Commissioning support for local authority sport and physical activity services

5 December 2014

Aim of this session

• To understand the context in which the cCLOA/Sport England commissioning project was undertaken

• Outline the process and activity undertaken

• Share the learning from the mapping stage

The commissioning cycle

Priorities

Needs

Resources

Userscommunities

Deliveryoptions

Procurement

Review

Monitoring

Delivery

Review Analyse

Plan Do

Commissioning is… the strategic activity of identifying needs and allocating resources to best meet that need, within available means.

Commissioning combines… effectiveness with efficiency – the best possible outcomes within the resources available.

It is not…the same as purchasing – which is the process of securing or buying services.…or as contracting which is the means by which that process is made legally binding.

These are commonly referred to as procurement – a small though very important, component of commissioning.

What is commissioning?

Observations: how is the sport sector responding to commissioning?

• Overall slow to understand and engage in commissioning– results are patchy

• More focus on procuring efficient sport & leisure service than the service being commissioned by others

• Austerity and health/social care reform offer huge opportunities for the sector to be part of wider service transformation

• There are huge risks if commissioning is seen as “a dash for cash” rather than delivering shared outcomes

The commissioning cycle

Priorities

Needs

Resources

Userscommunities

Deliveryoptions

Procurement

Review

Monitoring

Delivery

Review Analyse

Plan Do

Sector mainly found here

Project Aims/Objectives• Increase understanding of the commissioning

agenda• Improve the ability of the sector to engage as a

strategic partner– building relationships with commissioners– helping identify how the service can hone its

offer• Share the learning

The commissioning cycle

Priorities

Needs

Resources

Userscommunities

Deliveryoptions

Procurement

Review

Monitoring

Delivery

Review Analyse

Plan Do

Sector mainly found here

Sector needs to be seen here

The process Scoping• Diagnostic assessment of current baseline in terms of

commissioning relationships, existing contracts, partnerships and strategic positioning

• Assessment of the current situation within the sport and leisure sector in the local area – delivery mechanisms, awareness, capacity, strengths and weaknesses, track record, change and prospects

• Identification of key players and who to work with and plan programme

Mapping • Desk research • Interviews with senior commissioner and cabinet • The mapping document

Observations – the commissioners

Need to offer solutions that have a much wider reach – industrial scale

The leisure centre model is too constraining – promoting physical activity to deliver health improvement and prevention is not necessarily asset based.

Need to quality assure the offer Need to offer

innovation and be innovative

Advice – the commissioners

Come and talk to us – show us what can be done and make a

difference

The process

Awareness raising with the team• Understanding commissioning and the local picture• Preparing an outcomes framework• The opportunities and implications

Follow –up with commissioners• To explore issues further• Build relationships• Identify actions

Review and plan• Action Plan • Case study • Final report and lessons learned

• Actions plans finalised

• Case studies

• Evaluation report – early next year

• Dissemination of learning

Project next steps

Overview

• Commissioning work undertaken to date, some learning

• Some examples of what is working where traction achieved

Building on existing guides produced by cCLOA

-Adult social care

-Crime and anti social behaviour

Developed through wide stakeholder engagement across sport and cultural sectors

Commissioning Work: Sport and Active Lifestyles and contribution to Health outcomes

•West Yorkshire pilot•National pilot• Leeds perspective

Trying to work smarter with Health locally

• Making links with Health and Well-being Boards• Working with CCGs• Working with Leisure Operators• Understand how funding is allocated• Lifestyle and behaviour change approaches• Skilled and talented workforces• Improve positioning through better data and

championing

West Yorkshire: The need for transformation

‘If an older person has difficulty getting out of their chair, the response is to see if they need chair raisers to help them. Increasing physical activity or increasing the motivation to move would not be part of their care pathway’.

‘Our council has very high rates of sickness absence – double that of our neighbouring authority. Addressing this focuses on the tools and systems of sickness absence monitoring rather than looking at promoting health and wellbeing in our workforce. We need to look at things differently’.

‘Physical activity doesn’t feature in the council. The Dementia Strategy doesn’t mention physical activity. The Health and Wellbeing strategy didn’t include physical activity’.

‘ Whilst there is a willingness to address smoking prevalence and drug and alcohol abuse, the prevailing view is that exercise and physical activity are matters of personal choice and the culture is that councillors and managers don’t want to talk about it’.

‘There is no collective vision or ambition around this issue - just a few lone voices’.

 

‘Physical activity is part of the solution to so many conditions. Exercise is better than any medication’.

West Yorkshire: Findings• Unlimited opportunities• Low awareness of the sport and physical activity

offer – and limited contact outside public health• Limited understanding of the benefits in medical,

social and economic terms• Increasing concern about the costs of inactivity –

nationally• We are not seen as part of transformation

cCLOA/Sport England pilotsInterim Observations and Learning

Opportunities• The importance and value of physical activity is now better

understood and accepted by the health and social care commissioners “physical activity is a win-win”

• Prevention is gradually gaining traction because of the long term costs of health and social care

• Mental health is a growing issue for commissioners• Better Care Fund, Integration Transformation Fund and

personalisation are driving innovation and new ways of working

• Workforce programme, worklessness, re-enablement, improved parenting, healthy children and drug and alcohol rehabilitation are just some of the opportunities mentioned by commissioners

Attributable fractions (%) for all-cause deaths in 40 842 (3333 deaths) men and 12 943 (491 deaths) women in the Aerobics Center

Longitudinal Study.

Cardior

espira

tory

Fitn

ess

Obesit

y

Smok

ing

Hyper

tens

ion

High

Cholester

ol

Diabe

tes

0

4

8

12

16

The main health risks in a population

Men Women

Axis Title

Att

rib

uta

ble

Fra

ctio

n %

Blair S N Br J Sports Med 2009;43:1-2

Attributable fractions (%) for all-cause deaths in 40 842 (3333 deaths) men and 12 943 (491 deaths) women in the Aerobics Center

Longitudinal Study.

Cardior

espira

tory

Fitn

ess

Obesit

y

Smok

ing

Hyper

tens

ion

High

Cholester

ol

Diabe

tes

0

4

8

12

16

Low Cardio-respiratory Fitness is the most

Men Women

Axis Title

Att

rib

uta

ble

Fra

ctio

n %

Blair S N Br J Sports Med 2009;43:1-2

We know that inactivity is a key issue

cCLOA/Sport England pilotsInterim Observations and Learning

Opportunities• The importance and value of physical activity is now better

understood and accepted by the health and social care commissioners “physical activity is a win-win”

• Prevention is gradually gaining traction because of the long term costs of health and social care

• Mental health is a growing issue for commissioners• Better Care Fund, Integration Transformation Fund and

personalisation are driving innovation and new ways of working

• Workforce programme, worklessness, re-enablement, improved parenting, healthy children and drug and alcohol rehabilitation are just some of the opportunities mentioned by commissioners

cCLOA/Sport England pilotsInterim Observations and Learning

Challenges and barriers• Sector is seen as a provider not a strategic player and

lacks visibility and connectivity with commissioners• Sector seen as income focused, facility focused,

more interested in getting the active more active than the inactive active & traditional in its service offers

• Still major data gaps in terms of evidencing impact and value for money nationally and locally

• Providers not commissioner ready – fragmented, independent quality assurance

• Perception that “sport” is exclusive and not relevant to those in greatest need

Leeds Perspective

• Current work with health and social care

• Commissioning brief focus

Engaging with Health and Well-being: Leeds City Council• Political support for

culture and Sport• Budget cuts

presenting opportunities as well as major challenges

• Relationship building

• Contributions include;– Service integration/Adult social

care– Older people– Reminiscence– Cardiac rehab– School sport and healthy

schools– Public health spend uplift

Culture and Sport contribution to Health and

Well-being

Day Care Integration

“I just wanted  to feedback a really positive story regarding the gym cards. We have a client who has been on an ATR

and in and out of alcohol treatment for many years. He feels that the Gym card has been the single most helpful thing to

help him stop drinking and stay stopped in all that time.

He has a history of mental health problems and feels that he is really aware of how exercise can improve his mental health now and has found it better than any mental health

treatment. Since getting a gym card he has been going daily and has benefited and now intends to keep accessing

the gym through Leeds Lets Get Active” 

Service Manager ADS Leeds

Leeds Perspective

• Focus of future brief– CCG interface– Locality dimension– Mental health

Learning points • Understand the landscape and the commissioners needs• Learn a new language ( and teach yours)• Better understand the difference between client/user demands and

client/user needs• Be more visible in strategic discussions –influence and be influenced• Win hearts and minds, but you still need evidence • Innovate and articulate offers that meet need• Independently quality assure your service• Build the capacity and capability to deliver• If looking at health - public health now accountable politically- service

alignment opportunities; consider Long term conditions focus; don’t think just public health: CCG critical

• Use the toolkit- it does help