Jim McManus, OCDS, CPsychol, CSci, AFBPsS,FFPH, FRSPH Director of Public Health, Hertfordshire County Council 5 th December 2014 East of England Commissioning for Culture and Sport event Commissioning for Activity & Sport in Hertfordshire: A work in progress

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

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

Premature deaths in Hertfordshire

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

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

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

Value of CLOA advice to us Consultancy through c 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

Answer Use a modified commissioning approach to start building a framework Build a framework which incorporates c 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

c CLOA 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

Steps to a commissioning approach – much done in parallel 1. Needs Assessment2. Governance –multiple commissioners3. Clear shared priorities4.Commissioning Frameworks5. Commissioning and Delivering

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)

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

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

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

Step 4: Commission Framework c CLOA 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

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

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

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

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

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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