already we need to get the best of, not disrupt

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CCLOA Work – mapping exercise findings• Build on community initiatives:

• Promote successful low-cost community models for participation

• Design better signposting/navigation systems to improve access

• “Personalise” the process of introducing inactive people t

• Use commissioning cycle to strengthen the connections between health (including mental health) and physical activity, and demonstrate this in contracts

• “Improve the exercise-on-referral programmes

• pathways along with clinicians and providers

• Use the additional funds available for public health to build capacity

• Encourage partners to support this programme by redesigning their own work to promote active living, physical activity and sport

• Increase the number of physical activity trainers with advanced specialisms

• Work with commissioning partners and providers to develop realistic business models that can support greater participation in physical activity and sport by inactive people

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Steps to a commissioning approach – much done

in parallel

1. Needs Assessment

2. Governance –multiple commissioners

3. Clear shared priorities

4.Commissioning Frameworks

5. Commissioning and Delivering

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Step 2: Building the Commissioning

Landscape

• Bring partnerships together

– Formation of HLLP as overarching partnership

– Elected member led

• Public Health led commissioning cycle and approach from County

• Working with every other agency (Sports Partnerships)

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Commissioning cycles....various models

• World Health Organisation Planning Wheel

• Kellog Foundation Planning Cycle

• DH Commissioning Cycle

• Hybrid model based on what local areas seems to be using......

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Using a (very) Simplified Commissioning Cycle

Monitor

Plan

Review Need

for Service

and

Effectiveness

of existing

services

ContractThe Commissioning

Cycle

This is used just to introduce the concepts of what PH can help you

with.

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Monitor/

Evaluate

Plan

Review Need for

Service and

Effectiveness of

existing services

Public Health Input into the Commissioning

Cycle. Can be throughout or can be on specific

areas playing to the PH strengths

Community

Engagement

Support in establishing

meaningful indicators of

delivery and outcome

Model whether need will

Be met by proposed

volume

Check whether plans equate

To evidence and need and

Test for equity / inequity

Support and advise on

Evaluation and conduct

Bits of it if enough resource

Needs Assessments

Equity Auditing

Evidence of Effectiveness

Health Impact Assessment

Triangle of critical

influence – where public

health should be most

visible

Contract/Deliver

Triangle

of critical

influence

Triangle of

critical

influence

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The principles of our commissioning approach in

Herts: building the house while living in the

foundations

1. Build a system from the best we have, don’t reinvent

2. Transformation through phases and staged redesign

3. See potentials, not problems

4. See Potentials not Problems, assets as well as needs

5. Subsidiarity

6. Co-production

7. Behavioural Sciences

8. Pathwayed

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Step 3: Clear Shared Priorities1. the Lifestyle and Legacy Partnership (formerly the Olympic legacy

partnership) bringing 40 agencies together

2. each district council strategy and there are multiple services

3. University in Sports Science

4. Sports Partnership Plan and Stategy

5. Health and wellbeing Strategy

1. Strategic Shift to Prevention Report 2014 all agencies signed up

6. Public Health Strategy

7. Sustainable Transport Strategy

8. Being written into NHS Clinical Strategies

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3. Strategic Commitment and Priorities

1. A priority for the Lifestyle and Legacy Partnership (formerly the Olympic legacy partnership) bringing 40 agencies together

2. priority in each district council strategy and there are multiple services

3. A priority for the University in Sports Science

4. A large and thriving Sports Partnership

5. A large network of community sports clubs

6. A priority in the health and wellbeing, Public Health and Sustainable Transport Strategies

7. A priority in the Better Care Fund Plan for health and social care integration

8. A priority in each NHS Commissioning strategy

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From the Annual Report

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Step 4: Commission Framework

• The Hertfordshire Sports and Physical Activity Framework, led by the Sports Partnership, Commissioned by Public Health on behalf of the Lifestyle Partnership

• Strategic, Tactical and Operational Levels

• Consultation finished and is on its way through relevant bodies for sign off

Brings all of these strategic priorities mentioned above in one

place, in one framework agreed by everyone

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Step 4: Commissioning Framework key priorities Addressing drivers and barriers to participation including accessibility and affordability.

Strengthening strategic coordination, communication and cross-service planning for physical activity and

its delivery by unlocking resources and aligning with agreed priorities.

Improving targeted provision to those who are most sedentary and inactive and therefore at risk of ill-

health as a result.

Increasing participation in the context of the current financial and economic climate (where appropriate

budgets are constrained).

Improving understanding of the benefits of physical activity and the contribution it can make to many local

priorities including health improvement and preventative health.

Improving monitoring and evaluation of physical activity provision, linked to identified outcomes.

Influencing local planning, environmental and transport policy to create more active environments in new

housing, schools and other developments and create more active environments.

Increased understanding and inclusion of physical activity and sport to help address local priorities.

Adoption of Proportionate Universalism to reduce health inequalities and support of the nine protected

characteristics to address equality.

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Step 5: Commissioning & Delivering

• The “Years” – Walking, Cycling, etc

• Disabled Access and Adults with Learning Disabilities

• Health Walks

• Exercise on Referral as part of new self management programme, linked to Strategic Shift to Prevention Strategy

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Whats going on now – a selection 1

• Significant district council investment in leisure services and offers, every district offering a form of exercise on referral but this will be further developed over the next year

• Every district has a leisure offer encompassing indoor and outdoor leisure activities

• Chief Leisure Officers Association and Sport England are working on a joint District-County-Sports Partnership project to develop a commissioning framework for physical activity for Herts

• Community grants fund for physical activity funded by public health to be developed by Sports Partnership

• Every leisure service employee in Hertfordshire can access free public health training

• £1m per annum public health investment in district councils

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Step 5 : District Councils and Sports Partnership

• In addition to existing provision and joining up

• £1m investment per annum from Public Health

• Districts increasing success in Sport England monies

• Sport England disabled access programme

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Years of…

• An idea to build common purpose

• A mechanism for promoting cultural change

• A tool for focus on specific types of activity and sport

• One year for each plus a legacy for each

• Sustained push on events, promotions, campaigns and infrastructure

• Commissioning and programme approaches

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A further selection of work• 2014 is year of cycling, year of walking next….

• Public Health and CCGs and Districts are working with an at scale physical activity programme

• Workplace health challenge funded by Public Health

• Workplace health work funded by public health

• Pool bikes and bike to work scheme in the County Council

• District councils working on targeted and universal physical activity and leisure offer

• Public Health and NHS about to employ physical activity promotion manager in primary care to develop physical activity pathways

• 32,000 people go on Health Walks a year funded by Public Health and District Councils, led by Countryside Management Service

• Cycling development small grant fund for community agencies as part of Year of Cycling

• Key third sector agencies commissioned like Groundwork and others

• 2,500 bikeability courses in schools

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Year of Cycling 2014-2015

• We will put cycling on the map in Hertfordshire as a leisure, health and transport activity

• Complete revision of some work we’ve been doing including website and apps

• Start of a 3 year plus cultural push on physical activity

• County Council, Cycle Clubs, Districts, NHS, Police, working together

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Year of Walking – 2015 - 2016

• Be ambitious

• You are a public health army

• You are vital in cultural change

• We want to work with you

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Thank you!

Jim.mcmanus@hertfordshire.gov.uk

Public Health page

http://www.hertsdirect.org/your-council/hcc/publichealth/

Free learning resources for public health

www.hertsdirect.org.uk/phelearn