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Talking point: Activating the NHS

The NHS’s new long-term plan offers worryingly little detail on how the government plans to use physical activity to prevent serious health issues. Why is the government not utilising physical activity? And what can we do to change this? Steph Eaves asks the experts

by Steph Eaves, Health Club Management and Sports Management | Published in Sports Management 2019 issue 1
Read on turning pages | Download PDF of this issue
Activating the NHS / © shutterstock/Monkey Business Images
Activating the NHS/ © shutterstock/Monkey Business Images

Duncan Wood-Allum Managing director, SLC
Just do the right thing, says Duncan Wood-Allum

The NHS is currently structured and funded primarily around treatment, rather than prevention. With a government that cannot spare any quality thinking time on anything other than Brexit, I wasn’t entirely surprised to see the lack of foresight in this new long-term plan for the NHS.

Silo-based thinking has been the hallmark of central government for most administrations in recent memory. Prevention and whole-systems-thinking are still in their infancy in the eyes of many in government who want to see results in 18 months, not wait for 18 years. Why? Lack of leadership, exacerbated by a lack of resources and increased demand on primary and secondary care.

So, what can we do to change this? We can continue to lobby, provide great case studies of good practice and work with partners to influence key stakeholders. However, I strongly believe that we shouldn’t wait for government to tell us to do the right thing. Just do the right thing, consistently and relentlessly, and communicate the benefits through evidence.

"To many key decision makers, the sports industry is inconsistent in its messaging and commitment to health"

What does this look like? My thoughts are this: public sport and leisure provision is an intervention, not a replacement of the private sector, so let’s intervene more where the market fears to tread. Let’s help inactive and less active people stay active and well.

This can be funded in the short term through the sector being more effective and efficient at asset management, outreach and interventions. There are numerous examples of recent partnerships secured between leisure operators and their local authority partners, which are prepared to invest in sustainable services. Longer term, this funding should also come from other partners who see our sector as a key contributor to wider strategic outcomes.

However, to many key decision makers in government, the NHS and Public Health, we are inconsistent in our messaging, behaviors and commitment to health and wellbeing. One example of this is leisure operators who insist on selling unhealthy junk food and drink. We should be part of the solution, not the problem.

Steven Ward Outgoing CEO, ukactive
More investment in our sector is needed, says Ward

We welcome the focus on prevention, mental health and technology in the NHS Long Term Plan, and its recognition that a lack of exercise is a leading cause of premature death.

Despite the plan’s references to exercise, there has been disappointment at the lack of detail on precisely how physical activity – including sport – will play a part in this vision. Clearly, the plan is designed to re-model NHS frontline services within the community, rather than address public health in its entirety. However, this re-modelling does promise a healthcare pathway directly to our door.

The NHS Comprehensive Model of Personalised Care reflects ukactive’s call to use social prescribing to improve prevention and rehabilitation, with 2.5 million more people set to benefit within five years.

The physical activity sector stands ready and armed with the capacity and motivation to ensure success in this area.

We recognise how our sector can both impact and benefit from social prescribing. Our role now is to help the government to realise the full potential of our services, and at the same time educate our sector so there is a clear understanding of how social prescribing can be fully inclusive to the wider physical activity sector.

While we recognise the opportunity within social prescribing, we do remain concerned that £1bn has been taken out of public health spending since 2015, with further cuts of more than 4 per cent in real terms planned for the year ahead.

"Our role now is to help the government to realise the full potential of our services, and at the same time educate our sector to understand how social prescribing can be fully inclusive to the wider physical activity sector"

Government must match ideas with action, and that means investment. Physical inactivity causes more than 37,000 premature deaths each year, so we need to support our most vulnerable populations to be more active: disadvantaged communities, children and elderly people. Nobody is better placed to provide this support than our sector.

The government is in possession of three proposals with the potential to transform our nation’s health: a £1bn capital investment programme for Wellness Hubs; a Workout from Work scheme, which expands Cycle to Work to include gym passes and fitness equipment; and a plan to reimagine schools as community hubs, using empty facilities as places to support family health, education and care.

ukactive is ready to work with the government to realise our sector’s role in delivering against this plan and elevating the importance of a holistic approach to health. These conversations are ongoing and we must continue to demonstrate how we can provide a truly preventative solution.

ukactive has submitted a proposal to the government for a Workout from Work scheme, which expands Cycle to Work © shutterstock/goga18128
Andy Reed Director, Sports Think Tank
We have failed and need to learn from this, says Reed

The NHS’s new long-term plan has worryingly little detail on the government’s plans to use sport and physical activity to prevent obesity and other health issues related to inactivity. In fact, it was conspicuous by its absence.

We have made progress as a sector – the NHS’s own guidance on its website has great advice on the benefits of exercise – it’s just a pity this recognition didn’t make the pages of the 10 Year Plan.

We obviously need to redouble our efforts to convince policy makers of the value and contribution of physical activity to reducing the burden on the NHS and helping us all to live longer, healthier lives. We have to admit that, despite all the progress at moving this subject up the agenda and gaining more profile in the media, it still isn’t central in policy makers’ eyes. We have failed and we need to learn the lessons and come back stronger in our advocacy and evidence.

"Stopping people doing things like smoking, gambling and eating unhealthy foods is a simple proposition. Our offer is a tougher behavioural change"

Having taken time to listen to policy makers and why we are not making the impact we like, it comes down to four areas: i) Our evidence base is better but still not consistently good enough for the impacts we claim; ii) Our offer is fragmented and confusing to those outside the sector; iii) We are still not clearly differentiated from the obesity issue; and iv) We have convinced some policy makers but our reach isn’t wide enough to win the battles inside the machinery of government.

A general point also is relevant for us all. Stopping people doing things like smoking, gambling and eating unhealthy foods is a simple proposition. Our offer is a tougher behavioural change.

More evidence is needed to convince policy makers of the benefits of sport and physical activity © shutterstock/Monkey Business Images
Emma Boggis Outgoing CEO, Sport and Recreation Alliance
Emma Boggis

It is positive to see that prevention has been given such a focus in the NHS long term plan, but we are disappointed that there is no mention of physical activity and its role as a preventative measure. We have previously highlighted our frustration that physical activity remained largely ignored in Chapter Two of the government’s Childhood Obesity Plan last year. We strongly feel that the role of activity interventions must be recognised if we are to truly create a healthier nation.

For example, the plan states that cardiovascular disease has been identified as the single biggest area where the NHS can save lives over the next 10 years because it is ‘largely preventable’. But, despite the evidence, there remains no explicit mention of the role physical activity can play in reducing the risk of cardiovascular disease, yet alcohol misuse, smoking addiction and food reformulation are included instead. The Alliance is committed to working with government to drive greater collaborative working and helping to relieve the strain on the healthcare system, but until there is acknowledgement of the importance of physical activity, we believe that only part of the problem is being solved.

"There were plenty of positive signs in the report but we now need to see positive action"

The development of the long-term plan through detailed consultation with the public and varied stakeholders is also a welcome change, as is the creation of an NHS Assembly.

There were plenty of positive signs in the report but we now need to see positive action. We need improved, collaborative working across government departments with our politicians recognising the impact that inactivity is having on society. Funding improvements focusing on preventative measures will result in less pressures on the health care system in the future.

To give a specific example, we welcome the investment made by Sport England in the Moving Medicine programme to help upskill healthcare professionals to talk to patients about the benefits of physical activity – but would question whether this would better be fully funded by the Department of Health and Social Care.

Physical activity was also ignored in the Childhood Obesity Plan © shutterstock/Pressmaster

In light of this, we were pleased to see the Sports Minister say in her speech on 12 February that she will be working with her colleagues to ensure that future spending decisions take into account the huge benefits that sport and physical activity bring.

However, this is an incredibly urgent and expensive issue, it should be tackled by the government with the highest priority and given the same importance as any other issue.

The role of physical activity interventions must be recognised if we are to create a healthier nation, says Boggis © shutterstock/Caftor
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