Jim McManus, OCDS, CPsychol, CSci, AFBPsS ,FFPH, FRSPH

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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

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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 persons messy is anothers inclusion
• This is a work in progress - 20m and counting
  investment in physical activity and sport

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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

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Premature deaths in Hertfordshire
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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

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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

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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

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Value of CLOA advice to us

• Consultancy through cCLOA
• Report and Mapping
• Steps to an at scale system
• Build a commissioning approach
• Public Health monies enable the existing system,
  dont replace
• Improve and Build, dont restart
• Very valuable recommendations and advice

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Answer

• Use a modified commissioning approach to start
  building a framework
• Build a framework which incorporates cCLOA 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

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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

• 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

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Steps to a commissioning approach much done in
parallel
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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)

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Public Health Input into the Commissioning Cycle
Needs Assessments Equity Auditing Evidence of
Effectiveness Health Impact Assessment
Triangle of critical influence where public
health should be most visible
Check whether plans equate To evidence and need
and Test for equity / inequity
Triangle of critical influence
Plan
Model whether need will Be met by proposed
volume
Community Engagement
Review Need for Service and Effectiveness of
existing services
Contract/Deliver
Triangle of critical influence
Monitor/ Evaluate
Support in establishing meaningful indicators of
delivery and outcome
Support and advise on Evaluation and conduct Bits
of it if enough resource
Public Health Input into the Commissioning Cycle.
Can be throughout or can be on specific areas
playing to the PH strengths
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The principles of our commissioning approach in
Herts building the house while living in the
foundations

• Build a system from the best we have, dont
  reinvent
• Transformation through phases and staged redesign
• See potentials, not problems
• See Potentials not Problems, assets as well as
  needs
• Subsidiarity
• Co-production
• Behavioural Sciences
• Pathwayed

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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
6. Strategic Shift to Prevention Report 2014 all
   agencies signed up
7. Public Health Strategy
8. Sustainable Transport Strategy
9. Being written into NHS Clinical Strategies

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Step 4 Commission Framework
Brings all of these strategic priorities
mentioned above in one place, in one framework
agreed by everyone

• cCLOA 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

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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

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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-Spo
  rts 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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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

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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

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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 weve 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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Thank you!

• Jim.mcmanus_at_hertfordshire.gov.uk
• Public Health page
• http//www.hertsdirect.org/your-council/hcc/public
  health/
• Free learning resources for public health
• www.hertsdirect.org.uk/phelearn