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Guest Blog: Pritesh Patel
Back in September I attended the GM Moving stakeholder workshop and we were lucky enough to hear some inspiring opening words from Andy Burnham, Mayor of Greater Manchester and from Elaine Wyllie the founder of The Daily Mile.

It was a great start to the day and there was something about Elaine and The Daily Mile that grabbed my attention… The simplicity of the idea and the way it is delivered in schools, how it started so naturally and organically, the enjoyment the children had from being active outdoors together, and the incredible impact this is having on our children and our future leaders in so many different ways! You can see more of Elaine’s presentation here.

When the GM Moving Plan was launched earlier this year, we were all asked to make a pledge and it’s something I’ve been thinking about for a while – What could we do as a team in Bury and what could I do too? The pledge could be as small or as big as we wanted, but what were we going to do to make a difference to help get Greater Manchester Moving.
At lunch all those attending did our very own organised Daily Mile and it was great to see so many people getting out being active whilst still talking and networking. This is where I thought of my pledge and Carly came up with our team pledge for Bury Sport and Physical Activity Service (SAPAS) and I Will If You Will (IWIYW).
Pritesh 5
My Pledge: “To run for a minimum of 15 minutes each day for every day in October (#MyOctDailyMile)”
Carly’s Team Bury Pledge: “To do an office daily mile, starting in October” (#workplacedailymile)
Maybe more about My Pledge on another day or in another blog, but today we wanted to tell you more about Bury’s #workplacedailymile (SAPAS and IWIYW)
Just like any office I presume, our team is quite varied in terms of our activity levels and I would think every single one of us has moments where we feel like we should do more – well something like this pledge has helped us do that little bit more.
From my point of view what has really helped us be more active and do this Pledge (apart from being inspired by The Daily Mile and GM Moving) is having a ‘champion’ / advocate / motivator / ‘nagger’ in our office and this time that was Carly. What does our champion Carly do?? Simply just says a few choice words each day….
“Right lets go for a walk”
“I’m going for the Workplace Daily Mile today at 2pm, who’s joining me?”
“C’mon Sian – its only 15 minutes, and you’ll feel so much better for it”
“Let’s get some fresh air”
“I’ll meet you downstairs in reception in two minutes – see you down there!”
It really is that simple, that little kick we all need from time to time. We’re all really busy with work pressures and multiple deadlines, but we’ve really seen the benefit of getting away from the desk and getting outdoors for a bit each day. Have we had any less work to do in October – definitely not!! Is that work still there when we get back from the walk – yes! Do we feel in a better frame of mind to tackle those tasks and ’To Do Lists’ after walking outdoors – probably yes, and on most occasions certainly! Have we done any less work having taken time to go for a walk – no, and times we’ve even chatted about work on the walk! It is quite easy to say I’m too busy or that we haven’t got enough time, but the daily walk has really helped us as individuals and as a team!
‘Made small adjustments to squeeze in The Daily Mile, or having short breaks from the desk and office by having walking meetings’ – Jackie
What happens if it rains or if it’s cold? We take an umbrella, or make sure we’ve got the right coat and shoes on. #commonsense
What else has helped us:
I know a few of us have put the daily mile in our calendars – this helps some of us to stick to it, or ensures no one else puts things in your diary when you’re going for a walk

Most of us just keep the same pair of shoes on for the walk but some prefer to have a spare (more comfy) pair of shoes in the office to use for the walks.

What time we walk in the day is flexible – it doesn’t have to be a set time if that isn’t going to work for you. We do tend to aim for the middle of the day though.

Mix up the routes and durations but don’t worry about planning too much. We’ve mixed up the walks which have varied between 15 – 28 minutes so far. The routes can be the same but ours haven’t been which has been nice – so many different streets and options and we’re lucky we have a section of the River Irwell not too far which we’ve walked along too. A different person picks the direction each time.

We hope we’ve inspired you to get out the office or the work place each day, and to have a bit of fun on your walk.
Pritesh and the team (follow our journeys @PTUnited , @BuryBePartOfIt , @I_will_if , @CH5Eng)
Pritesh 6post

Guest Blog: Active Souls, Active Lives

Anna Lowe

I went to the GM Moving conference recently & was taken with the #ActiveSoles initiative. Everyone attending the conference had been encouraged to wear comfortable footwear and to integrate some activity into their day.

I’ve been thinking about how the clothes we wear influence our habits and the fact that, in some work environments, there are barriers (real or perceived) to active wear. Conferences can be incredibly sedentary affairs, the #ActiveSoles movement gave people permission to wear shoes that make it easier to be active during the conference.

I firmly believe in the transformative potential of physical activity, it improves lives, brings communities together and supports economic growth.  I also believe in personal liberty and if women (or indeed men) choose to wear pencil skirts & high heels then all power to them. However, if there is corporate pressure to conform to unwritten standards about attire and this is preventing opportunities for activity during the day, then this is not ok.

I wear my trainers with smart work clothes a lot, but I’m conscious of situations when I think ‘better not today’ this tends to be if I am attending important meetings, speaking at conferences or meeting new people. The #ActiveSoles initiative has made me reflect on why I do this and whether I really want to perpetuate the unspoken rule that women must look smart/corporate at the cost of comfort (and therefore activity and therefore health).

I’m always struck by the inequalities in physical activity; women are consistently less active than men across the life course.  I’m also struck by inequalities in earnings & lack of female representation at senior levels in organisations. I would love to see inspiring female role models making a stand against uncomfortable corporate clothing, making it clear that they want to be active during their day.  After all we know that physical activity helps to manages stress, prevent burnout and improve productivity.

Clothing is only a tiny part of the jigsaw, but so many things are and collectively these small things make a difference.  So, inspired by #ActiveSoles, I’m going to try to make a conscious effort to wear clothes and shoes that, at the very least, don’t impede my ability to move around, and hopefully enable me to grab a few extra bits of activity throughout the day.  If enough people do it, there is an opportunity to change workplace expectations, redefine cultural norms and make it easier for working women to be more active.

ALowe headshot 2019

Active Practices: What would it take?

When England’s Chief Medical Officer said ‘if it was a pill, physical activity would be the miracle drug’, she wasn’t exaggerating. Some of the benefits of being active – for just half an hour a day are outlined in Doctor Mike Evans’ You Tube video from 2011.

Some benefits include:

  • Reduced risk of some cancers
  • Preventing type 2 diabetes
  • Lower risk of developing dementia
  • Improved mental wellbeing
  • Better quality of life
  • Reduced risk of cardiovascular disease.

A few weeks ago, we started to explore the art of the possible when it comes to enabling staff, patients and visitors to hospitals to ‘move more’ every day. The conversation continued to grow, and is captured here.

People reading it were finding it a useful conversation starter, and someone suggested that we gathered similar ideas for Active Practices.

Here is what we have gathered so far. This is a work in progress, so please tell us what we can add, via twitter comments or email info@gmmoving.co.uk

Clearly, no one practice can address all of these things at once, but if the headlines in 10 years time were to read:

“How an active practice has transformed lives for patients, staff and visitors, saved £millions and helped it’s local community”.. how might we have got there?

Let’s look at the whole system influences on everyday movement around GP Practices and see what can be done:

Population level change Chart

Policies, rules, regulations and codes

  • Dress codes: shoes you can move in.
  • Uniforms that enable movement.
  • GP’s and nurses walk to waiting room to collect patients
  • Staff policy 45 minutes per week paid time to be active – lunchtime walks or daily miles encouraged.
  • Standing desks
  • Walking meetings encouraged
  • Incentivise and enable active travel- bike to work, bikes and scooters for on-site and home visits
  • Social prescribing approach throughout the workforce
  • Develop an active travel plan, which provides information about how the practice can be accessed via public transport/ car share scheme etc.
  • Enable practice staff to proactively engage with patients and the public in the pharmacy, to offer them advice, support and signposting to other providers of physical activity services in the community.
  • Practice staff provide an update to Patient Participation Groups to advise what they are doing to enable patients to move more, every day.
  • Practice website and social media platforms that give key messages about physical activity and links to key documents and the websites of local services and providers.
  • Text message templates signpost and ‘nudge’ patients to move more and engage in activities following appointments.

 Built Environment

  • Stairs, not lift- for those who can.
  • Walking routes around practice. Signposted and clear.
  • Noticeboard / TV screens displaying local physical activity campaigns and information.
  • Space for bikes and prams to encourage active travel to and from the practice
  • Active waiting – space to be active whilst waiting for appointments.

 Natural Environment

  • The practice has mapped local assets including parks and green spaces, sports facilities, community centres within a 1 mile radius.
  • Walking routes mapped from the practice.

 Transport

  • Bike racks and lockers
  • How to travel to the practice by walking/cycling/public transport, displayed on practice website and messages given via social media.

 Organisations and Institutions

  • Sign up as a parkrun practice
  • Daily Mile (for staff and patients where possible)
  • Practice walks for staff and patients together
  • GP’s trained to use ‘Moving Medicine’ Website
  • All practice staff to attend PHE ‘Clinical Champion’ training
  • Staff record physical activity levels of patients through use of validated tools eg GPPAQ and any advice given to patients regarding this on patient records
  • Robust referral mechanism in place to local Exercise Referral Programmes which includes feedback capabilities
  • Practice fully engaged with voluntary and third sector organisations to provide volunteer opportunities for practice led activities eg Walk Leaders, Gardening etc.
  • Practice enables Patient Participation Groups to lead walks or activities from the practice.

Social Environment and Influences: individual relationships, families, friendships groups, support groups, social networks.

  • Change the conversation – make every conversation an enabling one. Strengths based. Supporting movement.
  • Identify the critical influencers and welcome/draw people in all along the way. Be inclusive, open and keep asking people to ‘join in’
  • Local community groups, charities etc part of practice life. Make social connections with people as part of the conversation.
  • Goodgym, intergenerational activity.

Individual Factors: capabilities, motivations, opportunities, knowledge, behaviours, attitudes

  • Positive communications- noticeboards, leaflets, online advice all supporting and enabling movement.
  • Classes and rehab less clinical
  • Classes and opportunities for long term visitors to be active
  • Buddying
  • Self serve tea and coffee in social spaces
  • Practice TV to prompt moving and connect people to what’s in the community.

 What might the outcomes be?

  • Reduced repeat GP appointments
  • Increased activity levels of staff
  • Increased activity levels of patients
  • Happier, healthier, more productive workforce
  • Reduced absenteeism
  • Change in narrative (bed blockers and bed rest)
  • Change in narrative ‘we’ not ‘us and them
  • Practice as part of the community
  • Community organisations, charities etc offer integrated support
  • A beacon of community health and wellbeing
  • Knock on effect to hospital outcomes
    • reduced length of hospital stays
    • reduced waiting times
    • reduction in re-admittance rates
    • Reduced staff absenteeism
  • If we could create exemplar practices, and share the learning along the way, imagine how we could change things together!
  • Please help, by sharing your ideas and additions to these lists, in the comments below on twitter, or via email info@gmmoving.co.uk, and we’ll keep growing the list, and start working with our practices to bring about changes. Big and small.

An Active Hospital. What would it take?

A few months ago, we met Matt Evison, a chest physician in Greater Manchester, to explore the connections between lung health and physical activity. The conversation quickly grew into a much bigger one. There were so many ideas and possibilities to explore together. Tweet

One of the things Matt is fired up about is hospital life; for patients, staff and visitors! The way that hospitals are designed and run, inhibits movement and impacts negatively on health. The very thing we are all trying to improve. He tweeted this, a couple of weeks ago. We retweeted it and asked people to reflect on their own experiences of hospital life, and tell us all the ways that activity could have been enabled. Wow! Such brilliant input.

The ideas below have been crowdsourced.

Clearly, we can’t address all of these things at once, but if the headlines in 10 years time were to read:

“How an active hospital has transformed lives for patients, staff and visitors, saved £millions”.. how might we have got there?

Let’s look at the whole system influences on everyday movement in hospitals and see what could be done:

Population level change Chart

Policies, rules, regulations and codes

  • Dress codes: shoes you can move in (staff)
  • Uniforms that enable movement.
  • Patients to get dressed into normal clothes wherever possible.
  • People out of bed as much as possible.
  • Up and about message, rather than ‘take it easy’.
  • Explicit permission to move. Enable it. Encourage it.
  • Explicit permission for those that can to go outside, use gym, do gardening.
  • Post surgery activity and exercise ‘tuition’, buddying
  • No smoking zone to be off site
  • Shift patterns to enable active days
  • Walk for meals, meds and toilets for those that can
  • Staff policy 45 minutes per week paid time to be active- 2 walks a week?
  • Standing desks
  • Incentivise and enable active travel- bike to work, bikes and scooters for on site and home visits.
  • Scooters to get around hospital site- quick, active and fun.
  • Social prescribing approach throughout the workforce.

Built Environment

  • Gym, quiet space for rehab- less clinical- more welcoming- pilates, yoga etc. Music.
  • Follow Sport England’s Active Design guidance when building and refurbishing spaces.
  • Stairs, not lift- for those who can- visuals to point people towards this.
  • Lounge areas that people can walk to to socialise. Decent coffee.
  • Walking routes around hospital grounds- Daily Mile. Signposted and clear.
  • Fold away beds.
  • Day rooms that are inviting people out of bed.
  • Meals in day rooms, not in bed.

Natural Environment

  • Gardens, allotments.
  • Dogs for walking.
  • Play spaces.
  • Walking routes.
  • Open spaces outside wards to entice people out.

Transport

  • Integrated public transport system
  • Walking and cycling infrastructure built in
  • Bike racks and lockers
  • Bikes and scooters to get around site

Organisations and Institutions

  • Gain commitment at the highest level- Chief Execs and Directors. Make the business case: staff sickness costs etc.
  • Engage ALL staff from the start (nurses, allied health professionals, cleaners, catering staff, doctors, consultants, office staff, senior leaders, community and district nurses).
  • Look at all aspects of workplace culture: perceptions, rules, permissions and policies.
  • Look at what is measured and work out how to have an impact on it- eg staff sickness rates. Frame staff activity and wellbeing as a solution.
  • Train staff in having enabling conversations. Make moving more a core message of all conversations with patients and staff (eg Surgery School)
  • Recognise the opportunity that healthy competition presents to leverage engagement: eg league tables on reducing staff sickness, and % of staff managing their 2 walks a week.
  • Skype appointments
  • parkrun hospitals (like parkrun practice)
  • Daily Mile hospital (for staff, visitors and patients where possible)

Social Environment and Influences: individual relationships, families, friendships groups, support groups, social networks.

  • Change the conversation – make every conversation an enabling one. Strengths based. Supporting movement.
  • Identify the critical influencers and welcome/draw people in all along the way. Be inclusive, open and keep asking people to ‘join in’
  • Local community groups, charities etc part of hospital life. Make social connections with people for when they leave.
  • Goodgym, intergenerational activity.

Individual Factors: capabilities, motivations, opportunities, knowledge, behaviours, attitudes

  • Positive communications- noticeboards, leaflets, online advice all supporting and enabling movement.
  • Classes and rehab less clinical
  • Classes and opportunities for long term visitors to be active
  • Buddying when leave hospital
  • Self serve tea and coffee in social spaces
  • Hospital TV to prompt moving and offer exercise tuition to do in your chair/bed

What might the outcomes be?

  • reduced length of hospital stays
  • reduced waiting times
  • reduction in re-admittance rates
  • increased activity levels of patients pre, during and post stay
  • increased activity levels of staff
  • increased activity levels of visitors
  • happier, healthier, more productive workforce
  • reduced absenteeism
  • change in narrative (bed blockers and bed rest)
  • change in narrative ‘we’ not ‘us and them’
  • hospital as part of the community
  • community organisations, charities etc offer integrated support
  • last place you go, rather than first place
  • a beacon of community health and wellbeing

If we could create exemplar hospitals, and share the learning along the way, imagine how we could change things together. We already have two hospitals who are keen to go on this journey.

Please help, by sharing your ideas and additions to these lists, in the comments below, and we’ll keep growing the list, and start working with our hospitals to bring about changes. Big and small.GMM_Logo_Twitter_Arrows2 (002)

 

Greater Manchester Local Pilot Learning: Sept 2018-March 2019

GMM_Logo_Twitter_Arrows2 (002)1.0       Introduction

This report relates to process learning between September 2018 and March 2019.  It has been produced by the local pilot evaluation team, working with local pilot partners.

 

Greater Manchester’s Local Delivery Pilot (Local Pilot[1]) activity includes work at a strategic cross-pilot level, work in ten boroughs or ‘localities’ and work at neighbourhood level.  At all levels activity has focussed on introducing and embedding new intentions or ways of working.

Those working within the Local Pilot are influenced by a range of guidance documents and principles of working.  These include the Local Pilot investment principles, the Sport England / IFF community of practice learning themes, the GM Moving ways of working and the Pointers for Leadership Practice emerging from the recent initial process evaluation of GM Moving.  There is a great deal of synergy between these guidance documents.  This report highlights three themes which are featured in these documents and which represent where a great deal of the work over the last six months has been focussed. We have titled them ‘working together’, ‘reducing hierarchies’ and focussing on ‘what matters to people in place’

The document itself consists of a series of distinct sections:

  • What has been happening: Describing some of the key events and actions that have taken place and why they are important for system learning
  • Ways of working: Detailing key learning around the themes introduced above with a focus on intentions, example activity and the ‘so what’ or how these examples have contributed to change at system and locality levels.
  • What might have been done differently: Providing reflections on how both the Pointers for Practice and experiences over the last 6 months might help to shape a different approach in the future
  • Where next: Sharing thoughts on the future direction.

2.0       What has been happening?

timeline

The above timeline provides a summary indication of important and critical moments in the emergence of the Local Pilot and progress up to September 2018 as well as highlighting (in orange) some of the more significant events from the last six months. These include:

In November 2018 Andy Burnham, the Mayor of Greater Manchester set out a public service reform agenda that aligns well with the whole systems approach towards addressing physical inactivity being adopted by GM Moving and the Local Pilot

Following a thorough market engagement process in January 2019 an evaluation consortium was appointed to develop an evaluation of GM Moving and the Local Pilot up to March 2021.

In March the results from GM Moving’s initial learning journey process evaluation, Journeying Together, which ran from the summer of 2018 were released. Whilst focused on GM Moving as a whole, the work actively references the inter connections with the emergence of and relations with the Local Pilot. It also led to the production of the associated Pointers for Leadership Practice which aim to actively influence the ways of working adopted by both GM Moving and the Local Pilot at system and locality levels.

6 Pointers

Each of the localities involved in the Local Pilot have been actively focused on the gathering of data, evidence and insight, often through active engagement and consultation with communities at neighbourhood levels as they developed their plans for activity over the coming year. This has directly contributed to the submissions that were made on the 18th March.

Emergent learning has been shared through the introduction of monthly Local Pilot Network events which provide an opportunity for localities to share their progress and experiences as well as to gain further insight from guest speakers at different levels of the system and other Local Pilots. External visits to experience the Local Pilot in action have also been facilitated with the new Chief Executive of Sport England, Tim Hollingsworth taking up the opportunity to come to Greater Manchester, meet with the Public Service Reform Board, GM Moving and experience the Local Pilot first hand in Oldham. Following the event, he has expressed his interest in visiting again soon.

3.0       Ways of working

3.1       Intention:  Working together

A clear area of activity has been efforts to join up work across the system.  This has occurred at different levels within the system: both across GM and, across each of the localities.

3.1.1    Rationale: The main reason stakeholders gave for working in this way is that the barriers to being active will require whole system approaches; everyone from community members and groups to agencies and service providers. Inactivity is ‘too big’ a challenge for anyone to tackle alone.  The intention is to work together collaboratively and ensure coordination across systems, making simultaneous changes which together can have an impact.

A second reason recognises that expertise from communities and different sectors can stimulate innovative solutions; from individuals and communities and community groups, VCSE organisations, public and private sector.

A third reason relates to working effectively and efficiently, the rationale being that by knowing what work is going on where and for what reason the local pilot teams can tap into opportunities which already exist (and avoid duplicating effort).

3.1.2    Threats to these assumptions being realised/unintended consequences: The key threats identified include the sheer number of people and stakeholders who could be involved and keeping track of their interactions which requires a great deal of continuous effort. Stakeholders recognise that there is a need to let go of ‘control’ and trust that conversations to join up the system will happen without them instigating it or even being aware of it.

As this work has developed, stakeholders have become more attuned to the different structures and cultures which influence how parts of the system work which may not always be compatible.  For example, one locality lead highlighted that whilst the local pilot doesn’t require them to work to KPIs, they still need to justify the time they are spending on local pilot work to their colleagues who maintain traditional approaches.  This can increase workload and create an air of mystique which may not be conducive to good working relations locally.

3.1.3    System example: Stakeholders suggest that collaborative working has been enhanced because of a) the wider reform agenda in Greater Manchester and b) recognition that (higher levels of) physical activity can support partner objectives.  The reform agenda appears to be a key facilitative context with a common cause (around systemic change to reduce inequality across multiple spheres).  This has provided ‘evidence’ for the effectiveness of new ways of working and ‘permission’ to challenge systemic barriers and open doors to work across previous silos. This conducive context appears to be reciprocal, for example, the GM Moving Journey and Learning has highlighted the importance of relationship building, which is supported by the same messages that came out of Further Faster, at the GM Public Service Reform event in November. This ‘permission’ to prioritise relationship building in the work has spread further, with other GM leads using the same language to describe other aspects of systems change, which further embeds the principles into practice across GM.

3.1.4    System indicators of change and learning: The last six months have seen an increase in the number and range of incoming enquiries from a variety of different sectors and requests for GM Moving and Local Pilot leads to present and engage other system leaders at meetings, events and conferences etc.   This may indicate that the work to join up the system is beginning to reach a critical mass with more people having the physical activity on their agenda.  This raises the question of how to develop capacity further to respond and react to growing demand, without relying on a few key people in the centre.  The ambition over the coming months is to develop a whole range of system leaders who can share the narrative and messages with their peers, for example, clinical leads engaging with clinicians, planners engaging with planners, which stakeholders believe would be more powerful and have more potential for exponential growth.

3.1.5    Locality example: Locality leads have spent a great deal of time in cross system meetings and with community and voluntary sector agencies.   Activities such as asset mapping have identified large numbers of organisations, some of which have physical activity as a primary or secondary focus.

In addition, some localities have formed or tapped into mini steering groups. One mini steering group brings together voluntary sector organisations with an interest in food and nutrition, social prescribing, community games, a housing group with local authority and healthcare staff.  This helps to maintain a whole-systems approach by keeping key voices in the room when decisions are being made as to deliver the pilot.

3.1.6    Locality indicators of change and learning: Meetings and engagement of local partners can be seen as early indicators of change, and we will continue to observe how, if and when this translates into change on the ground.  All locality leads have expressed that the time it has taken to engage and join the system has been far more than they anticipated.  They are also beginning to realise the extent to which engagement is an ongoing process.  At least one locality has taken action around this by drawing down funds to employ a community liaison lead in order to increase capacity.  Others may not have done so, with the belief that the Local Pilot money should be used for more material expenditure or the delivery of ‘events’.  There is growing recognition across the localities, through enhanced networking at the local delivery events and interaction on KHub, that ‘doing’ can include ‘relationship building’ and that they can enhance their capacity to do that via directly employing new staff.

Furthermore, the local contexts mean that different localities started from different points.  In some localities, pre-existing cross-system working was already established via other initiatives.  In these cases, the Local Pilot activity has been able to connect into existing networks.  In other localities this was not the case. This means that progress towards genuine collaboration is at different points in different places.   This may have a knock on impact on community engagement and trust, for example, in one locality they have recognised that there are gaps and lack of consistency across their own system partners which have had a detrimental effect on engagement with communities.

‘There is an impression of uncoordinated and inconsistent range of services provided for the community.  There is no sense of permanence, continuity or progression for individuals which reduces motivation and trust’

This has stimulated renewed efforts to find meaningful ways to join up the system but also recognition that this takes time and will take more time to build trust with communities.  We will continue to explore these differences in our evaluation and following the level of engagement and quality of ideas which emerge from the localities where there is strong cross-system working.

3.2       Intention:  Reducing hierarchies

In addition to working better across the system (at both strategic and locality level), efforts have been made to reduce the power differences between and within levels of the system.  Stakeholders describe efforts to flatten hierarchies between Sport England and Greater Manchester, between Greater Manchester and localities, and between localities and the people that live and work in communities across Greater Manchester.

3.2.1    Rationale: Stakeholders proffer a suite of reasons for reducing hierarchies and power differences in order to enable people to become more active.  They describe power as being manifest in resources (such as funding), processes (such as accountability frameworks), language (such as technical marketing, management, or research ‘speak’) and ideas (such as intervention design and distribution).  Stakeholders consider that years of top-down control haven’t worked so they are keen to try something new.  Of particular note is the understanding of the evidence that ideas and issues which come directly from the community are more likely to be genuine opportunities and solutions to problems and/or issues that community members care about.  This in turn is more likely to lead to interest in and ownership of eventual solutions.  There is also recognition that the sphere of influence in place is actually really small so local, hyper local solutions are increasingly seen as being more likely to work. There is a perception that strict accountability frameworks limit innovation, create bottle necks for resources and are onerous for organisations to comply with resulting in historical experiences such as that articulated by a community group who had applied for funding from a national body, which felt like “£60,000 worth of volunteer work for a £50,000 grant”.

3.2.2    Threats to these assumptions being realised:  Stakeholders have observed that entrenched hierarchies take bravery and persistence to overcome.  Individuals ‘upstream’ must be prepared to take on risk and responsibility to challenge authority and governance models. Stakeholders have also observed that partnership with local communities is often limited to a few vocal groups (and not necessarily representative of the whole community) where there are existing trusting relationships.  This is to the detriment of other people or groups who may provide access to previously hidden communities and groups and which may also fuel local competition (and be a risk to working together across the system).

3.2.3    System examples: Strategic stakeholders have worked hard to create an atmosphere of ‘all one team’ between the GM and locality ’teams’.  This has included changing historical ways of working, to genuinely co-design and co-produce the approach, as well as the work at GM and locality level.

Simple steps have been taken, for example to invite all partners to all events and meetings to avoid creating a culture of ‘them and us’.  An open approach was developed to locality submissions, so that teams could produce plans in formats that fit with local need, aligned to the principles. The GM Moving Executive and local pilot implementation group have worked together to co-design the governance and ‘sign off’ process for plans.  This includes being open about the length and format of locality proposals (recently submitted) saying ‘write what you need to write’.

The strategic team have provided support to locality teams. Deadlines for submissions were positioned as ‘staging posts’ rather than ‘end posts. Rather than place marking criteria on these proposals they adopted a peer review process based on learning from sector led improvement work elsewhere in GM. The intention is to share good thinking and develop together in an ‘action learning’ approach rather than reinforce ideas of experts/non-experts, or right and wrong.

Ultimately there is a desire for communities to decide what is right for their place. All of this aims to encourage the teams to be bolder with their visions.

3.2.4    System indicators of change and learning: Opening invites to meetings has seen an increase in attendance from locality partners and more open discursive conversations about what and how to progress.  However, it has been noted that some localities engage in additional meetings more than others, due to capacity.  Some locality leads have also taken up extra opportunities, for example to visit other Local Pilots around the country, or become involved in other strategic components of the Local Pilot.  Future evaluation efforts will look to see whether these varying levels of engagement affect the success or otherwise of locality plans.  It has also been noted that whilst, in principle, engaging in peer review is welcomed as creating an air of collegiality it can also create a degree of uncertainty and additional workload given the openness of the brief and people’s varying confidence that their response will be ‘right’.  It highlights that change, however welcome and necessary, can be unsettling for people used to responding to opportunities in a specific way, suggesting the need for additional support and reassurance.

3.2.5    Locality examples:  A pre-existing model of distributed leadership was perceived to be a supportive context for the delivery of the Local Pilot at a locality level.  In one locality a community group been developed to make suggestions.  The public health team recognised the need to be patient to allow the group form and for them to develop a sense of what their important issues are and what they need from public health. Similarly, in other localities public health teams are aiming to work with community partners by directly investing in them – building capacity and allowing them to work in a way which is true to their skills, capabilities and cultures (as stated by a community lead ‘don’t make us like you’!). This requires trust, flexibility and time to evolve.  Stakeholders ‘higher up’ the chain have been open to changing processes, for example, Sport England are working hard to support change internally that enables the co-design and working alongside each other approach with the twelve local pilots to translate into legal and contractual practice. This hasn’t been straightforward, but it has been recognised as work that will help all pilots to work according to the principles that have been set out for this work.

3.2.6    Locality indicators of change and learning:  The community groups have started to make requests of the public health team highlighting a power reversal and indications that approach (supporting group formation and observing patience) is able to affect changes in the system.  Stakeholders have highlighted that this process has exposed public health fragility (related to low capacity/impacts of austerity) but further knock on impacts of this (positive or negative) are not yet known.   We will continue to observe whether this translates into a) effective local solutions and b) sustainable plans.

3.3       Intention:  Getting to the heart of what matters in place

Stakeholders have highlighted that alongside relationships and trust, deep understanding of the lives, concerns, motivations, skills and capabilities are important to progressing whole-system change.  This relates to the ’empathy gap’ Sport England have cited in the community of learning themes.  Importantly, the ’empathy gap’ exists not just between stakeholders and people in the communities but also between different stakeholders.

3.3.1    Rationale: Stakeholders suggest that framing conversations more broadly, (and specifically in a way which brings the partners’ core objectives/values to the centre of the conversation), enables those for whom physical activity may not be a core concern to identify opportunities to see it as a solution to a wider remit of issues (for example air pollution, crime, mental health, family/community cohesion).

This way of working also accepts that physical activity may be very low down on the priority list for residents but that it may be a solution to items higher up that same list.  Tapping into what really matters and then introducing the opportunities offered by physical activity to address it may help generate a win-win situation.

Stakeholders suggest that closing the empathy gap requires real and genuine insight and engagement, ideally with co-produced solutions.  This assumes that co-produced solutions are likely to be based on citizens’ needs (and strengths/assets) and more likely to be effective.

3.3.2    Threats to these assumptions being realised: Stakeholders identified risks in that starting conversations with ‘what matters to you’ can both dilute the physical activity message and even raise false expectations as the ability to help with their actual issues may be limited.  This might apply most pertinently in discussions with local people.  For example, if ‘what matters to you’ is that you have secure employment, there is little the Local Pilot can do about that directly.  Becoming more active might help alleviate the stress associated with a lack of secure employment but the suggestion might not be welcome and seen to be missing the point, inadvertently increasing frustration.

In addition, it is recognised that ‘not all co-production is equal’ in that what one person might consider to be co-production, another might classify as consultation.  For some, working in this way can be seen as time-consuming and unsettling and a distraction from ‘getting things done’.

3.3.3    System examples: The team have appointed an engagement officer directly from the VCSE sector, in partnership with 10GM.  This person has helpfully disrupted and challenged thinking on what engagement is and could be.  They have circulated toolkits and are available to support the localities and GM leads as a sounding board and or more hands on provision. The engagement officer has introduced a language checker to support the use of Plain English in line with the investment principles and ways of working which is accessible to anyone. In light of the danger of raising false expectations they have also highlighted the need for caution and to be more tactical in the promotion of physical activity as a solution to defined problems.

3.3.4    System indicators of change and learning:  Progress to changing language to make it positive and accessible has been made to the point that stakeholders are mostly now able to recognise and challenge where language does not meet the principles.  Most recognise that is hard to avoid slipping into technical or marketing ‘speak’ at times and that this will, overall, be a long process of change.

It was accepted wisdom that working with inactive people would be made easier by working with the existing VCSE organisations.  However, more sophisticated understanding of the engagement work has emerged in the last six months. For example, some VCSE organisations across GM are perceived to have entrenched traditional ways of working and, in fact, can act as gatekeepers to ‘the people’.  In these cases, direct approaches to residents have been more productive.  Alternatively, other VCSE organisations across GM are more progressive and facilitate the efforts of those seeking to engage.

There is also an emerging challenge where some organisations are motivated to come to the table by the prospect of securing investment into existing ‘solutions’ which is disruptive to the more consultative community lead approaches that are emerging. There will need to be open conversations with those who are confident that they have (or are) ‘the answer’ emphasising the risks of focusing on money and jumping to solutions.

3.3.5    Locality examples: Localities have developed submissions which highlight who their targeted populations and neighbourhoods are.  Most have done this primarily though analysis of demographic and SES statistics.  However, many have recognised that these statistics only tell a small part of the story.  Many localities have already conducted engagement activity to inform their plans. In others, although engagement has not yet started, a commissioning process has taken place to engage voluntary sector partners to conduct engagement activity.  The decision to ‘partner’ with experts in engagement emerged through understanding from prior engagement activities that indicated that voluntary sector organisations are often trusted more in local communities than local authority staff.  In addition, consultation by local authority staff risks discussion getting side-tracked by wider issues, given the prevailing culture of service provider:recipient and entrenched history of top down approaches in public service. Whilst the public service reform work in Greater Manchester aims to address this, it is very early days and will take time.

3.3.6    Locality indicators of change and learning:  There is emerging evidence of changes being made to locality plans and locality approaches as a result of engagement activities which highlight what really matters in particular circumstances.  At the moment these are tactical e.g. in one locality, the community liaison lead doesn’t wear his leisure centre branded uniform when he is out and about in the target ward; the community lead in another changed the content of her presentation slides when she heard what was important to the local community.  There are some questions remaining over the extent and nature of the ‘co-production’ activity which may cause some tensions across and within the team.

4.0       What might have been done differently?

The reflection workshop with localities on the 25th March 2018 provided an opportunity for people at different levels of the system to think about how use of the Pointers for Leadership Practice might have influenced some of the decisions and directions taken over the last six months as well as how things might be differently in the future.

One of the most consistent and powerful messages emerged around a desire to have engaged more with different groups and particularly those who are inactive. Specifically, there was a sense that the pointers would have helped them to test language and different perspectives in an open fashion. It was also felt that the VCSE sector could have been engaged more to facilitate this process.

More broadly, within the system, there was a sense of now being more empowered to speak with stakeholders and organisations at higher levels of the system in more open ways that both challenge the status quo as well as finding new ways to build shared agendas. Specifically, this coalesced around the idea of a focus on other stakeholders’ end goals and the role that people being more active might play in that. One example included work with DWP to reveal how active people will be more work ready and therefore less likely to continue claiming benefits.

There was also a greater comfort in the idea of failure and being open about the prospects of not all the test and learn initiatives being successful. The pointers were highlighted as a resource that might enable conversations to be opened up around what happens when things fail before that failure happens.

The pointers were also seen as a resource that needed to be tested themselves with recognition that they might not be useful in all situations and could be more useful to some than others. One suggestion was that they might be tested in the context of a local learning pilot to help reveal the strengths and weaknesses of the different elements.

5.0       Where next?

The next six months will involve continued efforts to join up the system and develop system leaders, work to build the ‘one team’ mentality and remove practical systemic barriers to delivering this.  Proportionate resources are to be applied across localities where contexts are variable.

The localities have submitted their proposals which are being collectively reviewed in order to offer suggestions. An increase in pace is then anticipated where localities begin to enact the ideas presented in their submissions.

Following the completion of a marketing insight exercise a creative agency has been appointed to help develop and launch a campaign.  The creative agency will be monitoring reach and awareness of the campaign to help with understanding of what impact the campaign may have with local populations.

The recently appointed evaluation partner is developing a detailed evaluation framework which over the next six months will provide a structure for wider reflections on process learnings, embedding researchers with the strategic and local teams and identifying ways to measure and monitor indicators of system and behaviour change.

Development of the workforce development strategy will also continue with a potential role out of training and identification of champions.

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[1] A decision has been made to make reference to the Local Pilot rather than Local Delivery Pilot in recognition that the investment is concerned with far more than ‘delivery’ in the traditional sense.

Contributors and facilitators:

Hayley Lever, Rob Young, Scott Hartley, Sara Tomkins, Matt Johnson, Matt Stocks, Hazel Musgrove, Richard Davis-Boreham, Jackie Veal, Neil Long, Tom Howarth, James McInerey, Neil Bardsley, Kate Ahmadi-Khattir, Annette Turner, Caz Whittle, Jane Gardiner, Kat Pursal, Lisa Clayton, Dona Sager, Louise Wright, Kim Liall, Steph Rush, Pritesh Patel, Louise Robbins, Pete Burt, Colin Greenhouse and Tim Woolliscroft.

Authors:

Tim Crabbe, Substance and Katie Shearn, Sheffield Hallam University

Captured via:

  • Local Pilot Implementation Group strategic reflection session on 12th March
  • Local Pilot Network Event in Wigan operational reflection workshop on 25th March
  • Interviews with strategic leads across GM Moving, Greater Sport, Local Pilot, VCSE

Other supporting information:

  • Local Pilot Network Event Presentations
  • GM Moving Reform Board Presentation
  • Locality plan submissions

Partners involved:

Greater Manchester Health and Social Care Partnership, Greater Sport, Sport England, GM Moving, Local Pilot teams from Manchester, Rochdale, Tameside, Bury, Wigan, Stockport, Trafford, Salford, Bolton and Oldham, 10GM (VCSE), Transport for Greater Manchester.

 

 

Journeying together:  the GM Moving story and learning so far

People often ask about the journey Greater Manchester Moving has been on so far.

Questions that come up often are:

Where did you start?
What have been the most important steps along the way?
Who leads, and how?
What have you learned about how to position and lead this work?
Is it working?
What might you have done differently, with the benefit of hindsight?
We will try to address these questions, and more in the story of GM Moving and the learning so far.

Preface

This is the story of the GM Moving Journey up to September 2018.

Early last year we commissioned an innovative team of researchers (the Revaluation Collective) to help us capture the story of GM Moving to date, because we knew that there had been so much value and learning over the last three years – and we did not want to lose it.

The research took the form of collective storytelling, leading to collective sense-making. Each of 15 system leaders from GM and beyond[i], who had played a pivotal role on the journey was interviewed to capture their individual accounts of what happened and how. The Revaluation team then weaved the facts of the stories together to create a single chronological account of the journey, and draw out the narrative about the value of GM Moving that went with the facts.

The resulting storyline is retold here: it shows that how the leaders in this work have been laying the road together as we have travelled. It also suggests that the value is in, and has flowed from, the ways of working we have established – these are spelt out at the end of the story as a set of ‘Pointers for Leadership Practice’.

In addition, people working in other places ask about the journey Greater Manchester Moving has been on so far and what we have learnt; whether about challenging inactivity or in wider system leadership on other agendas.

What follows is our story so far; other places will have their own stories.

What is important, in sharing our journey, is that it there is no ‘should‘ for every place. All we can share is what we did, based on where we started from.

Every place, its circumstances and conditions are different. Those leading in each place will use their own judgement and take what they want from our story, before reinterpreting it as part of their own journey.

One of the things we found out is that  ‘ticking boxes’ is not success to us.  We need long term, sustainable change, across the Greater Manchester population, and to reduce our activity and health inequalities.  In our transformational change we are envisioning something different that is not necessarily an end state but is continually evolving and developing.  We are trying to create the conditions for success, and these take time to come to fruition.   We are working at multiple levels and breakthroughs sometimes come from unexpected places.

The question of success depends what you place value on.  As a speaker at a recent Public Service Reform event in Greater Manchester said, we need to measure what matters, otherwise;

There is a danger that we may meet the target, but miss the point”.

Similar learning is emerging in the Sport England Local Delivery pilots across the country; ‘’not everything that counts can be counted, and not everything that can be counted counts.’

It is also important to say that we are still grappling with many questions of our own and are always looking outside of Greater Manchester to see what we can learn from others.  It is hoped that sharing our learning in this way, will contribute to an open, ongoing, collaborative conversation with others who share similar ambitions, and are using similar, and different approaches.

There is no single ‘true story’ of any journey. There are multiple stories, and different perspectives.  No one can see the whole system or the whole journey from any one place or point in time.  No one can be truly objective, and the Revaluation collective have been keen to point this out as they have interpreted the findings and focussed on the elements of stories that held most meaning for them.  However, the quotes that provide much of the story which follows are from people interviewed by the Revaluation team, so they represent evidence from multiple voices and perspectives. Note these appear in itallics.

Other people who have been on this Greater Manchester journey will have perspectives to add.  They may disagree with, or at least not recognise elements of this story. That is inevitable.  We will keep listening and capturing different voices along the way, to keep learning and understanding. The journey is likely never to be finished – so neither is the story. It can be retold by these and other voices, and it is definitely ‘to be continued…’.

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1.   Where did we start in Greater Manchester?

Greater Manchester has a long history of collaboration, under the Association of Greater Manchester Authorities (AGMA) where the ten local authorities have worked together for over 20 years. This is a significant contributor to the Greater Manchester Moving journey, particularly since devolution.

The Manchester Independent Economic review (MIER), published in April 2009, was a ground-breaking, independent study that provided the analytical underpinnings of successive Greater Manchester strategies for local growth and public service reform. The MIER reviewers stressed the need for GM to be equipped with more ‘policy tools’, noting that it lacked the fiscal and policy levers to build successfully upon the area’s strengths and confront the challenges it continued to face.

Their recommendations paved the way for the creation of Greater Manchester Combined Authority (GMCA) in 2011, the election of GM’s first metro mayor in 2017, and a series of devolution deals with Government that strengthened GM’s governing capacities across a range of policy areas[1].

There is a great sporting tradition and identity in the city region. There was the strong foundation of a well-connected physical activity and sport system, with high performing leisure and cultural trusts and County Sports Partnership (GreaterSport).

In 2014, physical activity, sport and health leaders around the country were awakening to the huge and fast growing challenge and cost of inactivity. The Designed to Move report had been published, by the Young Foundation in 2013 and Everybody Active Every Day (Public Health England, in 2014). The emerging narrative was that a shift of focus to addressing inactivity was required to effect real change.

In Greater Manchester, each local authority Chief Executive takes a lead responsibility for specific agenda across the ten local authorities. Steven Pleasant, Chief Executive at Tameside MBC, was the lead for health. He and Yvonne Harrison (then Chief Executive at GreaterSport) were instrumental to the start of the GM Moving journey.

Journey so far Chart

2.  Developing a shared purpose to addressing inactivity in Greater Manchester (Jan 2014)

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“We felt suddenly that we needed to bring the system together. The conversation was getting bigger than sport……… So we planned to bring multiple partners together from all the boroughs, across planning, schools, transport, education. There was a partner event. Steven Pleasant spoke. He had been instrumental in getting this agenda off the ground“.

 

 

We presented the rationale for the first time: budgets are shrinking, demands are growing. What benefits could we get from repositioning sport? People didn’t know what we would do, but they wanted to do it. It was a statement of intent”.

3.  Demonstrating the evidence of the power of physical activity for wider outcomes (2014)

Following the partnership event, it was critical to win the hearts and minds of system leaders, who were unaware of the costs of inactivity, and saw sports participation as something that ‘fit people’ did and promoted.

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So we needed to build a case for change. We assembled the evidence base….and we turned this into the business case, including return on investment data……that helped us to develop new language instead, so for example we talked about the CMO[ii]’s magic pill’ and such like”.  

“And this generated debate…..and slowly the momentum grew”.

4.  Devolution (Nov 2014)

Greater Manchester devolution, including Health and Social Care devolution was announced in November 2014.  This included taking charge of £6 billion spent on health and social care in the ten boroughs of Greater Manchester.  This was a huge opportunity and challenge.   It signalled a new chapter, accelerated transformation and reform and invited innovation and new paradigms to secure the fastest and greatest improvement to the health, wealth and wellbeing of the 2.8 million people of Greater Manchester.

Greater-Manchester-History-of-Devolution

“Greater Manchester devolution includes £450m for a Transformation programme to transform health and social care funding across to GM. The Fund is to put in place the transformation of the architecture, for example, single commissioning functions. Technically the devolution is a delegation from health and social care to GM with £6bn from NHS England. But we see that within the round of £22bn of public sector spend in GM”.

5.   GM Moving: the Blueprint for Change (July 2015)

BRING_TOGETHER_GRAPHICS_MAR19-3We formed a working group. Steven agreed to chair it, and because of that, people came. We had the lead Director of Public Health, Transport for Greater Manchester, involvement from New Economy, and Sport England… and that became the GM Moving Leadership Group. Over many months that group convened to draft the GM Moving Blueprint for Change“.

This was a significant step forward. An articulation of the cost of inactivity, the case for change, and the shared purpose brought the system together with a plan to deliver.

The key influencers were the politicians and the Chief Executives of the ten councils  Together the Greater Manchester system hosted an event where every GM leader and every Chief Executive signed the 10 pledges.

BRING_TOGETHER_GRAPHICS_MAR19-2“The Blueprint was launched in the Velodrome, about 18 months after it was first thought of. Jennie Price (Sport England CEO) was there, Charles Johnson (Director) too. I’d never seen such senior buy-in around physical activity, and we were keen to build on that momentum. People had come together by choice; normally they come together around a pot of money. There was no money here, just senior leadership. Devolution hadn’t happened yet, it hadn’t quite landed. But we all got on the same bus to go the same way – I’m proud of how we got everyone on board.”

6.  Formation of GM Active (Nov 2015)

GM Active

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“The 13 cultural and leisure trusts across Greater Manchester responded to the opportunities of devolution and GM Moving, in an unprecedented move to collaborate with one voice as one team. They formed GM Active under the leadership of Mark Tweedie (Chief Executive, Active Tameside) in November 2015”.

As leisure providers, there was an understanding from the member organisations of the key role they should play in Greater Manchester devolution and in particular health and social care transformation through their existing assets and role as prime deliverers and facilitators of physical activity in localities, communities and neighbourhoods. There was also a recognition that to develop this role and scale up best practice and learning there needed to be more formal collaboration between the organisations, leading to the formation of GM Active.

Soon to be a legal entity, GM Active is governed by a Memorandum of Understanding between its member organisations providing commitment to working together on a number of key objectives spanning profile and engagement, service development and capacity and resilience all working towards shared outcomes and a vision:

GM Active’s vision is for a network of innovative, responsive, resilient and high performing Greater Manchester Leisure and Cultural Trusts that deliver transformational outcomes across Greater Manchester’s communities.

7.  System Architecture and Strategy: Taking Charge (Dec 2015) and the Population Health Plan (Feb 2017)

From here on, there was a huge amount of work to do. It was the beginning of something exciting, but came with plenty of challenges too.

EXPLORE_GRAPHICS_MAR19-3[My] previous experience of sport was that it didn’t connect with anything else. It was filled with enthusiasts. All of them brilliant, but the system didn’t reach out to even the obvious places like health. Physical activity rates were low, there were no collaborative models, and no system leadership for increasing physical activity….so this (just) became a kernel of system leadership.

But outside of this group there were still high levels of scepticism for example among the health commissioners. ‘We don’t do physical activity, we commission beds in hospitals.’ They also said ‘What are you trying to do? Get the active more active?’ They had doubts that the sports sector was connecting with the less fit. So it was a difficult proposition to land.

The critical moment came from health and social care devolution. The ‘Taking Charge’ document put physical activity right in the middle, and it called for a Director of Public Health for Greater Manchester. GM Moving was then located within Taking Charge, and inside the governance of GMCA[iii] – before that it didn’t have a home. Now there was a route. Some authority, and a funding stream. That was a big step over moment.

“Jon Rouse was Director General in the Department of Health and he had previously been Chief Executive at Croydon Council. He had a wide support base in the NHS, and now he was heading up the Health and Social Care Partnership. He sponsored the GM Moving work and linked it to Taking Charge. The focus was on population health outcomes, and on moving money from acute services to community…

[We] developed the Population Health Plan and embedded physical activity in it. The gain was legitimacy in public health, and this was significant…

“You won’t see Jon around much [in GM Moving work] now day to day, but his work was fundamental. So that [we] could go into rooms and cite the Population Health Plan. [We] didn’t have to make the business case anymore”.

  1. GM Physical Activity and Sport Commissioning Project with Sport England (February 2016) and Memorandum of Understanding (signed July 2016)

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Sport England identified that there was something different happening here and were extremely keen to explore the opportunities of devolution and what this might mean for physical activity and sport.  They were keen to explore a strategic relationship with Greater Manchester and what this might look like.  Working with GreaterSport, an experienced consultant was engaged to progress this.

“In late 2015, Sport England asked me to look at the opportunities in relation to physical activity and sport arising from devolution in GM. They felt it was different from other unitaries and counties. Is there an opportunity for closer collaboration?

In February 2016 we started the process with an initial assessment and review of all the devolution documents. I had 8 pre-scoping interviews to get a picture of how things worked around here. In April 2016 I reported back to Sport England: ‘This is like nowhere else. Clarity. Culture. Devolved leadership. Blended teams…..this is a big deal. There’s a big programme emerging here that we need to consider and plan for’.

“From May 2016 I did 8 more interviews [for the commissioning project].  From this a clear and extensive programme was emerging, involving working with people across the lifecourse, in place based contexts and with workforces across the board.  Given the size and scope of the potential programme I recommended the early appointment of a Strategic Manager to help realise all of this potential.

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We held a big event in GM, a high level summit with Local Authority cabinet members and other leaders to get their buy-in.  We ran two sessions, both with William Bird.  Hundreds of people came.  Momentum was high.

In terms of the strategic relationship between Sport England and Greater Manchester, the suggestion for a Memorandum of Understanding (MoU) between the two came early in the project.  It was developed and signed within a three month period.

“I interviewed Steven Pleasant and the MoU concept emerged from there, as GM and Sport England both had a history of developing such approaches to collaborative working…

The MoU was developed, then launched and signed by key strategic leaders[2] including Jennie Price (Sport England CEO), in July 2016. It was the first of its kind in the country”.

Sport England Sign Up With MoU

 “The MoU was a factor not a driver and it’s because of the MoU that we have Hayley [GM Moving Strategic Manager] in post. It was a particular moment in time. And Sport England don’t have many MoU’s. It’s helpful because it suggests longevity of commitment. It was also helpful for the Local Delivery Pilot process, as we knew a lot about what we wanted and how we were going to design it.”

The MoU was launched alongside Sport England’s new strategy in July 2016

“It took a lot of work to get the legal approval. It tested the development of our relationships. It became a marker in the sand….. The relationships were more important than the words”.

“MoUs make shared commitments, and often these refer to different ways of working beyond the bog standard. MoUs are about intentions more than the specifics. Therefore it can be hard to say whether they have an impact on delivery: that’s not really the point”.

“We want Sport England to be really excited about working in GM. There’s so much potential here in terms of population and governance, and a group of [Local Authorities] with a history of working together”.

“Devolution has brought loads of MoUs. The devolution of health and social care in its entirety is based on an MoU. The February 2015 Devolution Deal is in fact, an MoU, though elements of that have been slower than we would like.  Changing ways of working is a lot more complex [than developing the MoU itself]”.

“It involves culture change and system change, which goes with the desire to do differently…..Things have been signed, there’s intent on all sides. But behind the signatories are systems”.

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“Change is more complex and time consuming than the signing of an MoU…..The MoUs remain useful; you can check back. In any change process people need to look back to see where they’re going. But the work is much broader, that’s the hard work. It’s not ‘hoorah, we’ve all signed and everything’s going to be different from here on’”.

The commissioning work left an agreed joint action plan between Greater Manchester and Sport England in July 2016. There was a need for a team in place for the MoU and for GM Moving.  That started with the Strategic Manager post, which took some time to develop, and started in April 2017.

9.  Physical Activity prioritised in Greater Manchester Mayoral Manifesto (May 2017)

“We started engaging politicians, with an offer to all] the mayoral candidates including Andy Burnham. It was all very tactical; relationships based on networking. People work with people they can get on with…

Our ManifestoSo [Andy Burnham moved] in our direction… the opportunity was to take the GM Moving Blueprint and frame the offer around that. We wouldn’t have to be starting again from scratch. He was happy…so long as we could bring in people’s views. We facilitated a stakeholder event based on insight and engaged the system…

Andy campaigned on increasing physical activity, and on having a Walking and Cycling Commissioner”.

BRAVE_GRAPHICS_MAR19-7“Suddenly we had high-level backing for [our] agenda, it was locked in and this was taking it up another notch. And [in May], Andy became Mayor. Once he was elected, we sat down to flesh it out with him”.

The Mayor’s ambition for, and commitment to the physical activity and sport agenda is second to none. From May 2017, GM Moving was taken to a new level.

10.  GM Moving Plan Launched (July 2017)

The new role, Strategic Manager, for GM Moving, was born out of the Commissioning Project Action Plan and MOU, as described above.  Hayley Lever started in the role in April 2017.

Between April and the election of Andy Burnham to the mayoral role in May, it became clear that a refresh of GM Moving was needed.  So much had progressed since 2015; Taking Charge, the Population Health Plan, The Mayoral Manifesto and other significant developments.

By July 2017, the whole system had co-produced a new GM Moving Plan. Leaders from every part of the system made their contribution in response to the question; what would it take to bring about population scale change in physical activity engagement here… in your part of the system?

Spatial planners, clinicians, active travel experts, headteachers, early years specialists, physical activity leads and many more across the system, wrote the GM Moving Refresh, over a two month period, to a comprehensive plan to deliver an ambitious target, set by the Mayor. 

The GM Moving refresh was launched in July 2017. It set out the principles by which Greater Manchester would lead this work, and an approach to transformational change, with whole system approach at its heart. GM Moving has embodied and built on principles that were already there, for instance in Taking Charge.  It hasn’t invented a totally new approach. It aligned with principles of reform in Greater Manchester.

Tranformational Change Chart

Person and community centred, GM Moving set out the priority actions to address inactivity, increase engagement in physical activity and sport at each stage of the life course, from early years to older age.

Strategic Framework

It also set out the priority actions for ‘place’ including the built environment, natural capital, walking and cycling infrastructure.

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A big ambition was set out to develop skilled advocates, clinicians and practitioners across the system. The widest possible workforce including primary and secondary care, planning, transport engineering, education, community and voluntary sector and physical activity and sport providers are included.

All of this was underpinned by the evidence base, in an insight led approach; understanding people and communities, engaging effectively through marketing and communications and campaigns.

Finally, the implementation of GM Moving was set out as a learning journey. This whole system approach to population scale change hasn’t yet been achieved anywhere.  Greater Manchester’s aim was to help create the evidence base that doesn’t exist yet. Evaluation of impact, outcomes and process would be vital.

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GM Moving 2017-21 was launched at the Greater Manchester Health and Social Care Partnership Board and Greater Manchester Combined Authority meetings in central Manchester, by Lord Peter Smith and Andy Burnham.

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It was followed by an event in the street, with builders dancing, leaders playing table tennis in the rain, kids riding bikes and Mayor Andy Burnham boxing in a tent. It was a significant day in the history of GM Moving.

 

Case Study: Engagement of the Voluntary, Community and Social Enterprise Sector

“I first came across GM Moving at an early Reform Board. The MOU was being signed and I was representing the VCSE. I made an offer to engage Sport England, and sport in fact, in community life and get physical activity more embedded. I don’t have a sport or physical activity background.  My experience is in community development, engagement and providing support to community and voluntary organisations. I didn’t know what I had to contribute and felt a bit of a fraud in a room full of passionate people on the Exec that have years of experience as activists for sport. So, I was a bit quiet at the start.

When Hayley joined the team as the lead for GM Moving, I was still quiet on the Exec Group but I remember meeting and discussing the importance of the VCSE role in the work.  Hayley has also had lots of experience of community development and encouraged me to be more vocal in the discussions at the Exec.  I reflected on this and participated much more in the Exec meeting and its work after this point,  Sports England and the rest of the Exec seemed genuinely interested in learning more about this and how the principles of working in this way can be reflected in the way the Local Pilots and the wider GM Moving work will be delivered.”

 11.  Walking and Cycling Commissioner Appointed (July 2017)

Alongside the work to write GM Moving, the Mayor’s team had been working hard to recruit Greater Manchester’s first Walking and Cycling Commissioner.

The day before GM Moving was launched, in one of Andy Burnham’s first live Q&A sessions with the public he announced:

“I said I would do something for cycling in Greater Manchester.

Launch Event (123)Tomorrow, there’s quite a big step forward for cycling in Greater Manchester. I will be announcing Greater Manchester’s new cycling and walking commissioner with the aim of building a high-quality, safe, dedicated cycling network across all our ten boroughs, getting more people out of their cars and onto their bikes, making air quality better, improving health and cutting congestion.”

“By the time of the GM Moving Refresh in 2017 we could run a session with the Combined Authority and the NHS, and it was announced that Chris Boardman would be the Walking and Cycling Commissioner“.

12.  Ambitions for Walking and Cycling: Made to Move

Six months after the appointment of the Walking and Cycling Commissioner, Chris Boardman, a report was presented to the leaders of the Combined Authority and the ten local authorities in Greater Manchester.  Made to Move sets out fifteen steps to transform Greater Manchester, by changing the way we get around.

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The report was approved by the leaders, and the Made to Move team started network mapping the whole of Greater Manchester.

The Bee Network is the infrastructure plan, and where the Mayor’s Challenge Fund will be invested.  Made to Move is the strategy specifically for utility walking and cycling. GM Moving is physical activity more widely.

 Together, new infrastructure and behaviour change work will enable, support and promote a social movement for everyday walking and cycling; utility and recreation.

13.  Sport England Investment; Active Ageing and Local Delivery Pilots 2017-18

On the GM Moving journey, there have been a number of key opportunities to bring investment in to support the work.

Funding has historically been one of the key reasons that partners have come together. Greater Manchester had started a different collaborative journey, through GM Moving. A shared purpose. A vision, a plan and an agreed set of principles to work to.

One of the big tests is how those principles stay the course when money becomes the focus.

Active Ageing

The Sport England Active Ageing investment programme offered the first opportunity to test the Approach to Transformational Change.  This provided a great deal of learning, as GM Moving leaders across the system started to use this approach to guide the work on all 12 GM Moving priorities.   In particular, we learned that in the first step of establishing the case for change, early community engagement is essential to ensure that we are setting the right course and examining the right evidence, data and insight.  Starting with people and communities comes first.group

Local Delivery Pilot

In early 2017, Sport England launched the Local Delivery Pilot (LDP) process.  Although there was a sense that investment in GM should come via the MoU, rather than through a bidding process, this wasn’t possible, so an Expression of Interest was submitted in March 2017.

PRINCIPLES_GRAPHICS_MAR19-2“The LDP looks like it was a more conventional ‘them and us’ bidding process. Competitive not collaborative.  We often have this with other departments: that they show willingness to change, but they struggle with the processes”.

There was concern in Greater Manchester that bidding for investment isn’t the most constructive approach. The MoU journey had built rich relationships, and there was a danger that the LDP process would take things back to a more transactional relationship.

There were also concerns that the LDP would drive a ‘programme’ mentality, rather than one about communities, system change and behaviour change.

Looking back on the story of GM Moving, we can identify a sense of frustration shared by many of the system leaders in GM that we placed too much emphasis on the LDP bidding process, and that due to limited capacity available, it was a distraction during the important phase following the launch of GM Moving in July 2017.

“The LDP and GM Moving are at risk of becoming one. But they’re not: the LDP is just a part of what GM Moving does”.

PRINCIPLES_GRAPHICS_MAR19-6“Money changes people’s approach doesn’t it? The GM Moving Refresh was published last summer, and we’ve spent [a lot of time since then working to] meet the requirements of Sport England [for the LDP]. I think we’ve probably not put enough emphasis on what we wanted to achieve more broadly. I think we’re getting there now but I think we got pushed off track by chasing the money”.

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Case Study: Oldham visit for the Local Delivery Pilot Assessment and LDP in localities

The Oldham visit was a bit of a gamble as it was largely unscripted. We showed Sport England communities working with communities. It was a very open dialogue day, on the street and not hiding anything. We went to visit the Chaddy Park Steppers: Sport England spoke to them, and we didn’t know what they would say but it was a great conversation. The Steppers were originally a football club but you wouldn’t know it. They are all about tackling loneliness and mental health. They set up a walking group, and recruited volunteers to the football club in the process. ‘Mind’ were partnering with them. We also visited the Ghazali Trust in Oldham with some community leaders. Jennie Price came on the visit and was able to have a conversation with local leaders rather than a bureaucratic grand process. I’ve never got so many people out from London to see my residents. If you live there and you’re a woman in your forties you probably have no work, high blood pressure and you’re on long term medication. 

 [They] came to Glodwick Leisure Centre in Oldham where there’s a leisure centre that had been shut. The Ghazali Trust took this on as an asset transfer from the Council for community benefit, and not for commercialisation.

ghazali trust

The Leisure Trust supported them to develop a gym offer. Sport England [colleagues were surprised that] a leisure trust would support ‘a competitor’ developing a gym offer. But that community isn’t there to compete in the market for gyms……we are place-based, so it should be complementary. The LDP [process] told me that they weren’t in the same place as us. It’s a philosophically different place but when you apply these perspectives on a visit, in a place, these are very different constructs.

The allocation of the LDP investment is the next stage, so that each [locality] has money to work with to deliver. The LDP delivery group in Oldham involves housing, walking and cycling, the Executive Director, the CCG, the Director of Public Health, the leisure leads, and Employers Guilds among other people. And every borough is doing the same. The question is how to go from big to small to big to small, zoom in and out. And then from [Oldham] to GM to Sport England (national). It’s all about the learning and taking that back to Sport England. It’s not going to be a question of success or failure.

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The LDP money is not a lot of cash but it’s a catalyst. [I’ve] used it as a mechanism to keep influencing the Chief Executive, the elected officials and so on. It doesn’t matter if it’s a lot or a little, it’s enough to [help bring about change].

 “The danger is that chasing the money can be at the expense of system transformation. GM is a complex adaptive system, and massive. Then this is joined to the reform agenda in health and social change, the Health and Social Care Partnership, and then that all has to feed down to locality level. There’s oodles to change. But it’s difficult to ensure that your agenda is taken forward – and money can be a hook to draw people in. In the LDP process, everyone did buy in. When it’s spread out though it’s quite small money, but if you added it to the £160m walking and cycling infrastructure, and the £2m Transformation Fund money…. And we’re only just getting into the local processes with the LDP money”.As recently as autumn 2018, there was still a risk that there is still too much emphasis on the LDP, since there is now a pressure to deliver on the plan. This was still occupying a large part of the GM Moving Strategic Manager’s focus and time, whilst preparing to appoint an small team to lead it.

 “There’s a real risk that the LDP could be a distraction. It’s a bit counter-intuitive compared to the direction of travel of the GM Moving Executive team and our ways of working. It’s [could be] all a bit ‘programme delivery’”.

PRINCIPLES_GRAPHICS_MAR19-1 [However] It could be one of two things: one, it could provide more evidence that GM Moving isn’t wider activity, it’s just sport and leisure again. There’s a real risk we revert to silos.

Or, it could show how to embed and mainstream physical activity in the system……that’s the ambition.

“[If we’re not careful] We could end up with all we’ve already had: a couple of sports outreach workers, maybe a way to extend the leisure offer. The strength of the partnerships in different places will determine this, and if there’s an influence on public sector spending”.

There has been a significant job to do, to drive forward the implementation of GM Moving and the Local Delivery Pilot, with limited leadership resource in GM and localities, and with committed investment taking until late 2018 to come through.

However, as we move forward, more people are beginning to see the Local Delivery Pilot as a way to accelerate the wider GM Moving and whole systems approach in a tangible way.

Case Study: GM Moving in Tameside

In Tameside I’m building a £140k wellbeing centre. I’m strapped for capital but the politicians are socialised into the agenda, and we’ve just had a £6m refresh for physical activity. We are [enabling] two parkruns, improving footpaths and all of that.

It’s the GM Moving narrative that drives this. I’ve embedded it, and I can bend investment plans to physical activity – which before would have been below street lighting as a priority.

I can aim for communities who aren’t active at all.  I talk to headteachers about The Daily Mile. I spoke to a GP who’s a parkrun practice.  That’s not about money – we should change the behaviours and assumptions within the whole £6bn budget.

None of that relates to the £1m LDP money or whatever I’m going to receive. We should get sport out of the box it was in 10 years ago”. 

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“Despite some of these contradictions and challenges, our funders are absolutely part of the journey.  They have worked hard on our behalf and their support, challenge and partnership is a vital component of what we are doing together.  We’re on the same journey”.

Reflections, September 2018

“It has been a journey from small conversations to pushing at the door of big institutions, to developing a rationale and a business case, to locating it within the Combined Authority, to winning key politicians and national leaders…… GM Moving is now part of the narrative; it’s where we are. Levering in money, yes but more fundamentally part of everyone’s local delivery strategy”.ROLL_GRAPHICS_MAR19-2

“It’s not a linear progress but it is quite splendid: from the periphery to the centre. You don’t have a plan. You start from somewhere. There was enough around in terms of opportunity, a mixture of ambition and opportunism, including the Mayor”.

Lots of our success is down to our ways of working: system leadership, collaboration, leaving your egos at the door.  There’s a long history of working like this in Greater Manchester, we’ve been at it for 30 years. The Combined Authority cements that. The door was always half open and we just had to push.

“The stars are now aligned around GM Moving. We’ve come a long way. It was all laying the foundations to here. They’re in a good place. It [was] a placeholder for a social movement. It’s still that, a pulling together of collective learning: behaviour change, ways of working, principles and values. These have been surfaced, and quality standards set around them. There’s lots here that people wouldn’t otherwise have articulated. The risk has been raising expectations: lots of talk, less action, and no money. But we’re ready now”.

“GM Moving is about learning, and at the bottom, relationships.  We challenge each other, but we work pretty seamlessly.  Greater Sport have been a brilliant ally and an asset. Yvonne Harrison was fantastic. Even with Yvonne leaving, the County Sport Partnership has held it together. The relationships on the ground are fantastic among the people who are doing the work.  It is a testament to them”.

“We have to check ourselves sometimes: at this [locality] spatial level, have we got the mass mobilisation we want to see? That’s the big prize, don’t be distracted by the warm words and accolades at higher levels of the system”.

“Sometimes people can’t recognise the health language. How do we create leaders who can operate in this slippery environment: facilitative, outside of hierarchies, and a little bit scary? Moving across these boundaries is important”.

There is a need to ensure that the governance and leadership of GM Moving is distributed widely, and embedded throughout the system. This will further strengthen and sustain the impact of the work, and bring meaningful system change.

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“The proportion of people physically active is a proxy for other changes. The key change we’re looking for is that when we talk about physical activity we don’t mean sport. So having allotments is as important as a high-end training centre for elite athletes. Physical activity is broader than sport and has more outcomes than physical health.  We can only really go by the principles and ways of working”.

 “GM Moving is part of a longer journey but it’s relatively new, and the journey from sport to physical activity is new. That’s what we’re all aiming for. The question is how do we organise ourselves to deliver that transformation?”.

GM Moving seems to be working for us all. It seems to be broadly owned, as you say. Everyone now seems very enthusiastic. It’s motivating GM Active to collaborate further”. 1

“Building a social movement for physical activity is the aim – but will people mobilise around GM Moving or Made to Move? It’ll be interesting to see”.

Where Next?

Distributed leadership is critical to the next phase of GM Moving.  The ambition, principles, approach and strategic framework are in place so anyone can lead in their own context, be that in councils, health, local communities, workplaces, and people right through the system at every spatial level.

Embedding the belief and advocacy of physical activity across the whole system is fundamental to success. Opportunities to engage and contribute are emerging all the time; cancer, diabetes type 2, pharmacy, mental health, low carbon GM, education, school readiness, dementia, spatial planning, urban design, natural capital…. the list goes on and on.

Leaders across the system are convinced of the role that a more active Greater Manchester can play in achieving the broad ranging outcomes of the Greater Manchester Strategy.

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Despite the physical activity and sport sector making strong connections with other services, the prevailing view at the outset was of a service dominated by sport, not connected with the bigger picture of outcomes and scepticism about the benefits.  This perception must not be forgotten, and has to be consistently addressed, so that the narrative is about moving more. Physical activity and sport are part of an active life.

Positioning physical activity and sport in the system was central in the devolution of health and social care, through the Taking Charge strategy. This, amongst other things, shifted the focus to prevention. Having people whose background or job is not physical activity and sport as leaders, advocates and champions is essential. It’s a complex system but an endlessly rich one if we explore it through small conversations, build relationships and engage widely.

“Fundamentally we want GM Moving in every locality, in every locality plan, in every neighbourhood model: so it can show itself in all sorts of shapes and forms. For example, The Daily Mile in every school, parkrun [with every community]….”

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The movement is growing all the time.

  • How can Greater Manchester realise the potential of real system change?
  • How can we ensure the change addresses, and doesn’t grow, the inequalities across the city region and in localities?
  • How do leaders work in ways that are true to the principles that Greater Manchester has set out, in leading GM Moving and wider reform?

To address these big tests, we are developing our ways of leading, based on our Pointers for Leadership Practice. This will help us to work in ways that will bring about greater change and impact. It will further enable us to live out the principles of public service reform in Greater Manchester, and help us to achieve a shared GM Moving ambition.

 ‘Lay the road as you journey together’

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Pointers for Leadership Practice

Having co-created the story of the GM Moving journey, and identified some of the value it has created to date, the Revaluation team was asked to pull out a set of principles which could help create more of that kind of value in future – in GM Moving, across other parts of GM, and for people working in complex systems in other places. The result was a series of  ‘Pointers for Leadership Practice’, summarised below.

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The pointers are principles for whole system working. They aren’t instructions as such, but implications for leadership practice, flowing from the storyline of GM Moving to date, and how it has created value.

Taking the learning and ensuring that it informs practice, across the system, is vital to the success of GM Moving, and has wider relevance for public service reform in the city region.

These Pointers for leadership practice will help us to lead in ways that get to the heart of the challenges of system change. We will be sharing them, developing them, reflecting on them and using them to guide our work from here.

The Pointers will be of wider relevance outside the GM Moving system, across GM and beyond: potentially for all kinds of practitioners adopting whole system approaches.

But that is not to say they are complete: other systems and storylines will generate other pointers. These GM Moving Pointers aren’t universal, though they could have universal applicability.

The Pointers have cumulative value: that’s to say it’s not a case of ‘pick one’. They all apply, in different combinations and proportions, at any one time. And that means there will be tensions within and between them. These tensions will be worked out on the ground, in practice.

The Pointers apply to all of us. For as long as we work in the same system, learning together, we are all in the system and we are the system. If they have value, they have value for all of us.

They are very big lessons and we need to constantly revisit them.  They are not easy. They are easy to pay lip service to but not easy to live by.

6 Pointers

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[1] https://www.greatermanchester-ca.gov.uk/media/1132/gm_prosperity_review_baseline_report___evidence_review___november_2018.pdf

[2] Lord Peter Smith Chair, Greater Manchester Health and Social Care Strategic Partnership Board, Tony Lloyd Greater Manchester Interim Mayor, Chair Greater Manchester Combined Authority, Dr Hamish Stedman Chair, Greater Manchester CCGs: Association Governing Group (AGG), Ann Barnes Chair, Greater Manchester Provider Federation Board, Dr Tracey Vell Primary Care Advisory Group (GPs), Chair Greater Manchester LMC’s, Jon Rouse Chief Officer, Greater Manchester Health and Social Care Partnership, Jennie Price Chief Executive, The English Sports Council

[i] Appendix 1: List of stakeholder groups and interviewees

[ii] Chief Medical Officer

[iii] Greater Manchester Combined Authority

 

GM Moving: Pointers for Practice

The full GM Moving Journey and Learning can be found here.

The pointers for practice below have emerged from this work and are starting to be used to aid conversations about leadership approaches in systems approaches. They have come out of GM Moving, but hold wider relevance to other systems work, and may be helpful to those outside Greater Manchester too.

Feel free to use them, share them, and let us know if there are other formats that we could produce them that would be helpful, via info@gmmoving.co.uk

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GM Moving Local Pilot. Our learning journey so far (Oct 2018)

Partners in Greater Manchester are working together as one of Sport England’s Local Delivery Pilots which went ‘live’ in July 2018.

All background documents, bids, engagement reports etc are here.

The Local Pilot work forms an important strand of the implementation of GM Moving, and will test and explore what it takes to secure population scale change in physical activity behaviour.

Our local pilot team brings together leaders from across the ten localities, who are working at neighbourhood scale, in parallel to the work taking place across GM to take a whole system approach to reducing inactivity.

Our work together is focused on three key audiences:

  • Children and young people aged 5-18 out-of-school time.
  • People out of work, and people in work but at risk of becoming workless.
  • People aged 40-60 with, or at risk of, long term conditions: specifically cancer, cardiovascular disease and respiratory disorders

Part of our work together is to capture and share the learning as we go, aswell as to evaluate the impact and outcomes of the pilot.

To start this learning journey, the implementation group and local leads spent some time together, reflecting on what we’d noticed so far. Next time we do this, the learning will be gathered from a wider group of people as the local pilot network grows.

What are we learning so far?

Observations

The historical context of GM is important in the development of the pilot. The Greater Manchester MOU helped to set the context for a different way of working, then the development of GM Moving (refreshed in summer 2017) cemented this.

Journey so far Chart

The pilot is a tangible opportunity to put the principles into action. It is becoming clearer that the pilot gives us an opportunity to find out what a whole system approach to inactivity requires at neighbourhood, borough and GM spatial layers. The pilot provides an opportunity for GM to test the wider GM Moving approach which is based on whole systems thinking.

The context of GM in terms of both GM Moving and the pilot; their connections, similarities and differences confuses and concerns some partners because of its complexity and ultimately the lack of separation to allow us to evaluate progress and attribute success to one thing or another- although there is a recognition that this is typical in a whole system approach.

In the whole system sense, the work has largely been focussed in the policy, and organisations and institutions layers until now, but the discussions in terms of developing the work firmly sit in all five layers.

Population level change Chart

Leadership; strategic, political, framework, governance has been key to developing the pilot within the GM context. This relates to people, and GM Moving itself, as the plan to enable the development of the pilot. The leadership capacity of the GM Moving Strategic Manager role has been critical to be the broker and lead the process of transformational change in GM.

Capacity is critical. The initial development work is time consuming, and based on goodwill from partners and individuals. It is based on building relationships, bringing interested and passionate people together.

All key partners and individuals are pulling together and working hard. It is about engaging the system and exploring the concepts together. It isn’t always easy to align; with different perspectives, working preferences and demands.

This work heavily involves considering how we approach the work, and the processes we need to go through to stay true to the principles of whole systems working. We strive to continually ask difficult questions and challenge each other in a constructive and open environment.

The GM pilot landscape consists of a wide variety of partners, organisations, leaders, and potential communities to work with. It is considerably diverse but the VCSE sector are essential to the GM approach. Distributed leadership as an investment principle is allowing us to try new approaches related to this principle.

Initial work on the pilot submissions and defining the cohorts has helped to develop connections, bring partners (including wider partners) into the conversation to explore common ground.

An area of focus now is to ensure that the investment from different sources (eg Local Pilot, Health Transformation Fund  (walking), Made to Move (infrastructure) and the ‘delivery’ of these ‘programmes of work’ all come together, complement each other and enable the greatest impact possible.

We are observing both speed and patience; reflection, space and time are a crucial element of this work to ensure that we are working proactively not reactively, however pace provides both a challenge in terms of keeping momentum, and also the speed in which organisations within our system work which sometimes feels relatively slow or fast dependent on the organisation. It is both a challenge to balance both of these elements and to keep all of our partners comfortably engaged at their pace.

LDP Principles Infographic

What is changing/happening/different as a result of what has been going on?

1. People have embraced the opportunity to have a different conversation and work in a different way
2. People are interested, inspired and optimistic about the approach
3. People see the pilot as a way to accelerate the wider GM Moving and whole systems approach in a tangible way.
4. People are keen to test, learn, share and grow what is good.
5. The investment principles provide an important platform to ensure that the work is based/founded in whole systems thinking.
6. Insight, evidence, evaluation, research and community engagement are at the forefront of the GM approach and this is grounded in localities through the pilot investment principles.
7. There is a continual theme that people feel challenged and uncomfortable with the complexity and flexibility of this approach, and it will be a constant battle to avoid digressing to a traditional way of working that anchors to targets, processes and boundaries.
8. Partners are keen to communicate and ensure this is programmed to include; commonalities, processes, partners involved, places targeted, cohorts targeted, success and most importantly failure to help other localities accelerate the development of their work. There is also a need to ensure that locality plans are based on realism in terms of capacity, outcomes of their work and scale.

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Wider Outcomes

Since 2015/16 there has been an Active Lives increase of 2% in Greater Manchester. Support for the physical activity agenda and how it complements other agendas has grown. The pilot is developing commitment and more of a shared responsibility for leadership.

We are having different conversations, asking different questions, grappling with new theories and approaches, and connecting with new people and parts of the system

Different people are involved in the conversations which translates into an approach where you have to build trust, knowledge, insight and evidence at a similar time

We are developing a new relationship with partners, based on new collaborative conversations and not jumping straight to what ‘we’ think are the answers ‘for’ inactive people in communities. This is a challenge though

The intangibles are changing; how we work in GM, the collaboration

The partnership with Sport England is changing and the way we work together; with a greater emphasis on codesign. The approach to the investment plan is an example of this”.

GM Health and Care Board representatives and others with 10m in trainers

What has been learnt?

It’s not easy; it’s hard work, complex and time consuming.It is easy to slip back into traditional ways of working. Honesty and holding true to the principles is critical. We need to be brave and hold our nerve even if this feels uncomfortable, which requires difficult conversations and challenges the system and its expectations.

It is an iterative process; we develop, learn, and understand more everyday but need to keep aligning to the purpose. People need support and professional development opportunities built in, to work in this way sustainably,

It’s about telling a compelling story to those who are not bought into the approach yet

Reflection and sharing learning needs to be factored in continually on this journey.

There is a huge cultural shift required to engage influencers and leaders around this agenda; we are currently engaging those who are passionate, interested and value change but how do we bring other colleagues who don’t feel that way along with us?”

There are huge opportunities to link and connect wider and complementary agendas, but this is complex and which of those you prioritise is difficult to agree

Boundaries; whether those are geographical, organisational or self-defined have a potential impact on the work of the pilot in GM, and we are keen to work together to remove and/or understand those.

Partners are keen to understand this new way of working but are equally challenged by how we change conversation to action with communities.

There is a risk that ‘competition’ between localities in GM could be a challenge to open and honest sharing and learning, so a continuing open conversation about this is important. This has started well.

There is a fear of openly sharing failure but a will to work through this wherever possible. This is a pilot. Test and learn has to be fundamental to our approach.

Ongoing investment for this work is a concern for some partners involved due to the fact that sustainability does not necessarily equate to no ongoing costs no matter how minimal these are. However, it is also about getting away from a programme mentality and thinking of how the pilot can be used to embed ways of working system wide. The sustainability of the approach will be developed from the transformation of approaches and behaviours across GM.

This initial phase is critical but has allowed us to reflect that we need to continue to disrupt and build collaboration; but both need an investment of time, effort and potentially resource. The risk if we don’t get this right and all go on the journey together, is that we see a more fragmented approach across GM and the investment principles on which the work is founded aren’t actually seen through. It is starting to feel ‘whole system‘ where wider engagement of sectors in the approach allows us to see different system barriers and different parts of the system start to challenge those.

There are a number of barriers/challenges to working in this way; the size of the challenge itself, the scale of GM – ten localities/GM, capacity, and embedding ways of working.

What does this mean for what pilots will do next? Others, are there things that are transferable to other places/contexts? Any consequences?

1. A forward calendar of reflection and shared learning has been established but topic areas are yet to be developed; partners are keen to protect time in their diaries to prioritise this and to include self-reflection in these topics.

2. The Marcomms work stream has a key aim to help us develop a narrative around this work.

3. The Workforce Transformation work stream has a role to play in supporting and developing the sustainability of the approach.

4. The Implementation Group are supporting the ten localities to plan and develop their local approaches, including ensuring that the GM pilot investment principles are at the heart of these discussions. We are also having to challenge ourselves to stay true to this, but the environment is one of trust and honesty.

5. The recruitment process has been, and continues to be, thoughtful and reflective. The recruitment team are very aware of the importance of these appointments. It has challenged the thinking around recruitment processes, as we need to recruit to values, principles and behaviours and the potential to work in a whole system approach, which few people have experience of yet.

6. Previous and ongoing work in GM (in particular Active Ageing) has positively introduced and begun to test this new way of working, with GM and local teams.

7. The role of a wide variety of organisations including GM wide, national and sport and physical activity providers is yet to be determined, and we need to establish more clarity in terms of approach before we start trying to define those roles and communicate with those wider partners. Some providers are starting to come together to collaborate and engage with one voice, which is really positive.

8. We need to ensure as a partnership that our behaviours and approach mirror our principles, and the expectations of our partners we are building with them based on those principles to try and avoid scepticism of the flexibility of this approach; we need to ensure that we don’t slip back into traditional ways of working. The right language is key.

9. We need to develop into one GM wide team that can learn, test, improve and scale together. This includes bringing the work under different investment strands together in a coherent way in a place, for example the ‘Active Communities’ and the ‘Made to Move’ walking and cycling exemplars.

10. Transferable elements particularly include some of the background work/developments such as recruitment, budgeting, legal contracts etc which to a certain degree pilots are already beginning to share with each other.

12. The Leaders in GM place-based challenge work in each locality presents an opportunity for the pilot to learn from how whole system solutions to complex problems are generated. There may be an opportunity for the pilot work to be wrapped up into place-based learning, and the self-reflection and individual learning can be captured in that way.

13. We also need to consider how we can learn from other models e.g. NESTA 100-day rapid testing approach.

Where next?

With the neighbourhood planning work underway in localities, and the workforce transformation, insight, engagement evaluation and marcomms work taking shape, it feels like we are entering the next phase. 

The involvement of people in identified focus communities comes next. Together we will consider what community means to them, how a more active life can contribute to health and happiness for them and their families, and how a whole system approach in their neighbourhood can bring about lasting change.

This is all part of our ambition for 75% of the Greater Manchester population to be active by 2025. Our next big goal is 2 million people moving by 2021.

This pilot work will help us to learn what it takes to enable active communities. The learning can be shared to help us grow a movement together across the whole city-region.

The work has started.

Different conversations, different teams of people working together across the system. Conversations in communities start to change thinking and behaviour from the minute they happen. We are underway……but this is just the beginning, and there is a long way to go.

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