- Hertfordshire County Council is taking a commissioning approach to physical activity and sport to promote health and wellbeing. - This involves bringing together multiple stakeholders through a Lifestyle Partnership to establish shared strategic priorities and a commissioning framework. - The approach is being implemented in phases, building on existing assets and taking a co-production approach to harness energy from various sectors. - Initial results include investments in exercise referral programs, district council leisure services, and launching a "Year of Cycling" campaign to promote cultural change.

1. 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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The key messages from Herts experience
• Commissioning as a way of place shaping
• 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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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 cCLOA
• 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 cCLOA
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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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 Priorities
1. 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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Step 4: Commission Framework
• cCLOA report essentially gave us our priorities
• 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 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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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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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