hertfordshire sport and physical acivity development conference 2014 mcmanus
DESCRIPTION
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 futureTRANSCRIPT
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Jim McManus, OCDS, CPsychol, CSci, AFBPsS ,FFPH, FRSPH
Director of Public Health, Hertfordshire County Council
10th September 2014
Hertfordshire Sports and Physical Activity Conference
Challenges and opportunities for Sport and Physical Activity
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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
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Important to Hertfordshire: Some common goals
• Sport perspective• Punching our weight in
sports at all levels• Economic, environmental,
cultural outcomes
– Employment in sport
• 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
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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
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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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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
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• 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])
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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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Avoidable disability
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Avoidable Disability 2
74 year old sedentary male
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Avoidable Disability 3
70 year old tri-athlete
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We invest in the wrong thingsOur Burden of Disease is not the right way round
PrimaryPrevention
SecondaryPrevention
TertiaryPrevention
in andOut of hospital
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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
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Health and Care: Our Burden of Disease is not the right way round
PrimaryPrevention
SecondaryPrevention
TertiaryPrevention
The shift to prevention
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Prediction
forecast / target services
Secondary Prevention
Pri
ma
ry P
reve
ntio
n
Un
ive
rsal
& W
ell-
be
ing
LOWMODERATE
SUBSTANTIAL CRITICAL
Reduce numbers of people coming into high-cost services and
moving along threshold banding
Intensive Home Support
Residential Care
Motivation, Support
Skills, Services
Tertiary Prevention
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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
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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
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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
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Lifecourse and behavioural change
• Make health and Sports Psychology more available
• Identify skills and competencies across the whole system
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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
Policy and Delivery Tools
• Pathways and structured care approached
• Health and social care integration
• Behavioural sciences• Health Checks and public
health services• Brief interventions
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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
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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
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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
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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
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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
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Strategic Shift
• Implications for the Sports Partnership• Implications for the Lifestyle and Legacy
Partnership• Where is the LEP in all this?
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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
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
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Behaviour Change Pathway Approaches
2nd Line – Behaviour Change 3rd Line - Activity 4th Line – Specialist1st Line – Brief Intervention
Opportunistic brief advice by GP, pharmacist or practice nurse
1 Identify health issue of concern (and follow appropriate pathway for that, e.g. obesity)
2 Assess motivation to change
3 If motivated, refer on4 If not motivated,
Raise awareness of risks.
Offer written information on healthy eating and physical activity.
Raise again in 3 months.
Offer information prescription
Smoking is primary, main or only goal
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 ….
Discuss primary or main goal then refer appropriately For patients with co-
morbidites
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
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
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
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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
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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
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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
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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 agreeto new policy on cycling events/races
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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
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Thank you!
Public Health page
http://www.hertsdirect.org/your-council/hcc/publichealth/
Free learning resources for public health
www.hertsdirect.org.uk/phelearn