Where Systems and Lives Collide

Twenty years ago, my mum passed away in her early 40s. Despite being a sporty family, my mum could have been a little more active… who knows whether that would have made any difference. I’ve often wondered whether the doctors and nurses could have done more to encourage my mum to do more exercise in the early stages after her diagnosis.

I’ve wondered whether the running club, cricket club, dance schools and others could have been more encouraging of parents stood on the sidelines. I’ve wondered whether we could have done more as a family, whether I could have done more.

What I don’t wonder about, is whether we as a collective group of councils, health professionals, sports clubs, community groups and government – ‘the system’ – could do more. Could we more effectively encourage, support and adapt the way we do things to make it easier for people to be active? The answer is a resounding yes!

Over the last two years I have been working with colleagues on the Sport England-funded local delivery pilot (LDP) in Pennine Lancashire – Together an Active Future (TaAF). Right from the start, the TaAF project intrigued me because it wasn’t about more programmes or new activities, but rather doing things differently that could make a difference.

Pennine Lancashire is a collection of six local authorities, half a million people, a fifth of whom are inactive and facing huge health inequalities. In the early stages of the LDP, during discussions with stakeholders, it occurred to me that rather than focusing on demographic cohorts, perhaps we could focus on the events that happen in people’s lives and the impact these have on physical activity and mental wellbeing. For me, everything fell into place as we started to think about system change through the lens of life’s events.

Born to be active

As a father of five young children, I’m convinced that humans are innately active. Babies roll, crawl, run and jump without prompting. Unfortunately, traditional ‘good parenting’ involves training our children to ‘sit still’, ‘stop fidgeting’ and then as we go through our lives some of us never fully recover.

Not only do changes in activity levels link with life events, but we realised that in those pivotal moments people often interact with the ‘system’. Unfortunately, those conversations with system professionals rarely involve encouragement to be physically active. If we could change the focus of those existing conversations, to be centred on the person’s wellbeing, could it positively impact activity levels?

We’ve progressed some of those life-event workstreams and started engaging with colleagues who work with new parents, people looking for a job, and those experiencing other key life events too. Through our work with the local job centres, we’ve discovered that despite often challenging relationships between job centre teams and local people, in the right setting the conversations around physical activity can be incredibly positive.

“It makes you think about how much you don’t do in terms of exercise,” said one customer attending a Department for Work and Pensions (DWP) event. “I know how good it does make you feel when you’re down, you do get a sense of purpose, so doing more would be great. But then I know on the other side that when I do get down, you have no motivation and you get so lazy and you don’t want to see anyone. It’s shown me that I can make a change.”

The keys to change

We’re finding that there are a few important principles that can underpin positive change to the conversations we are having with people and the processes and policies that sit behind the way we work:

  • It’s crucial that our focus is on people and the things happening in their lives. We must find ways to empower people to be part of changing the system with us.
  • We need to be much more creative and authentic in the way we foster conversations and interactions with local people, communities and organisations.
  • Building on the existing systems, process and assets we have is essential. We don’t need lots more stuff, we need lots more connection.
  • Changing the system really means evolving the way people think and feel about the work they do, the place they are working in, and the way increased physical activity can help people with the challenges in their lives.
  • Collaborations and partnerships need to be focused on shared successes and better outcomes for communities, rather than a transactional relationship that is simply moving resources. We need a connection focus not a contract focus.

When you combine all these various elements, it’s clear that the biggest change is going to be on a place basis. Everything and everyone are based in a place. Whilst the NHS can move structures from clinical commissioning groups to primary care networks, and the DWP can change national protocols, it’s not national policy alone that will lead to a narrowing of the significant health inequalities in our towns.

Our attitudes, relationships, and the collaborations and connections we form within our place will make the biggest difference. We have to find ways to change those existing conversations and ultimately, if we want to change the system, if we want healthier and fairer communities, it starts with a change in me, and it starts with a change in you.

Ken Masser

Director, Miova