1. Jeannie Wyatt-Williams
Wales National Exercise Referral Scheme (NERS) & Its Long term Behavioural Change Success
Date: March 22nd 2017
Jeannie Wyatt-Williams
Rheolwr Cynllun Atgyfeirio Cymru ar gyfer Ymarfer Corff,
Cymdeithas Llywodraeth Leol Cymru
National Exercise Referral Scheme Manager for Wales,
Welsh Local Government Association

2. Overview Why be Physical Activity
Background to the National Exercise Referral Scheme ( NERS)
Evaluation results
Staff development
Aim of NERS
Highlight examples of exit route developments from across Wales
Ceredigion team present their story
Q & A’s

3. Why be Physically Active? Research has shown us that:
Habitual Physical Activity is associated with a reduced risk for over 25 chronic conditions and premature mortality
Moderate intensity physical activity on most days of the week is of benefit to most individuals with chronic disease and /or disability, but these individuals should have their capability to exercise independently assessed by an appropriately trained Exercise Professional.
NERS professionals are suitable qualified and able to signpost post programme those who are suitable for other sustainable activities to ensure they maintain the health and wellbeing benefits they have gained through accessing the programme.

4. Background to NERS
WG commissioned a review of exercise referral schemes in Wales in 2007
NERS was set up in July 2007 and funded by Welsh Government (WG)
Established NERS alongside a randomised controlled trial (RCT) aimed at those of risk of developing a chronic condition
Areas joined the scheme in 3 phases
In 2008 WG approved the appointment of a National Coordinator was appointed by WLGA.

5. Background to NERS
In 2009 NERS developed delivery to include those with chronic conditions to meet Welsh Government priorities (Level 4 Specialist Instructor delivery) and provide access to high quality supervised activities.
In 2012 funding was transferred to PHW and has continued annually following successful outcomes of the Health Impact Review
The scheme works in Partnership with Welsh Local Government Association, Local Authorities, WG and Local Health Boards.
NERS continues to be coordinated by a National Manger employed by WLGA
NERS is funded until March 31st 2018

6. What is NERS?
NERS is an evidenced based health intervention incorporating physical activity and behavioural change to support referred clients to make healthy lifestyle changes to improve their health and wellbeing.
Delivered by registered, insured, and appropriately trained instructors
National secure database to centrally monitor performance, hosted by WLGA.
Programmes run from weeks dependant on referral reason and need.
Cost £2.00 per session

7. NERS Structure
One National Manager employed by Welsh Local Government Association who is supported there by a part time administrative support.
26 Local Coordinators which equate to 22 WTE posts employed locally through Local Authority and or Trust
96.6 WTE Exercise Professionals employed in the scheme employed locally through Local Authority and or Trust
All operate on a yearly contract dependant on grant allocation currently funded until March 31st 2018

8. Evaluation Results
The Random Controlled Trial’s conservative base case analysis is robust to a range of sensitivity analyses, leading to the conclusion that NERS is 89% likely to be cost effective, at just over £12,000 per QALY, and for those who adhere to the full programme and is likely to be marginally cost saving (-£367 per QALY).
The National Institute for Health and Clinical Excellence (NICE) has suggested that interventions delivering a cost per QALY of under £20,000-£30,000 are likely to be an acceptable use of NHS resources.
Referral to the National Exercise Referral Scheme falls well within this range and is potentially cost saving, particularly where participants pay a nominal fee per exercise class.

9. The Aim of NERS Health Interface Primary Care
Rehabilitation Programmes .
Primary Care
Brief Intervention Lifestyle Advocates
Jeannie Wyatt-Williams
NERS National Coordinator for Wales
2015
Health Education Programmes
Secondary Care
Mainstream Leisure
Personal Trainers
Community Classes
Active Daily Living/Home Based Exercises Exercise
Conservation
Walking and Cycling Groups
Golf
Dance
Adapted Sports/Walking Football
NERS Level 3 Generic Exercise Referral
Swimming
INTERGRATION OF HEALTH AND THE NATIONAL EXERCISE REFERRAL SCHEME IN THE PREVENTION, TREATEMENT AND MANGEMENT OF CHRONIC CONDITIONS
Health Interface
LHB health promotion initiatives
Foodwise4Life Nutritional Education Programme
NERS Programmes
NERS Level 4 Condition Specific Rehab Pathways
To establish the NERS pathway as an effective bridge from health into leisure by supporting patients in supervised activity, building their confidence enabling them to go forward and undertake mainstream activities to maintain and continue to improve their health and wellbeing the priorities were:
Training, development and implementation of standard protocols, partnership development with health professionals, third sector, partner projects and leisure mangers to ensure development of appropriate exit routes.
As Foodwise is indicated here is an over view of what is covered in the eight week programme.
Independent Activity

10. NERS comprises two distinct but inter-related elements:-
Chronic Condition
Development 2009
NERS comprises two distinct but inter-related elements:-
Exercise Professionals that are registered at Level 3 of Register of Exercise Professionals (REPs) provide ‘generic’ NERS sessions for ‘low risk’ population groups that need some support to increase fitness and reduce general risks of developing chronic conditions.
Level 4 (REPs) Exercise Professionals provide more specialist NERS sessions for population groups deemed to be ‘higher risk’ and needing to undertake tailored exercise sessions as part of their rehabilitation following an intervention by the NHS or to manage a chronic condition and use exercise as a means of secondary prevention.

11. Staff Development & Delivery Level 4 Cardiac Rehabilitation Instructor
Level 4 Respiratory Disease
Level 4 Postural Stability Instructor (Falls Prevention)
Level 4 Exercise following Stroke
Level 4 Mental Health
Level 4 Cancer Rehabilitation Instructor
Level 4 Weight Management instructor ( Obesity/Diabetes)
Level 4 Back Care Instructor
Parkinson’s (PSI /EfS CPD)
Osteoporosis (PSI CPD)
Dementia 1st Steps
Level 3 Pre/Post Natal ( covering Maternal Obesity Pathway)
Adapted Tai Chi for Wellbeing

12. NERS & Sustainable Gardening Projects
This is a disused bowling green adjacent to Pwllheli Leisure Centre which was
donated for development as a community garden by the Local Authority.

13. Open Day Planting the orchard
National coordinator and a local GP assisted in the tree planting , Asda stores supplied much need refreshments. The garden was officially opened by a local resident who was recovering from a Stroke and said the garden was his reason to get out every day.
The donated 12 fruit trees successfully
planted at Pwllheli community garden
gained recognition and the orchard was
awarded NHS Forestry Status and successful
in achieving Keep Wales Tidy Green Banner
Award.
A young man with learning disabilities has
gone on find full time employment at a local
community garden project

14. Pwllheli Community
Garden Development

15. Building the Polytunnel at
Pwllheli

16. Community Garden during Summer 2016
Ongoing maintenance is supported by
NERS Exercise Professional but it is very
much a community asset with locals sharing
and leading their expertise.
Across Gwynedd there are now three
Community gardens adjacent to Leisure
facilities supported by NERS but managed by
the NERS graduates and the community .

17. Groups in Monmouthshire
Sustainable Walking
Groups in Monmouthshire
Chepstow
Monmouthshire as developed a training programme to train interested NERS Graduates to become Walk Leaders offering several walks per week from their local leisure centres for low risk referrals or other graduate referrals. These volunteers Are supported by the Local Authority but manage the walking programme themselves working in teams of three.

18. Ceredigion Team and it’s
Sustainable Social Enterprise
Here are the team and I will hand over to Paul Jones who will begin to tell their story.
Paul Jones - NERS Coordinators Ceredigion
Steve Jones - Ceredigion Leisure Manager
NERS Graduates - Margaret Fitches and Cath who are out leading a Nordic Walk but are due to arrive here at 2.30pm to tell us their about their journey through the NERS programme and how it has lead to a successful social enterprise project which they are an integral part of.

19. Adapted Tai Chi for Wellbeing
at the top of Constitutional
Hill

20. Diolch yn fawr am wrando Many thanks for listening
Jeannie Wyatt-Williams
Rheolwr Cynllun Atgyfeirio Cymru ar gyfer Ymarfer Corff,
Cymdeithas Llywodraeth Leol Cymru
National Exercise Referral Scheme Manager for Wales,
Welsh Local Government Association E: T: M:
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