1. Hertfordshire County Council is using a commissioning approach to promote physical activity and prevent chronic disease on a county-wide scale. 2. The approach involves coordinating multiple partners, conducting needs assessments, establishing shared strategic priorities, and developing a commissioning framework to guide investment. 3. Initial efforts have focused on exercise referral programs, cycling and walking initiatives, and leveraging the skills of over 70,000 sports volunteers; future work will address inactivity in priority groups and build physical activity into urban planning.

1. Commissioning for Activity &
Sport in Hertfordshire:
A work in progress
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
www.hertsdirect.org

2. Contents
• contextualize commissioning as a
means of place shaping and affecting
large scale culture change.
• cover how a countywide approach to
commissioning exercise referral,
exercise for older people and those
with disabilities will contribute to the
prevention of long-term disease.
www.hertsdirect.org

3. The key messages from Herts experience
• 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
www.hertsdirect.org

4. 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
www.hertsdirect.org

5. Premature
deaths in
Hertfordshire
www.hertsdirect.org

6. Some issues
• On the whole we do better than England
• Look below that though....
• 11 year gap in life expectancy between richest
and poorest
• Significant avoidable disease, disability and
death
www.hertsdirect.org

7. Obesity
www.hertsdirect.org

8. www.hertsdirect.org

9. www.hertsdirect.org

10. Where we want to get to
www.hertsdirect.org

11. But...
• 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
• How on earth do we get there?
www.hertsdirect.org

12. 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
www.hertsdirect.org

13. 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
www.hertsdirect.org

14. 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
www.hertsdirect.org
• 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

15. Value of CLOA advice to us
• Consultancy through 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
www.hertsdirect.org

16. Answer
• Use a modified commissioning approach to start
building a framework
• Build a framework which incorporates 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
www.hertsdirect.org

17. 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
www.hertsdirect.org
• 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

18. 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
www.hertsdirect.org

19. 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)
www.hertsdirect.org

20. Commissioning cycles....various models
• World Health Organisation Planning Wheel
• Kellog Foundation Planning Cycle
• DH Commissioning Cycle
• Hybrid model based on what local areas seems
to be using......
www.hertsdirect.org

21. Using a (very) Simplified Commissioning Cycle
www.hertsdirect.org
Plan
Monitor
Review Need
for Service
and
Effectiveness
of existing
services
The Commissioning Contract
Cycle
This is used just to introduce the concepts of what PH can help you
with.

22. Community
Engagement
www.hertsdirect.org
Plan
Monitor/
Evaluate
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
Check whether plans equate
To evidence and need and
Test for equity / inequity
Model whether need will
Be met by proposed
volume
Support in establishing
meaningful indicators of
delivery and outcome
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

23. 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
www.hertsdirect.org

24. 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
www.hertsdirect.org

25. 3. Strategic Commitment and Priorities
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

26. From the Annual Report
www.hertsdirect.org

27. Step 4: Commission Framework
Brings all of these strategic priorities mentioned above in one
place, in one framework agreed by everyone
• 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
www.hertsdirect.org

28. Step 4: Commissioning Framework key priorities
 Addressing drivers and barriers to participation including accessibility and affordability.
 Strengthening strategic coordination, communication and cross-service planning for physical activity and
its delivery by unlocking resources and aligning with agreed priorities.
 Improving targeted provision to those who are most sedentary and inactive and therefore at risk of ill-health
as a result.
 Increasing participation in the context of the current financial and economic climate (where appropriate
budgets are constrained).
 Improving understanding of the benefits of physical activity and the contribution it can make to many local
priorities including health improvement and preventative health.
 Improving monitoring and evaluation of physical activity provision, linked to identified outcomes.
 Influencing local planning, environmental and transport policy to create more active environments in new
housing, schools and other developments and create more active environments.
 Increased understanding and inclusion of physical activity and sport to help address local priorities.
 Adoption of Proportionate Universalism to reduce health inequalities and support of the nine protected
characteristics to address equality.
www.hertsdirect.org

29. 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
www.hertsdirect.org

30. 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

31. 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
www.hertsdirect.org

32. 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
www.hertsdirect.org

33. A further selection of work
• 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

34. 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
www.hertsdirect.org

35. Year of Walking – 2015 - 2016
• Be ambitious
• You are a public
health army
• You are vital in
cultural change
• We want to work with
you
www.hertsdirect.org

36. 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