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
The key messages from Herts experience
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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
www.hertsdirect.org
Challenges
• Large County
• Distributed infrastructure for
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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
www.hertsdirect.org
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
Problems and risks
• Not joined up
between primary care
and rest of sectors
well enough
• Distributed system
• Variable pathways in
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• Distribution of
inactivity and disease
and disability
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• Facing multiple fronts
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– Sports world
– Health world
– Public Sector world
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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 cCLOA
• 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
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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
www.hertsdirect.org
cCLOA
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Work – mapping exercise findings
Build on community initiatives:
Promote successful low-cost
community models for participation
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Design better signposting/navigation
systems to improve access
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“Personalise” the process of
introducing inactive people t
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Use commissioning cycle to
strengthen the connections between
health (including mental health) and
physical activity, and demonstrate this
in contracts
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“Improve the exercise-on-referral
programmes
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pathways along with clinicians and
providers
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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 Assessment
2. Governance –multiple commissioners
3. Clear shared priorities
4.Commissioning Frameworks
5. Commissioning and Delivering
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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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Needs Assessments
Equity Auditing
Evidence of Effectiveness
Triangle of critical
influence – where public
health should be most
visible
Health Impact Assessment
Triangle of
critical
influence
Check whether plans equate
To evidence and need and
Test for equity / inequity
Plan
Model whether need will
Be met by proposed
volume
Community
Engagement
Review Need for
Service and
Effectiveness of
existing services
Contract/Deliver
Monitor/
Evaluate
Triangle
of critical
influence
Support in establishing
meaningful indicators of
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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Support and advise on
Evaluation and conduct
Bits of it if enough resource
delivery and outcome
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
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Step 3: Clear Shared Priorities
1. the Lifestyle and Legacy Partnership (formerly the Olympic legacy
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partnership) bringing 40 agencies together
each district council strategy and there are multiple services
University in Sports Science
Sports Partnership Plan and Stategy
Health and wellbeing Strategy
1. Strategic Shift to Prevention Report 2014 all agencies signed
up
Public Health Strategy
Sustainable Transport Strategy
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
www.hertsdirect.org
Whats going on now – a selection 1
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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
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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
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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
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…
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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
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
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