Our Journey

The Starting Point

In 2019, the Integrated Care System spotted the opportunity offered by increased physical activity to improve population health, tackle health inequalities and reduce the burden on the NHS.

A system-wide strategy for Physical Activity for health and social care , All Together Active, was commissioned by the Integrated Care System Population Health Board, developed by Active Cheshire and MSP in conjunction with place-based and subregional partners – capable of improving physical activity levels at scale.

Research, engagement and strategic alignment

To develop firm foundations for the strategy, we set up a Physical Activity Board of relevant experts and stakeholders (both local and national). This included representatives from public health, primary care, secondary care, education, academia, the voluntary sector, the sport & leisure sector and more.

The Board guided us along a roadmap of key milestones that included:

Exploring local data
Mapping physical activity systems
Identifying opportunities for Place-based collaboration

Research

We also commissioned academic research to establish the evidence base for what does and doesn’t work, linking with Place-based priorities.

Engagement

Local engagement with organisations and with individuals facing health inequalities highlighted both the complexity of the task and a phenomenal appetite to get stuck in and make it happen.

Strategic Alignment

Nationally, All Together Active aligns with strategies such as the NHS Long Term Plan and Sport England’s 10-year Uniting the Movement strategy. Locally, All Together Active aligns with the four ICS strategic priorities and supports implementation of the Marmot Principles. There are also strong synergies with Place strategies and other local initiatives such as Joint Strategic Needs Assessments (JSNAs), Health & Wellbeing Board Plans, Place-based Partnership Plans and Local Cycling and Walking Infrastructure Plans (LCWIPs).

In building the strategy, we have worked closely with both local and national organisations including Champs Public Health Collaborative and Sport England.

Core themes and opportunities emerging from our engagement

Engagement identified a number of themes and opportunities consistent across our Places, and these themes form the core of All Together Active. Each Place will lead on how this strategy is implemented in their area, aligning activities to local priorities, resources and building on the great work already happening.

Some themes may change over time, as needs evolve and we learn more. Nonetheless, the initial themes give the initial direction for work towards a whole-system approach.

Taking a Full Life Course Approach

The most effective way to reduce health inequalities is by taking a full life-course approach. The strategy therefore covers every life stage, prioritising the most vulnerable groups within each stage.

Start Well

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Live Well

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Age Well

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Building Active Environments

Building active environments will be essential for success.

In taking a system-wide approach to physical activity, All Together Active considers each of the following:

The settings that inactive people move through in their daily lives where we can have an influence.
How these environments impact on health, choices and behaviour.
How we can make it easy for inactive people to change behaviours and increase activity levels in these settings.

At Home

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Active Travel

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In the Community

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Work and Education

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Health & Social Care settings

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Key Common Opportunities

All Together Active will collaborate with each Place to consider how the key common opportunities emerging from engagement could be used to tackle local priorities.

Integrating physical activity into care pathways

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Encourage more inclusive access to walking

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Maintaining physical activity for healthy ageing

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Supporting mental health

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Tackling loneliness and social isolation

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Making It Happen

The Starting Point

Taking a Full Life Course Approach

Building Active Environments

Key Common Opportunities

Get Involved

If your organisation would like to be involved in progressing the work at a local or a subregional level then get involved today!

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Start Well

A good start in life is widely recognised as a crucial determinant of long-term physical and mental health (All Together Fairer, 2022). Being active plays a key role in this good start, both within and beyond the education system.

All Together Active takes a whole-family approach to identifying opportunities where physical activity can support healthy development, from building physical activity into support for new parents and babies through to offering movement and sport opportunities for vulnerable young people.

Positive outcomes here include:

Healthier families in which higher levels of activity are the norm.
Less childhood obesity.
Improved mental wellbeing for young people suffering mental health issues.

Live Well

Physical activity can ease many of the physical and mental health challenges faced by adults of working age - and especially by those living in the most disadvantaged areas. Unsurprisingly, there are strong correlations between higher healthy life expectancy and higher employment rates (the Health Foundation, 2019).

Positive outcomes here include:

Better management of long-term health conditions such as diabetes and hypertension.
Improved wellbeing for those suffering mental health problems.
Increases in fitness that enable people to gain and retain employment more easily.

Age Well

Supporting people to maintain good health as they get older is a major priority across the subregion, with even small health gains helping people to be happier and more fulfilled. Physical activity contributes to this in multiple ways. Importantly, because older adults tend to access health and social care services more readily, small improvements at an individual level can significantly reduce pressure on teams and services.

Positive outcomes here include:

Improved management of long-term health conditions resulting in reduced NHS demand.
Maintaining physical activity levels to increase independence and reduced social isolation.
Reversal of deconditioning (made worse in many cases made by the pandemic).

At home

The health and social care system supports a wide range of people in their home environment. These include older adults, disabled people and those with a long-term health condition (all of whom who may spend more time at home than others) as well as young families. This gives us opportunities to help and encourage inactive people to move and exercise more, supporting independence, preventing deconditioning, and increasing quality of life.

Active Travel

Day-to-day travel creates natural opportunities for walking, wheeling and cycling. We will build on the excellent work being led by colleagues in transport and planning to make active travel a feasible, safe and attractive option for part or all of as many journeys as possible. We aim to establish active travel as the norm across all ICS and partner estates for staff, partners, and patients.

In the community

The voluntary and community sector is a vital partner and asset for health and social care, offering a wide range of services and opportunities for physical activity. All Together Active will strengthen relationships with the sector and build more and better referral pathways (including through social prescribing) to connect people with local opportunities. We will also partner with community organisations to help them secure funding and build sustainable capacity.

Work and Education

Workplace health and wellbeing is a priority across much of the region. Again, physical activity can be an important tool. The impact of the growth in home working on levels of activity must be recognised. The Integrated Care System and other anchor institutions will lead by example in becoming active workplaces, making the most of every opportunity to use physical activity to enhance the health and wellbeing of staff, partners, and patients. We will also work closely with workplaces and education settings across the subregion to share learning about what proves most effective.

Health and social care settings

Health and social care settings give us a key opportunity to engage with those who face the greatest health inequalities. We will build physical activity into the fabric of these settings, through policies and processes, patient consultations, treatment pathways, and staff, carer and partner wellbeing. We will ensure all stakeholders get appropriate training and support so they can embed physical activity into day-to-day practice.

Integrating physical activity into care pathways

The evidence base shows that integrating physical activity into care pathways delivers clear benefits.

We want all our healthcare practitioners to consider the potential of physical activity to be an effective and accessible medical solution across every aspect of patient care. We also want to see practitioners and community organisations become System Leaders in physical activity for health. Improving referral pathways into community organisations will be crucial. Success here will require providing adequate training, support and capacity.

Encouraging more inclusive access to walking

Stakeholder and public engagement across all 9 Places showed that walking (or inclusive alternatives) is one of the easiest and most accessible physical activities. The opportunity to be outdoors and connect with nature was also seen as a major benefit for mental health and wellbeing whether alone, as part of an organised group, or with family, friends and colleagues.

Maintaining physical activity for healthy ageing

All Together Fairer highlights that in parts of Cheshire and Merseyside, healthy life expectancy is significantly below the national average, with women faring worse than men. Living in poor health takes a significant toll on quality of life, limits people’s ability to contribute to their communities, and results in significant costs for health and social care. We want to use physical activity to its full potential to reduce the need for treatment, minimise demand on social care, allow people to retain their independence, and improve quality of life as people age.

Supporting mental health

According to Mind, the equivalent of more than 675,000 people will experience a mental health problem in the next 12 months, across Cheshire and Merseyside. Amongst secondary school pupils, almost 1 in 7 are now thought to have a mental health disorder. Across Cheshire and Merseyside, a quarter of GP appointments are for a mental health related issue. The evidence base for physical activity as a tool to support good mental health is growing. By increasing physical activity levels, we will play a key role in turning the tide on the mental health crisis.

Tackling loneliness and social isolation

Loneliness can affect anyone. It has a significant impact on wider health & wellbeing and is a growing problem across the region. 25% of adults across Cheshire and Merseyside feel lonely always or some of the time, and data (Sport England, November 2021) shows that 16-24 year olds are affected just as much as older adults. Being active with others presents a significant social opportunity to reduce loneliness, allowing people to form new relationships and access social support.