8th Report – Healthy Ageing: physical activity in an ageing society

Physical activity remains insufficiently prioritised across health and care systems despite its clear contribution to preventing illness, improving population health and reducing inequalities. While some integrated care boards (ICBs) have embedded physical activity into strategies, this is not yet consistent or widespread, with physical activity too often being treated as an optional add-on, rather than a core, evidence-based intervention. (Conclusion, Paragraph 12)

The Department should require ICBs to embed physical activity as a core preventive intervention within population health strategies. ICBs should demonstrate how physical activity is being integrated into healthy ageing, long-term condition management and health inequalities frameworks, with clear accountability for delivery. (Recommendation, Paragraph 13)

Physical activity can be more effective than drugs in preventing, treating and managing many long-term conditions. Health and care professionals have an important role in encouraging and supporting people to include physical activity in the management of their health. Conversations about physical activity must become a core component of clinical practice to implement current National Institute for Health and Care Excellence (NICE) guidance on physical activity. We welcome the recognition from NHS England that health and care staff must be supported to gain the skills and confidence to discuss and prescribe physical activity. However, for this to happen health leaders must demonstrate that it is a priority and ensure all staff have access to training and examples of best practice. The NHS will need to go further than encouragement alone and begin rebalancing how it invests in prevention—recognising that evidence-based physical activity can be as effective as drug treatment for many conditions—and shifting resources and spend towards its routine promotion and prescription. (Conclusion, Paragraph 17) 41

We recommend that the Department work with integrated care boards (ICBs) to develop a national roll-out of existing best-practice models to support clinicians to have conversations about physical activity with patients, particularly older patients. This should include a communication strategy to reach all health professionals, clear messaging about the benefit and priority assigned to these conversations and resources to support managers to promote it to their staff. (Recommendation, Paragraph 18)

In addition, we recommend that ICBs explore methods for increasing investment in the prescription of physical activity as part of a broader shift towards prevention. This should be pursued alongside appropriate clinical treatments, ensuring patients benefit from the full range of evidence-based interventions available. (Recommendation, Paragraph 19)

Frailty is not an inevitable or irreversible aspect of ageing, and early intervention offers significant opportunities to prevent or slow its progression. Exercise programmes can reverse frailty, reduce the risk of developing dementia and improve outcomes for people living with dementia. However, these benefits will only be realised at scale if underpinned by a coherent national strategy. These interventions must also be understood by commissioners, and prescribed and delivered by health professionals, in a comparable way to drug treatments. (Conclusion, Paragraph 26)

We recommend that as part of the Modern Service Framework (MSF) for frailty and dementia, the government identifies and sets clear standards for delivering exercise programmes to prevent and reverse frailty. This should include a requirement for integrated care boards (ICBs) to commission evidence-based exercise programmes at the duration and intensity necessary to deliver outcomes. We also ask that the government sets out the accountability arrangements that will accompany the MSF for frailty and dementia in its response to this report. This should include how the government will ensure consistent uptake of evidence-based exercise programmes among ICBs to remove the current national variation in access. (Recommendation, Paragraph 27)

Addressing inequalities in healthy life expectancy will require integrated care boards (ICBs) to take a targeted approach with specific interventions targeting communities where inactivity and poor health outcomes are most concentrated. Successful development of population health delivery methods, using hyper-local insight, will ensure maximum value for money is achieved by delivering the most effective interventions in the areas where the need and the benefits are greatest. (Conclusion, Paragraph 33)

We welcome the publication of the model ICB blueprint and the intention that ICBs will move towards population health delivery models, which should support more targeted intervention to address health inequalities in 42 ageing. In its response to this report, the government should set out how it will judge whether ICBs are successfully moving towards this approach. This should include how the government will ensure ICBs’ monitoring and data collection are standardised to allow for meaningful evaluation and learning of interventions across ICBs. (Recommendation, Paragraph 34)

Partnerships between health services and the physical activity sector can deliver effective programmes in local settings, support long-term condition management and improve older people’s health and wellbeing. Expanding these approaches could also ease pressure on hospital-based services and support the government’s ambition to shift care from hospitals into the community. A lack of national strategy and the deterioration of leisure facilities mean opportunities to embed physical activity in community-based care remain limited. We welcome the £400 million the government has announced to support grassroots sports facilities. The government must use this funding strategically to support the infrastructure that the NHS will rely on to deliver care—particularly physical activity-based interventions—in the community. (Conclusion, Paragraph 42)

The Department should develop a national framework to support integrated care boards and local authorities to commission and scale health interventions delivered in leisure and physical activity settings. This should include preventive, treatment and long-term condition management programmes to support healthy ageing. It should also set out how appropriately qualified physical activity professionals can be safely integrated into care pathways and promote understanding among health professionals of the role this workforce can play. (Recommendation, Paragraph 43)

If the NHS is serious about prevention, it seems perverse to reduce support for social prescribing. The benefits of social prescribing will only be realised at scale if it is recognised by the Department as a core mechanism for increasing physical activity, particularly among older people and those with long-term conditions. To fulfil its potential, social prescribing must be prioritised within the health system and supported with the workforce development, infrastructure and national leadership necessary to prescribe physical activity routinely and confidently. Social prescribing link workers are a vital bridge between the health system and the community-based organisations that deliver physical activity opportunities to older people. By connecting people to local programmes that reflect their interests and circumstances, link workers can turn clinical advice to become more active into meaningful, sustained behaviour change. (Conclusion, Paragraph 47)

The Department should assess whether the overall funding, infrastructure and training available to social prescribing are sufficient to reflect its growing role in promoting physical activity and reducing demand 43 on health services and set out how it will ensure social prescribing is consistently embedded, prioritised and supported across the health system. (Recommendation, Paragraph 48)

We were disappointed to hear of the reduced support that NHS England is providing for social prescribing. This is directly impacting on the quality of related training and development for link workers. As part of the ongoing merger between NHS England and the Department, we recommend that the Department review and strengthen the support it provides for social prescribing. This should include ensuring the National Academy for Social Prescribing has the resources it needs to continue promoting best practice, supporting workforce development and acting as a national centre of expertise. (Recommendation, Paragraph 49)

The voluntary, community and social enterprise (VCSE) sector plays a vital role in engaging older people—particularly those at greatest risk of inactivity and poor health. However, VCSE organisations lack sustainable funding to plan for the future and continue delivering the physical activity programmes that health services rely on to achieve their prevention objectives. (Conclusion, Paragraph 54)

We welcome the intention in the strategic commissioning framework for integrated care boards (ICB) to treat VCSE organisations as partners in the development and delivery of a neighbourhood health service. In its response to this report, we ask that the government provide more details on what support from the strategic commissioning development programme will look like in practice. This should include details of any training or guidance that will be offered to ICBs. (Recommendation, Paragraph 55)

Physical activity must be recognised as an essential part of adult social care delivery—not an optional additional leisure activity. Equal weight must be given to the risks of inactivity as to the benefits of staying active so that older people receiving social care, whether at home or in a care setting, can remain healthy and confident. A preventive, strengths-based model of care can help older people maintain the abilities that underpin their health, wellbeing and independence. This will require a change in how the social care sector thinks about risk to support older people to remain active. Social care staff equipped with the right skills, and an approach that focuses on what people receiving care can and want to do, will be essential. (Conclusion, Paragraph 62)

We recommend that Baroness Casey, as part of the Independent Commission on Adult Social Care, prioritise opportunities for physical activity to support a new, prevention-focused vision for the system. This should identify how government can support the social care sector to embed physical activity into the delivery of adult social care. It should 44 include how local authorities, the NHS and social care providers can work together to identify older people at risk of sedentary behaviour and offer early, tailored interventions. (Recommendation, Paragraph 63)

We also recommend that the Department work with social care providers to develop a national training programme for social care workers to improve their confidence and skills in supporting older people to be active, including understanding deconditioning and how to prevent it. This should include supporting the workforce to take a strengths-based approach to physical activity, with care assessments focusing on what older people can do. (Recommendation, Paragraph 64)

The Department should work with the Care Quality Commission (CQC) to set national standards for the delivery of physical activity in social care settings, with physical activity being provided in line with the Chief Medical Officers’ guidance. We also recommend that the CQC places a greater emphasis on physical activity in its assessment framework and inspections of social care provision. (Recommendation, Paragraph 65) Embedding physical activity in society

The government must start a national conversation about ageing which talks about getting older in a more positive way, challenges assumptions about unavoidable and irreversible decline and motivates people to remain active. (Conclusion, Paragraph 74)

We recommend that the Department’s “national movement campaign” include targeted messaging aimed at the least active and people approaching older age. These messages should demonstrate how movement can be incorporated into daily habits, use relatable role models and focus on examples of movement that will increase strength and balance. (Recommendation, Paragraph 75)

Poorly designed built environments prevent older people from being able to leave their homes and actively participate in their communities. By embedding principles that promote physical activity into planning guidance, the government can ensure the creation of healthy places that support people to age well. (Conclusion, Paragraph 79)

Designing a built environment that promotes physical activity for everyone, including older people, must become a core requirement when designing public spaces. We recommend that the revised National Planning Policy Framework and the Design and Placemaking Planning Practice Guidance embed Sport England’s active design principles. (Recommendation, Paragraph 80) 45

Physical activity remains insufficiently prioritised across government despite extensive evidence of its central role in prevention and healthy ageing. Tackling physical inactivity requires political leadership and cross-departmental collaboration—recognising that supporting people to age well will not be achieved by health alone. To make this a reality the government needs to create mechanisms that incentivise Departments and local government to jointly address traditionally siloed and fragmented efforts. (Conclusion, Paragraph 86)

The government should restore the health mission and develop a cross- government 10-year plan to embed prevention and reduce inequalities in healthy life expectancy, that prioritises physical activity. This should include creating pooled budgets that require multi-department bids to access, supported by shared outcome and accountability measures to encourage joined up action to address public health challenges, such as addressing barriers to healthy aging. (Recommendation, Paragraph 87)

While we welcome the government’s recent increase to the public health grant, we remain concerned that public health teams have been left with inadequate funds to carry out preventive interventions vital to healthy ageing. The shift to prevention will require a long-term, whole-system response. As part of this shift, the government must commit to shifting resources towards preventive interventions, including an immediate commitment to restoring the public health grant to 2016–17 levels in real terms. Such an investment is proven to save money, by preventing people developing ill health and reducing demand on health services. (Recommendation, Paragraph 90) 46