The Active Ageing Project takes a system change approach to embedding physical activity, with a focus on the 55+ age group. The Active Ageing project is managed by Active Dorset but is a collaborative project led by all Our Dorset Integrated Care System Partners.
Dorset is a county in South West England covered by the 2 unitary authority areas of Dorset and Bournemouth, Christchurch and Poole (BCP). The county is part of an NHS integrated care system (ICS), known as ‘Our Dorset’, which is comprised of one NHS Clinical Commissioning Group, 6 NHS foundation trusts and Public Health Dorset.
Dorset’s population stands at just above 800,000 and is increasing. It is a largely rural area with no cities and few small towns. It has an ageing population, with the proportion of adults aged 65 and above much higher than the England average (28% vs 18%, respectively), and one third of the population lives with one or more long-term health conditions. The population has significantly lower levels of Black, Asian and Minority Ethnic residents than the national average (4.4% vs 19.5%, respectively). Almost 10% of the population live in the most deprived areas of England. Physical activity levels are largely comparable with the England average, although there are pockets where physical inactivity is high.
Whole systems approach to physical activity
Dorset has been developing its own whole systems approach to physical activity for many years. Investment from Sport England and local partners led to the establishment of Active Ageing - a whole systems approach to embedding physical activity for the 55- 65 population. Active Dorset collaboratively leads this work, and is one of 43 Active Partnerships across England, designed to provide a set of core services to strengthen the local delivery of physical activity. Whole systems work is integral to the Active Partnerships mission, which recognises that “[physical] activity levels are affected by a complex system of influences and no single organisation or programme [can] create sustainable change at scale.”
NHS support for physical activity is highlighted in the ‘Our Dorset: Sustainability and Transformation Plan’ (STP) and the ‘Dorset Integrated Care System (ICS) Operational Plan’. It has 3 inter-related programmes of work which are:
- Prevention at scale
- Integrated community services 6 Data presented in context sections are all sourced from resources listed in web links for each case study Engaging NHS system leaders in whole systems approaches to physical activity 45
- One Acute Network, with physical activity featuring most prominently in the prevention at scale programme of work, which aims to help people to stay healthy and avoid getting ill
Activities include: the development of a systematic physical activity programme; taking a whole school approach to increase physical activity levels; and, maximising the built and natural environment to improve health and wellbeing outcomes, including physical activity.
Another area of whole systems work, driven largely by collaboration between Active Dorset, Public Health Dorset, and the NHS CCG, is focused on 3 areas of physical activity promotion: primary and secondary care (targeted at individuals receiving advice from a health professional); workforce (targeted at public sector workers nearing retirement); and, localities and schools (targeting inactive parents and grandparents of children). The aim is to work across systems, care pathways and specialties to identify points in the system at which physical activity messages or interventions can be delivered; shifting the focus from individual-level behaviour change to a whole systems approach to physical activity.
A key activity has been the development of system changes at primary and secondary care levels. Examples of changes made to primary care pathways include: physical activity promotion training for all primary care staff; the inclusion of physical activity in the specification for commissioning of the National Diabetes Prevention Programme and re-commissioning of the NHS Health Checks programme. Efforts have also been made to embed physical activity into secondary care pathways, including cancer, musculoskeletal disorders, and pre-habilitation.
Whole systems working on physical activity in Dorset has been enabled by a variety of factors. Firstly, Dorset has benefitted from intensive input from Active Dorset in creating and influencing physical activity system change. This has occurred through the provision of physical activity-specific skills and expertise from Active Dorset to NHS and Public Health Dorset partners. Second, time has been essential for building trust and relationships across sectors. The presence of enthusiastic, committed and connected individuals working across local authority public health teams, the voluntary and community sector, and CCGs has been integral to progress. Further, the identification and engagement of key partners working in specific primary and secondary care speciality areas has created a sense of shared ownership and provided opportunities for shared learning across NHS care pathways.
Key challenges include the pace of change within the NHS and high levels of disruption in the system; this has resulted in physical activity promotion within NHS settings not always being seen as a priority. Second, physical activity is not traditionally considered or embedded when designing NHS services or pathways, or when commissioning programmes or projects; whole systems approaches to physical activity therefore challenge the status quo. Third, despite positive engagement from NHS systems leaders at some levels, the identification of ‘change agents’ within acute settings has been difficult to establish. This is coupled with the issue of limited capacity and financial resources, which has made it difficult for partners to work effectively across sectors.
The Dorset case study has shown that whole systems approaches to physical activity require time to build trust and relationships. It also highlights the importance of finding and working with enthusiastic and committed key partners from all sectors. The engagement of NHS systems leaders in whole systems approaches to physical activity may require a culture change, which moves away from the traditional medical model of care, to a place where NHS systems leaders are supported to consider and embed physical activity throughout treatment pathways.
Contacts Charlie Coward, Deputy CEO, Active Dorset (email@example.com)
Web links Active Dorset Strategy 2020-2025 [short version].Available from https://www.activedorset.org/active-dorset-strategy-2020-2025
Our Dorset Sustainability and Transformation Plan for local health and care. Available from https://www.dorsetccg.nhs.uk/project/stp/
Dorset Integrated Care System Operational Plan 2018/19 Refresh. Available from https://www.dorsetccg.nhs.uk/wp-content/uploads/2018/03/Dorset-ICS-Opera... Engaging NHS system leaders in w