The presentation to the Hertfordshire Sport and Physical Acivity Development Conference 2014 on the contribution of sport and physical activity to public health, and covering some framework and strategic issues for the future

1. Challenges and opportunities
for Sport and Physical Activity
Jim McManus, OCDS, CPsychol, CSci, AFBPsS ,FFPH, FRSPH
Director of Public Health, Hertfordshire County Council
10th September 2014
Hertfordshire Sports and Physical Activity Conference
www.hertsdirect.org

2. Some starting points
• Physical activity as routine is important to the
future of our county
– Health
– Economics
– Healthy, resilient, rounded people
• Sport is equally important
www.hertsdirect.org

3. Important to Hertfordshire: Some common
goals
• Sport perspective
• Punching our weight in
sports at all levels
• Economic, environmental,
cultural outcomes
– Employment in sport
www.hertsdirect.org
• Health perspective
• A strategic shift to
prevention
• The resilience agenda
• The sustainability agenda
• Healthy population,
thriving economy
• Employment and skills perspective
• Employment in the sector
• Skills of participation in sport benefit people and employers

4. Hertfordshire’s strategic commitment to
physical activity
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
www.hertsdirect.org

5. 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
www.hertsdirect.org

6. Whats going on now – a selection 2
• 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
www.hertsdirect.org

7. • 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 (get
behind the Sports and Physical Activity
Framework consultation])
www.hertsdirect.org

8. Why: We are facing an epidemiological crisis with
avoidable disability creating huge burdens
• Avoidable early deaths
• Chronic disease – poor self management, poor
management of sub-clinical risk, must do better
on prevention and early intervention
• Disability and costs to social care and NHS
• Some sections of our population at very high
risk of avoidable misery and death
• Mental health – intervening too late
• Resilience and Happiness – likewise
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9. Avoidable disability
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10. Avoidable Disability 2
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74 year old sedentary male

11. Avoidable Disability 3
70 year old tri-athlete
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12. Primary
Prevention
www.hertsdirect.org
Secondary
Prevention
in and
Out of hospital
Tertiary
Prevention

13. Ok, so if that’s why, then how?
• We cant just turn off the tap
• We can just shift huge quantities of money, the
need is still there
• A culture shift to everybody active has got to
be part of our plan
www.hertsdirect.org

14. Primary
Prevention
www.hertsdirect.org
Secondary
Prevention
The shift to prevention
Tertiary
Prevention

15. Reduce numbers of people coming into high-cost services and
www.hertsdirect.org
Intensive Home Support
15
Prediction
forecast / target services
moving along threshold banding
Secondary Prevention
Primary Prevention
Universal & Well-being
LOW
MODERATE
Residential Care
SUBSTANTIAL CRITICAL
Motivation, Support
Skills, Services
Tertiary Prevention

16. So how do we get there?
1. Produce a clear single framework for physical
activity and sport we all sign up to
2. Build a system wide approach to deal with it
1. Be clear on roles, responsibilities and
outcomes
3. A more nuanced understanding of lifecourse
and behavioural change
1.Cogntiive and Planned
2.Habitual and automatic
www.hertsdirect.org

17. Produce a clear single framework for physical
activity and sport we all sign up to
• Shared framework across the county we all
agree to
• Understand the contribution of each agency to
that and work it through commissioning
– Eg Exercise on referral
www.hertsdirect.org

18. Build a system wide approach to deal with it
1. Identify what we want
2. Identify whose job it is to do what
3. Build the system together
www.hertsdirect.org

19. Lifecourse and behavioural change
• Make health and Sports Psychology more
available
• Identify skills and competencies across the
whole system
www.hertsdirect.org

20. Quick wins and delivery tools
Five big wins
1. Shift up clinical complexity in
primary care
2. Step up secondary prevention
of complex cases
3. Step up self care and self
management in chronic
disease
4. Commission secondary
prevention pathway
5. Commission primary
prevention for key risk groups
www.hertsdirect.org
Policy and Delivery Tools
• Pathways and structured
care approached
• Health and social care
integration
• Behavioural sciences
• Health Checks and public
health services
• Brief interventions

21. What it means for NHS Services
• Preventive services in every patient pathway and
lifestyle for every patient
• Routine referrals to physical activity
• A “can do” approach to disability and rehabilitation
• Exercise on referral at scale
• Sports and Exercise medicine
• Levels and competencies from brief intervention
onwards
• Preventive services in clinical services link up to
community services (referral for leisure and behavioural
interventions)
• Commissioning for self-management in chronic disease
www.hertsdirect.org

22. What it means for public health
• Commission lifestyle services
• Commission them in a way which enables
people to work together and build systems
• Commission to support a strategic and cultural
shift to prevention
• Support the leadership of the Lifestyle and
Legacy partnership and the Sports Partnership
• Lead Exercise on Referral and Sports Medicine
developments
www.hertsdirect.org

23. What it means for District Councils
• Be the local glue for exercise on referral
schemes
• Provide menu of activity choices at all levels
• Use district offer monies and sport england
monies to build culture change
• The lead agencies in their areas
www.hertsdirect.org

24. What it means for providers
• A menu of opportunities from walking to elite
sport and back again
• A register of trainers who can work with people
• Close links with commissioners and with NHS
referral mechanisms
www.hertsdirect.org

25. What it means for Sports
• Continue to be part of punching our weight in
elite sports
• Continue to drive up participation
• Be a major part of cultural shift
www.hertsdirect.org

26. Strategic Shift
• Implications for the Sports Partnership
• Implications for the Lifestyle and Legacy
Partnership
• Where is the LEP in all this?
www.hertsdirect.org

27. 15 Actions being taken so far (more will be done)
1. New weight management service already
commissioned and reached 1st 1,000
referrals in three months, more will be
commissioned
2. Obesity pathway in place for tiers 1 -3
obesity care. Revision late 2014
3. New lifestyle partnership launched with
lifestyle offer for Herts residents to be ready
by Easter for phased roll out
4. New online lifestyle service launched in
February
5. Workplace physical activity challenge
funded and running (Herts Sports
Partnership)
6. Workplace Health improvement programme
running (Business in the Community)
7. 93% of GPs in Herts now doing NHS
HealthChecks
www.hertsdirect.org
1. Obesity Plan approval by Cabinet due
March 2014
2. New child weight management service to
be commissioned in 2014
3. Broxbourne whole area obesity pilot
underway with Borough and County
Council, schools and NHS
4. Fast food takeaway restrictions
5. Countryside walks scheme
6. Year of Cycling launching May 2014
7. Funding for District Councils to work on
health improvement agreed and each
District working out its plans
8. Continue child weight measurement
programme

28. Behaviour Change Pathway Approaches
The evidence base for changing health behaviour is developing quickly. Brief interventions in primary care (by practice nurses and
GPs) can motivate people to change, providing referral onwards is speedy. This pathway
2nd Line – Behaviour Change 3rd Line 1st Line – Brief Intervention - Activity 4th Line – Specialist
Opportunistic brief advice by
GP, pharmacist or practice
nurse
1Identify health issue of
concern (and follow
appropriate pathway for
that, e.g. obesity)
2Assess motivation to
change
3If motivated, refer on
4If not motivated,
Raise awareness
of risks.
Offer written
information on
healthy eating and
physical activity.
Raise again in 3
months.
Offer information
prescription
Discuss primary or main goal
then refer appropriately For patients with co-morbidites
Smoking
is primary,
main or
only goal
www.hertsdirect.org
If fall into 1st or
subsequent line category
of advice within Obesity
Care Pathway refer to
Lifestyle Programme,
provided there are no
contraindications and if
co-morbidities or person
has BMI over 30, GP has
assessed and supports
referral. Check this ….
Patients who are diabetic or
have coronary heart
disease or a history of heart
problems must have referral
from appropriate primary
care team or secondary
care to participate in
programme.
Behaviour change
programme to be developed
in partnership with specialist
services
Refer to
smoking
cessation
service
Weight
loss,
healthy
living or
CVD risk
is main or
primary
goal
Refer to
ifestyle
Service
Patients with highly complex psychological or emotional
issues (e.g. depression or eating disorder.)
If not already in contact with such services, refer to IAPT
programme psychology or primary care mental health team

29. Example: cycling as part of a County of
Opportunity
• Physical activity becomes second nature
• Health benefits from self propelled transport
(walking, cycling)
• Sustainability benefits from self propelled
transport
• Cycling on referral
www.hertsdirect.org

30. Our ambitions for cycling
• More people cycling more often
• Cycling as sustainable transport
• Cycling as pleasure and keeping healthy
• Cycling on referral from health professionals
• Cycle safety and learning for kids and adults
• Mental health and physical health benefits
• A new way of doing the Cycling Forum
www.hertsdirect.org

31. Year of Cycling
• 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
www.hertsdirect.org

32. Year of Cycling
• 1 year plus legacy period
• Year of walking follows
• Then year of swimming
• Culture change
• Already having an impact
• £2m investment in District
Councils by Public Health
Chief constable and county council agree
to new policy on cycling events/races
www.hertsdirect.org

33. The Policy Context (England) does give us scope
to address this
• Local Authorities – duty to promote and protect
health of population
• NHS CCGs – duty to reduce inequalities in
health
• Behaviour change is a tool but we need to use it
properly and use the right methods
• A balanced strategy using a range of tools and
strategies
www.hertsdirect.org

34. 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
www.hertsdirect.org