Health and sport – a winning team

The NHS Sport and Healthprogramme is delivered by

Top tips• Speak to local professional sports

clubs to identify the scope forcollaboration.

• Focus on building partnerships –identify common goals and whateach partner can contribute.

• One-off events do not tend tohave much impact, so look atlonger-term planning andinitiatives.

• Ensure there is clear signpostingfor those who need follow-uptests or support, or want furtherinformation.

• Establish a sub-group or networkof the health and wellbeing boardto plan and coordinate activities.

• Use evidence from joint strategicneeds assessments to supportcommissioner cases for includingsport initiatives in joint healthand wellbeing strategies.

• Evaluate and follow up all projects.

• Play a full part in the NHS Sportand Physical Activity Challenge.

This Briefing highlights the benefits of sport in improving the nation’sphysical and mental wellbeing and aims to support NHS providers,commissioners and those with public health responsibilities to harnessthe opportunities provided by sport to improve the health of localpopulations.

The proven advantages of increased physical activity on physical andmental wellbeing makes the sports-health nexus a crucial area for thenew NHS to tap into. The influence and ability of sporting personalitiesand clubs to reach under-engaged groups in society provide a valuableopportunity the NHS cannot afford to miss.

This Briefing outlines how NHS can build mutually beneficialrelationships with sports bodies, both to promote sport as a way tophysical and mental wellbeing, and to use the expertise, profile andattraction of sports clubs to reach greater numbers of people moreeffectively. It sets out some of the benefits that collaboration with sport can bring, and includes key lessons and case studies others can use to inform their plans. It also emphasises the value of the NHS Sport and Health Programme – a national initiative run by the NHS Confederation.

What is ‘sport’?“All forms of physical activity which, through casual or organisedparticipation, aim at expressing or improving physical fitness and mentalwellbeing, forming social relationships or obtaining results in competitionat all levels.”

European Sports Charter

NHS Sport and HealthFebruary 2013 Issue 1

Improving physical and mentalwellbeing is a priority for membersof the new health and wellbeingboards, including local authorities,clinical commissioning groups andlocal Healthwatch. In addition, theimportance of meeting thisobjective to fulfil the NHS Mandatemeans the health benefits of sportand the vast opportunitiespresented by sporting organisationsmust now take centre stage.

The benefits of health,wellbeing and physicalactivityIt is hoped that the lasting legacy ofthe London Olympic andParalympic Games will be anincreased uptake in peopleengaging in sport and other formsof physical recreation. This in turnwill help combat health issuescaused by increasingly sedentarylifestyles and rising rates of obesity.Such lifestyles present risks of long-term health problems, bothdirectly, through the increase inType II diabetes, hypertension,raised levels of problematiccholesterol, fat-related cancers anddementia, and indirectly, throughreducing social contact andheightened levels of stress,depression and poor mental health.

Achieving a healthier lifestyle is a significant side effect ofparticipation in sport. It makes it easier to maintain a healthyweight, reduce the risks ofinactivity and improve mental andphysical wellbeing. It also providesa sense of purpose, widens socialcontact and gives additionalstructure to daily lives.

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An unrivalled opportunityOrganised sport plays a significantrole in British society. For spectatorsand players, sport has wide-rangingappeal and reaches and engagespeople from different backgrounds.With a nation riding high on thelegacy of the 2012 Olympics andParalympics, sport provides anunrivalled opportunity to make alasting difference to the nation’sphysical and mental wellbeing.

NHS Sport and Health 1Health and sport – a winning team

‘Sport provides an unrivalledopportunity to make a lastingdifference to the whole nation'sphysical and mental wellbeing’

The role of sport• Football has over 7 million adult

participants, in addition to 5 million participants in schools,and over 500,000 volunteers.

• Rugby Union and Rugby Leaguehave over 190,000 and 57,000weekly participants respectively.

• Around 196,000 adults playcricket at least once a week.Angling has over 4 millionparticipants in the UK.

• Many people do not play a sportbut are part of a very large andloyal fan base of clubs: thePremier League reports annualmatchday attendances of over 13 million; the Football Leaguehas over 4 million registered fans,with a matchday attendance of 16.2 million and TV coverage of28.7 million each year; 2 millionpeople attended Rugby LeagueSuper League matches in 2012,with 29 million viewers on TV.

“If a million more people acrossthe country played sport eachweek, it would save the taxpayer £22.5 billion in health andassociated costs.”

Sport England

Realising the dividends ofsporting organisationsSports clubs can use theirrelationship with fans to attractthem to wellbeing-relatedactivities. There is emergingrecognition of the opportunitiessports create for targetingpreviously under-engaged groups. Sports clubs often haveattractive, iconic premises whichfans feel comfortable accessing,and which can provide an ideallocation for delivering healthservices. Sport clubs can also often engage fans more easilythan statutory bodies. As such,collaborations between health and sports organisation offersignificant mutual benefits.

Over the last 20 years, there hasbeen recognition of the influencesport can have in supporters'behaviour. Most of the majorsporting stadia are situated withinthe most deprived communities.However, historically therelationship has mostly been one way with fans attendingmatches and little effort made toreach the local population. Anumber of changes have emergedwith the stadia recognising theirresponsibility to promote theirsupporters’ health and safety,such as smoking bans; alcoholrestrictions; availability of sunscreens; healthy eating

local health experts to uncoverunmet needs and a complementaryrole for the club.

Many clubs have developed theirown local initiatives. The TacklingMen’s Health programme with theLeeds Rhinos saw specialist men’shealth nurses setting up store inbars, cafes and entrance areasbefore the matches started, toundertake health checks with fans.The club also ran a successfulweight loss group for men, whereretention levels and overall weightloss were higher than the standardprogrammes. Many of theparticipants reported that theyhad only joined because of theconnection with the club.

Approaches tailored to the needs,preferences and behaviours of atarget group are more likely to beeffective. Many efforts to influencemen’s ill health are challengingand activities delivered throughtraditional channels often havelimited effect.

Within the English PremierLeague, a three-year initiative sawfunding made available for 16clubs to employ health trainerswho worked in the club stadia andalso in the community, to attractyoung men into physical activity.This group was selected as havingsignificant unmet health needswhile not engaging with localhealth services. Through making

NHS Sport and Health 1Health and sport – a winning team

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opportunities; safety issues; access issues and anti-vilification/anti-discrimination policies.

Today, stadia that have a capacityof over 10,000 have to complywith the requirements for a safetycertificate, which include havingadequate medical and first aidarrangements.

Some clubs, such as MillwallFootball Club, are transformingtheir facilities beyond basic firstaid, with GPs and nursing staffproviding support to manyindividuals who are eitheridentified as having problemswhile at the game or prefer to usethe facilities over that of otherlocal providers.

Building links withcommunitiesClubs have made greater efforts tointegrate with their communities.Most have communitydevelopment officers whoundertake outreach work withschools, youth work and otherlocal organisations. The largerprofessional clubs have charitablefoundations or trusts whose focusis on working with localcommunities through schools,clubs and community groups, andthe wider public.

Although much of thisengagement relates to increasingparticipation in sport, there is amajor focus on promoting healthand wellbeing messages withspecific programmes on healthyeating, being more active, self-esteem, mental wellbeing

and avoiding the dangers of drugsand knife crime. They alsoadvocate schemes in partnershipwith bodies like Job Centre Plusand specialist charities to supportthe local unemployed or olderpeople who have become isolated.In many cases, these initiativestarget those who may bedisengaged from mainstreamhealth promotion activities, butwho are attracted to initiativesbecause they are being run bytheir local sports club.

Most sports are taking action tobroaden their appeal and aredeveloping different forms of theirgames to attract new participants.In Rugby League, 'touch rugby' hasbecome a popular sport for peoplewhose anxiety about injury detersthem from the full contact game.Within the Yorkshire and Humberregion, a Department of Healthsponsored touch rugby leaguetargeted those over 32 years oldand attracted over 1,000 players in one season, for a minimalinvestment. All of the participantssurveyed said they would like tocarry on playing the sport.

Meeting local needs There are a number of ways in whichsports and clubs have developedtheir role to reflect the public healthand wellbeing agenda. This is seenat club and national level, either as aresponse to campaigns, such asChange 4 Life, or in response tosupporters’ needs, such as PremierLeague Health and Rugby LeagueCares/Sport Relief Mental Wellbeingprogramme (see case studies onpages 4 and 5). In bothprogrammes, clubs worked with

‘There are a number of ways inwhich sports and clubs havedeveloped their role to reflectthe public health and wellbeingagenda’

highlights the wide range ofaudiences sport engages with andthe contribution it makes to widerpolicy priorities.

Other initiatives have carefullyconsidered the needs of othergroups, including women’s healthand that of teenagers and youngadults (Sportivate). Many studiesfocus on encouraging andmeasuring changes in behaviourand identifying what does anddoes not work. Building on this,the Scottish Premier League istrialling a Football Fans in Training(FFIT) initiative to assess theeffectiveness of an interventionaimed at men to improve their

levels of physical activity and tolose weight.

Benefits of working withsports clubsBuilding partnerships with clubsenables health and wellbeingboards to access a wide range ofbenefits, skills and expertise,including:

• services that are directly relevantto promoting better publichealth, such as healthy eating,physical activity and mentalwellbeing, and working withspecific groups, includingyounger and older people

• trained and qualified staff,including nurses, dieticians,physiotherapists andpsychologists

• public relations andcommunications skills that cancontribute to campaigns andinitiatives; easy routes toaccessing large numbers ofpeople, including at matches,when it is known when a largecrowd will be present, makingplanning easier

• fans are interested in what theclubs and players say and do

• locations, access and openinghours of clubs mean it is easy for locals to get to, which makes them an attractive place for activities. An activity at a well-known club may bemore appealing than othervenues, and fans may feel more comfortable in a familiarsetting

• studies suggest that fanswelcome health and wellbeinginitiatives at the ground

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NHS Sport and Health 1Health and sport – a winning team

the engagement enjoyable andtargeting specific health advice inshort interventions, the initiativewas able to bring about changes inhealth behaviour. Each clubresponded to local needs and setup different initiatives, such asmidnight badminton for southAsian shift workers, a footballleague for homeless men andstadium walks. The scheme

Case study: Rugby League promotes mental wellbeingAs part of a wider programme topromote mental wellbeing inRugby League communities,Rugby League Cares, inconjunction with Super Leagueclubs, the NHS Confederation’sMental Health Network, NHSChoices and Leeds MetropolitanUniversity’s Institute for Healthand Wellbeing, ran a pilot mentalwellbeing campaign inSeptember 2012 focusing onRound 27 (the last match ofthe main Super Leagueseason).

Its aim was to promotewellbeing through the FiveWays to Wellbeing, usingmedia interviews withplayers , websites, t-shirtsworn at matches, leafletsand a dedicated web page.

Leeds Metropolitan University’s research with fansshowed that well over 90 per cent of fans welcomed the ideaof a mental wellbeing campaign.

‘The scheme highlights the wide range of audiences sportengages with and thecontribution it makes to widerpolicy priorities’

Photos: JamiePeacock andKevin Sinfieldof the LeedsRhinos (top)and KevinSinfield of theLeeds Rhinos(bottom).

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NHS Sport and Health 1Health and sport – a winning team

One of the largest academic studies of men’s healthin England found that Premier League football clubshave a powerful effect on changing men's health,especially those regarded as hard to reach and whose lifestyle choices lead to a substantial burdenon NHS services.

Premier League Health, a £1.63 million three-yearprogramme, was a national men’s health promotioninitiative, engaging over 10,000 men. Sixteen clubswere awarded funding to run programmes to meetlocal needs, identified in conjunction with partneragencies. The programmes were delivered by healthtrainers, managers and health professionals whoreceived education and training in behaviouralchange techniques and men’s health promotion.

The programme evaluation found that top-levelfootball clubs can encourage positive lifestyle changesin working-age men and can deliver effective healthpromotion campaigns. Three-quarters of men madepositive health changes through participating inPremier League Health. These included:

• a quarter reducing harmful lifestyle risk factors

• over 40 per cent improving their level of physicalactivity

• a third moving to a healthier weight category

• 30 per cent reducing harmful levels of alcoholconsumption.

The study found that many participants had multipleproblematic lifestyle behaviours, and many did notview themselves as having poor health. Over a thirdnever consulted their GP and over half never usedhealth advice and information services.

Case study: Premier League – promoting men’s health

Why did it work?The study gave a major insight into the types ofintervention that work with this group.

• Combining the appeal of professional football clubs with the opportunity to develop health in a ‘male-friendly’ way represented a uniqueopportunity for reaching men.

• Football-based awareness-raising events andoutreach activities were especially important forreaching men who were ambivalent about orthodoxhealth-promotion activities.

• The informal approach of Premier League Health staff and familiar settings such as stadiawere essential for encouraging regular involvement in physical activity and lifestylesessions. Such surroundings were seen as having substantial advantages over conventionalNHS locations.

• The interventions incorporated socially-supportive environments that facilitated a sense of belonging and a fun and enjoyableatmosphere. For many men, this experiencesupported maintaining newly-acquired healthier behaviours.

The study outlined key lessons for practitioners on how to assess needs, plan, implement andevaluate gender-specific health interventionsimplemented in and by football clubs. Central toPremier League Health was engagement with public bodies. Clubs communicated key healthmessages to a wide audience through one-off events and regular sessions to raise awareness and signpost people to local services. In some cases, the programme had wider benefits, forinstance on employment.

• health and wellbeing boards andclubs could apply jointly forfunding, particularly as mostclubs have their own charitablefoundations.

In addition to increasingparticipation in a sport, there are many possibilities forprofessional sports clubs to becommissioned to act as health-promoting organisations,including delivering health-related services andinitiatives. There are already manysuccessful examples.

Making change happenOne of the core commitments ofthe NHS Responsibility Deal is toincrease levels of physical activity.The Responsibility Deal PhysicalActivity Network is beingestablished to help coordinateaction on the Olympic legacy. The Behaviour Change Network is tasked with identifying hownational expertise in behaviouralsciences can be harnessed to helpguide approaches to improvingpublic health.

The early work of both thesenetworks reinforces the benefits tobe had by engaging with sport as away of ‘nudging’ participantstowards health-enhancingbehaviour. This work will besupported by the creation of theNational Centre of Excellence forSport and Exercise Medicine(NCSEM).

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NHS Sport and Health 1Health and sport – a winning team

The NHS Sport and Physical Activity Challenge is part of thewider NHS Sport and Healthprogramme. It is specifically aimedat improving the health andwellbeing of NHS staff throughsport and physical activity. It is led by NHS Confederation chiefexecutive, Mike Farrar, in his role as the National NHS Sport andPhysical Activity Champion.

The NHS Sport and Physical ActivityChallenge was launched by SirDavid Nicholson in 2010. It aims to use the power of the London2012 Olympic and ParalympicGames to engage NHS staff in sportand physical activity and create alasting health and wellbeing legacy.It particularly seeks to encouragestaff not currently engaged in sportor physical activity to make a change.

The challenge consists of a range of sport and physical activityprogrammes, from pedometerchallenges betweenwards/departments, to the firstNHS 'funtriathlon' and 'NHSolympics'. The scheme has createdpartnerships nationally and locallyto support NHS organisations whowant to develop a programme aspart of their staff health andwellbeing programme. Since itsinception, many NHS organisationshave gained their bronze, silver orgold accreditation certificate inrecognition for the work they havedone and their success in deliveringon the challenge.

NHS organisations involved in theNHS Sport and Physical ActivityChallenge report improved moraleand team working, as well as anincrease in positive responses tostaff surveys.

• Over 75 per cent of NHSorganisations in the north westhave developed sport andphysical activity programmes.

• 4,000 staff from Guy’s and St Thomas’s NHS Trust clockedup over 1 billion steps betweenthem and tried out 20 newsports as well as raising over£65,000 for local charities.

• NHS staff across Leeds clockedup over 1 million active minutes and hosted a number of sporting events across NHSorganisations.

• East of England SHA has led astaff health and wellbeingprogramme across NHSorganisations and other localbusinesses.

• In Somerset, the challengebrought around £100,000 ofsavings and improvements inhealth, fitness, patient care,morale and team work as aresult.

The NHS Sport and Physical ActivityChallenge

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NHS Sport and Health 1Health and sport – a winning team

Get involvedThe programme has traditionallybeen aimed at NHS provider trusts,but has now been extended tocommissioning organisations with further opportunities for GPs and other primary care staff, as well as staff working fornon-NHS providers of healthservices.

You will need:• enthusiastic staff to promote this

in the organisation (see alsoImplementing NICE public healthguidance for the workplace –overcoming barriers and sharingsuccess)

• commitment and support fromyour chief executive – leadershipis crucial for success. All of theNHS organisations receiving anaccreditation certificate from SirDavid Nicholson had todemonstrate executive-levelsupport for increasing sport andphysical activity in the workplace,with many chief executives andboard members participating in events.

NHS Sport and Physical ActivityChallenge accreditationHave you already taken up thechallenge? You could be eligible

to receive a Sport and ActivityChallenge accreditation certificate.The deadline for submissions is 30 March 2013.

Email Sue Henry, national director,NHS Sport and Health, atNHSSportandhealth@hotmail.co.uk to put forward asubmission or to find out more.

Further informationTo find out more about the NHSSport and Physical ActivityChallenge, and view examples ofwhat other NHS organisations arealready doing, visitwww.sportandphysicalactivity.nhs.uk

For further information, pleasecontact Sue Henry, nationaldirector, NHS Sport and Health, atNHSSportandhealth@hotmail.co.uk

NHS Responsibility DealIf you are already (or intend to get)involved in the NHS Sport andPhysical Activity Challenge, wewould encourage you to also signup to the NHS Responsibility Dealand pledge your support toimproving public health inEngland.

To find out more about the NHSResponsibility Deal and how tosign up, visitwww.responsibilitydeal.dh.gov.uk

Sir David Nicholson and Mike Farrar presenting an NHS Sport and Physical ActivityChallenge accreditation certificate to Lisa Earnshaw (left) and Carlene Holdent (right) atRotherham, Doncaster and South Humber NHS FoundationTrust.

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NHS Sport and Health 1Health and sport – a winning team

References and further informationSport England provides a range of tools and research for purposes,including making the case for sport and understanding participation.These include:

• Improving health through participation in sport: a review of research andpractice, British Heart Foundation Health Promotion Research Group

• local sports profiles and mini sports profiles: www.sportengland.org/support__advice/local_government/local_sport_profiles.aspx

• sporting profiles for local areas, bringing together data on sportingparticipation and provision

• small area participation estimates: www.sportengland.org/research/understanding_participation/small_area_estimates.aspx

• local sport maps showing participation at the middle-level super-outputarea (MSOA), with the option for overlaying facility data

• the Value of Sport Monitor: www.sportengland.org/research/value_of_sport_monitor.aspx – an online monitoring service of the most up-to-date reference sources and critical reviews of published researchevidence on the contribution of sport to a range of broader social issues,including both physical fitness and health and psychological health and wellbeing

• Sports Market Segmentation: www.sportengland.org/research/market_segmentation.aspx – an online tool to develop understandingof local markets and allow more effective targeting.

The NHS Confederation50 Broadway London SW1H 0DBTel 020 7799 6666Email enquiries@nhsconfed.orgwww.nhsconfed.org

Follow the NHS Confederation on Twitter@nhsconfed

AcknowledgementsThe NHS Confederation would liketo thank:

• Professor Alan White, Professorof Men’s Health, Institute forHealth and Wellbeing, LeedsMetropolitan Universitya.white@leedsmet.ac.uk

• Jane Riley, independentconsultantjaneriley@btinternet.com

• Sue Henry, national director, NHS Sport and Health,NHSSportandhealth@hotmail.co.uk