The 'Walking the way to Health' Initiative, which the Agency is implementing with the British Heart Foundation, is getting people to walk more, both in parks, greenspaces and in the countryside. Its emphasis on communities with relatively poor healt...
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Countryside Access and the Health Connection (AP02/25)

Principal Manager Responsible: Roger Ward Lead Board Member: Luna Frank-Riley

FOR  DECISION

  • to approve the Agency's participation in a new pilot project with the Department of Health and Sport England to promote physical activity leading to better health outcomes, using the countryside and other recreational assets to increase participation;
  • to contribute a total of £900,000 to this project over the period 2003/04 to 2005/06 and to participate in its' development and management.   

Relevance to Strategy and Corporate Plan:

  • this project supports the Countryside on Your Doorstep strategy aim of helping everyone to enjoy the countryside and greenspaces near where they live. It will also be a practical and early contribution to the emerging new theme in the draft 2003/04 Corporate Plan about showing how the countryside can deliver health and well being benefits for everyone.   

Staff and financial implications:

  • One part time countryside officer post, for up to 3 years, will be dedicated to oversee the Agency's interest in this project and will be managed from within the 'Walking the way to Health' team. Re-deployed support costs will pay for the staff time. Programme costs will be found from recycled funds within the relevant programme of the new Corporate Plan.   

Main issues to concern the Board:

  • The principle of this joint venture and our capability to mainstream it if successful. 
  • The effort we should put into influencing the Department of Health, NHS and the education sector to promote countryside activities as a major source of free physical recreation leading to improved health outcomes.
  • How can we best ensure that the countryside, particularly in and around towns, is seen as the "natural" place to improve health and well being?
  • Are there other areas of work we should be pursuing to advance this agenda?   

Background

1. The countryside is a popular and appealing location for a wide range of leisure activities. Half of all visits take place within five miles of home, and with three out of the four people living in urban areas, this demonstrates the importance of local countryside in and around towns. Yet, despite the local countryside offering free, accessible and convenient opportunities for a wide range of leisure activities, four in ten people in a typical year do not make use of the countryside. It is important that opportunities to be active in the countryside are promoted and offered to everyone who wants to enjoy it.

2. Lack of use of the countryside by certain groups contributes to sedentary lifestyles which are one of the major causes of high levels of coronary heart disease, stroke and diabetes. It also highlights the need to make the countryside more accessible to everyone.

3. The 'Walking the way to Health' Initiative, which the Agency is implementing with the British Heart Foundation, is getting people to walk more, both in parks, greenspaces and in the countryside. Its emphasis on communities with relatively poor health is giving the Agency a track record of working with people who rarely visit the countryside. These people tend to be subject to health inequalities measured by life expectancy and length of life free from serious medical conditions. Health inequalities are a major driver for Government health policy.

4. The Department of Health recognises that increased levels of physical activity, especially walking, can help achieve many of its own health targets. Sport England too, recognise the importance of sport for health and are keen to see an increase in activity rates. Our officers have been in discussion with the Department of Health and Sport England for some time to see if a synergy of interests could be realised around the themes of countryside, sport and health inequalities. Sufficient agreement was reached in May for the then Public Health Minister, Yvette Cooper, to announce the outline of a pilot project (originally called the Community Health Initiative). An interim report was given to the Board in July. Since then negotiations have made sufficient progress for officers to seek Board approval now.

What can our participation in this pilot project deliver for the Agency?

5. The Agency wants to get more people enjoying the countryside and greenspaces near where they live. We are already seeking to improve the infrastructure for walking, cycling and other activities as well as boosting the confidence and awareness of groups such as ethnic minorities and disabled people. Motivational triggers such as personal health benefits may also play a part in opening up the countryside to more people.

6. We have evidence from research and experiments that some people need help to overcome the barriers they face in wanting to walk or take part in other countryside activities. And we know some, but not all, of the solutions to overcome these barriers. The unique aspect of this project is in bringing together expertise from the health, sport and countryside sectors. Together we intend to achieve more than by working in isolation. And what we learn will complement our knowledge from 'Walking the way to Health'. 

7. In the short term we can use this pilot project to demonstrate how the countryside, greenspaces and paths near where people live can contribute to government health targets. The project will contain at least three pilots that focus on countryside activities such as walking, cycling, informal games and sports, voluntary conservation work. Each will be located in a different countryside location - the urban fringe of a major city; in and around a market town and a cluster of remote rural communities.

8. In the medium term, if successful, we will use the results and our increasing profile with the health sector to encourage the Department of Health, and others, to make the promotion of countryside activities part of their core work on preventative health. We have built into the project sufficient time to work out how to mainstream the successful elements.

9. The outcomes of this pilot project for the Agency are likely to be:

i) more people (estimated minimum of 150,000) being able to enjoy their local countryside and greenspaces in the pilot areas;ii) further insights into the reasons which encourage or discourage people from using the countryside which will make a useful contribution to the Diversity Review;iii) an enhanced track record for the Agency in countryside/health projects which will help our prospects for succeeding in any future health related bids to Lottery Distributors; iv) a clearer rationale and motivation for local highway authorities to maintain and improve their rights of way networks: andv) a raised profile for the countryside as a health enhancing resource which may lead to new opportunities to work with the health sector.

What the Pilot Project will do

10. The aim of the project is to test new ways of encouraging adults and children to become more physically active in their own communities by using their local countryside, greenspace, formal and informal recreation and sports facilities. It will:

  1. support nine community based pilots (one in each of the nine government regions across England, including at least three concentrating on the countryside and countryside activities);
  2. gather hard evidence about the effectiveness of techniques used in the pilots to encourage people to become more active; and
  3. share good practice to encourage the wider implementation of the ideas.   

11. The pilots will be located in disadvantaged areas where health outcomes are poorest and where participation in sport, exercise and use of the countryside for recreation is particularly low. Pilots will be led by Primary Care Trusts (PCTs) - the new local tier of the NHS which has responsibility for many front line health services as well as preventative health. The PCTs will work with local strategic partnerships including local authorities, community groups and the owners of land or facilities. The overall aim will be to encourage Primary Care Trusts to mainstream community based programmes to promote physical activity.

12. The project will be managed by the Department of Health, within their Cardiovascular Disease and Cancer Prevention Branch, using a dedicated national co-ordinator. The Agency's interests will be secured through the dedicated countryside officer working with the co-ordinator. Other staff will be active members of the steering and management groups.

13. The new project now carries the working title of LEAP ( Local Exercise Action Pilots) - previous discussions with Board members used the earlier working title of the Community Health Initiative.

Financial and Manpower Consequences

14. A budget of £2.6 million has been tentatively agreed. £2 million is planned to be spent on the pilots and £600,000 set aside for national costs including evaluation, training and disseminating the results. The Agency's contribution of £900,000 will be allocated to the three pilots that will focus on the countryside, and will also contribute to the national costs. These resources will be found from recycled resources from the relevant programme of the new Corporate Plan and will be spread over three years, starting in 2003/04. 

15. A part time countryside officer post will represent the Agency's interests, managed from within the 'Walking the way to Health' team. 

Next Steps

16. Subject to the Board's agreement we will negotiate a Service Level Agreement with the Department of Health and Sport England setting out responsibilities, management arrangements and outcomes so that we ensure the Agency's interests are properly represented. The intention is for the project to last for three years, commencing this Autumn, with the individual pilots having a minimum of two years of activity.

Risks and Mitigation Measures

17. The main risks and mitigation measures are:

  1. The pilots may not yield much that is new. We will ensure the pilots have sufficient resources and access to experience from elsewhere, including 'Walking the way to Health' (WHI). We will ensure close contact and support through our dedicated post. If the results are not materially significant this may well encourage the Department of Health and the NHS to take over and mainstream WHI in its present form, rather than buy into a more widely based approach to promoting physical activity.
  2. The pilots may all end up in urban areas. We have stipulated that three pilots should be in countryside / urban fringe areas. We will have a place on the group that selects the pilots. We will ensure the selection represents all funders' interests.
  3. It may be difficult to measure the outcomes of the pilots.  We have set aside a significant part of the budget for local and national evaluation work so that we can obtain meaningful results.  Department of Health and Sport England are also very focused on the evidence based  approach to  policy making. 
  4. Partnership working with the Department of Health and Sport England may be difficult and ineffective. We  will  play an active part in the management of the project and escalate to Chief Executive/Chairman level if we cannot secure adequate outcomes for the Agency. Building a new partnership is not likely to be easy but the potential rewards of building a successful relationship are significant.   

Recommendations

18. The Board is asked to:

    1. approve the Agency's participation in a new pilot project to promote physical activity with the Department of Health and Sport England;
    2. agree to an Agency contribution of £900,000 over the period 2003/04 to 2005/06, which is provided for in the draft corporate plan using resources recycled within the relevant programme.