The Leisure Review: February 2014

Is it just me that thinks there has been a flurry of documentation produced recently which state the blindingly obvious?

Physical activity is good for you, blah, blah, blah…

To the casual observer it might look as though the potential of physical activity to deliver in terms of health currency is increasing in a convincing way but I would say that many organisations are generating rain forest-depleting materials that yet again tell us being active is a good thing. We have known this forever.

We need to get smarter.

If you stand to one side, just out of the blinkered vision caused by years of failing to scan the horizon and learn from what works, it also appears that many continue to sing evangelically, but not in unison, about the Utopia of getting more people active: reduced health costs, improved social harmony, a tier of educational outputs never before seen, all acting as the binding agent to fix all our austerity-infused troubles. To me there are more similarities to Brownian motion (or pedesis), with documents and interventions crashing together out of synch from a sector that should be co-producing a strategic vision and developing realistic delivery plans that all providers in a diverse sector can generate outputs for.

I think there is a need for a Haynes manual. There is always room for big diagrams and easy-to-follow words. After all, many a garden-based laboratory (or shed) has produced some of the biggest science and technical discoveries known to humankind. It is time to collaborate and get our hands dirty.

I’ve given this obvious disconnect a name: EBI.

This newly published three-letter initialism (we can never have enough three-letter initialisms) stands for ‘evidence-based ignorance’. EBI is rife in a sector that clearly needs to introduce clearly identifiable evidence-based practice to its armoury. What the sector needs to know is what to do and have the permissions to do it.

There are lots of examples of what works and these have been available for years – Four commonly used methods to increase physical activity, for example, from NICE (March 2006) – yet many have found it difficult to adopt the approaches discussed in NICE Guidance Note PH2 (which has been partially updated by Guidance Notes PH41 & PH44), probably because they don’t fit the programming adopted by the majority of the sector. I also fail to see where this type of evidence has been used to inform the design of approaches offered to commissioners. It is very clear to someone who does horizon-scan and who does seek reliable and validated solutions to the inactivity problem that, left to their own devices, the sector comes up with many, many solutions to increase participation that simply don’t work.

The current delivery approaches used to programme the majority of leisure centres up and down the country, both private and public, are to blame. They don’t work. All they do is keep touting for business from the already engaged.

If ever there was evidence that the mould used by the sector for so many years does not work just look at the most recent Active People Survey results. Even after the Olympics, the biggest strategic investment in the history of sport the UK has seen, participation has decreased for many sports. Many of these have simply sat on their laurels for years, failing to assess, plan, do and review.

Something is out of kilter. Something is wrong with the mixture. The lessons from Breaking Bad have failed to hit home. Either there is an inability to decipher the ‘blindingly obvious’ or there is simply no appetite for the market to change.

For those who won’t change, I fear a fall from a lofty height. For those who can’t change, I fear a failure in the abilities of those who write specifications, and maybe it will be these that will find themselves teetering on the edge of a precipice that will ultimately engulf their inability to shape the market and challenge the sector. For those that have changed, keep changing. You are the ones the rest will have to follow. Shine the light as bright as you can. Those who have lived with their heads in the sand, unaware that their solutions are their solutions and not the best solutions, need the 1k lux to help show them the way. The new Royal Society of Public Health document will help boost this light by at least another 500-1000 lux, more than enough for live TV broadcasting of volleyball.

I believe the most valuable piece of paper mulching documentation to appear recently is this: the Royal Society of Public Health Guide to Commissioning for Health Improvement http://www.rsph.org.uk/en/policy-and-projects/projects/commissioning.cfm. It is the must -read of the past few months.

Understanding the world of public health commissioning is as useful as finding the ‘B’ of the big bang via the Large Hadron Collider (LHC). This document, in my opinion, is a crucial part of the knowledge jigsaw. It provides many with the ammunition they need to take a reflective view of what it is they are doing to improve health and develop successful interventions that achieve measurable change; change that is so unequivocal that public health commissioners and others who are investing in landscape- changing strategies, policies and delivery (ie health and wellbeing boards) cannot dare to look the other way.

There are other examples of effective, local initiatives that fail to get the coverage they deserve, probably because they are difficult to scale up or hard to transport to another region, town or community; or they have failed to develop sound mechanisms to record the outcomes generated, capture the process learning and write down the unique building blocks that have helped produce the products they celebrate.

Sometimes I think we might as well be looking at ways of utilising the LHC to take us back to a time when more people rode a bike, walked to and from work and school, had manual jobs and less opportunity to eat food that had not seen the conveyor belts of one of the 10 Big Food processors. It will probably be easier to find the secrets of time travel than change the programme at a local leisure centre, or have them change their menus or secondary spend choices lined up in the banks of vending machines. The world has changed, yet the sector still continues to do what it has always done.

Your seven-step plan:

Collect, collate and learn from the evidence what works, whether this is well-proven via gold-standard, randomised control trials or just simply generated via a well-thought-out local evaluation that has been validated by an independent process.
Use the information in the new Royal Society of Public Health guidance as a reflective opportunity to examine what you do now and what you must do in the near future.
Bring both the above together and use the ‘binding agents’ that have been cited in the various evangelical hymn books produced recently, along with the evidence clearly touted in the many and varied NICE guidance documents.
Stir well and add the mixture to a planned discussion between those who can make decisions without seeking permissions, eg a lead commissioner and a strategic manager.
Get busy mobilising and implementing cost-effective offers that inform the programming of your facilities and reach out to those communities that need support to become more active more often.
Make small but easily recognisable steps to changing the stuff you sell so that they complement your physical activity offers. Low sugar, no sugar is the way forward. Consider how to achieve this without building reliance on the top 10 Big Food processing companies.
Make sure you capture everything you produce via a well-informed process of monitoring and evaluation. Consider how you will capture the process learning. The Kolb action learning cycle will help you focus your attention here. Share your findings widely.

You don’t need a Large Hadron Collider to produce your own big bang. You simply need the ability to convert what works into replicable delivery.

Welcome to a new you!

The Commissioner is a time-served health professional who continually champions the role of physical activity as a means of health improvement.

References:

NICE public health guidance 2: Four commonly used methods to increase physical activity. Issued March 2006, last modified May 2013. Accessible via www.nice.org.uk

NICE Guidance Notes PH41 & PH44, accessible via http://guidance.nice.org.uk/PHG/Published

The Royal Society of Public Health Guide to Commissioning for Health Improvement, accessible via www.rsph.org.uk

The Leisure Review, February 2014

Download a pdf version of this article for printing

Previous Healthy Comment columns by the Commissioner in the Leisure Review:

Take a moment
The Healthy Comment column
With the sector facing unprecedented challenges, the Commissioner argues that it is time for story-telling, evidence-based decision-making and some very loud shouting.
April 2014

Leave the clinical to the clinicians
The Commissioner considers the origins of the promotion of physical activity and wonders whether exercise professionals have the right to decide who will and will not take part.
February 2014

Why nudge the public when it’s the sector that needs a shove?
How to persuade people to change their behaviour? The Leisure Review’s health correspondent wonders whether the gentle approach now needs to be revised in favour of rather more pointed measures.
November 2013

Healthy comment: it’s only work
The Leisure Review’s new health correspondent wonders about the nature of partnership and what it takes to create one that works. After all, making things happen doesn’t just happen.
July 2013