“If you always do what you've always done, you'll always get what you've always got.” Henry Ford (1863–1947)

The problem and potential solution: health and well-being boards

Strategies to modernise the National Health Service (NHS) in England have brought about the development of local organisations called Health and Wellbeing (H&WB) boards through the Health and Social Care Act 2012. These boards are intended to become a forum where key leaders and stakeholders from the health and care systems work together to improve the health and well-being of their local population and reduce health inequalities.6

Across the country these boards have been formed around the 158 local authorities and they will assume statutory functions from April 2013. These ‘shadow’ boards (‘shadow’ until April 2013) have been considered for drafting public health priorities and strategies on behalf of their local population for future years. These priorities will inevitably lead to further strategies that form the basis for the development of future services and project funding.

The Hertfordshire story

For readers not familiar with UK geography, Hertfordshire is a fairly leafy county just north of London with a population of approximately 1.1 million.7

The Hertfordshire H&WB has representatives from the NHS, County Council, District Councils and the Hertfordshire Local Involvement Network (LINk) (LINk has been set up ‘across England to help local people influence the way that their local healthcare and social services are planned and delivered’). Health and well-being priorities were chosen as areas where ‘health service and local government can make a real difference by working together’. Last year an evaluation process was used to analyse numerous key local health and social issues and these were scored against local needs, impact and importance.

A draft strategy was developed, which included eight proposed local priorities for 2013–2016. Physical inactivity and physical activity promotion were not included in this draft list.

Physical activity was not even evaluated to see whether it warranted being included in future strategy, despite overwhelming evidence of the importance of increasing physical activity for improved health, well-being8 and with numerous other positive social effects. Ironically, evidence supports increasing physical activity would positively affect nearly all the eight initial draft priorities.

The proposed eight priority areas were:

1. Tackling obesity

2. Reducing smoking

3. Managing long-term conditions—to reduce the use of emergency care

4. Supporting family carers

5. Promoting good mental health—including helping people to live well with dementia

6. Helping families facing multiple problems to thrive

7. Reduce harm caused by drugs and alcohol

8. Fulfilling lives for people with learning disabilities

The draft priorities were made public and there was an open consultation period enabling feedback.

The social media solution

The H&WB provided a unique opportunity to develop strategies across silos, agencies and sectors and so we decided to attempt a small evidence-based translation and implementation experiment. The plan was to use social media and electronic mail to try and change the draft priorities by seeking as much feedback as possible to the open consultation in support of including a physical activity priority. Our goal was to inform and interest as many people as possible about the perceived problem by using ‘viral marketing’ techniques in the hope that they would be guided to leave feedback to the open consultation.

We drafted a BJSM blog explaining the Hertfordshire problem, asking concerned readers to respond to the consultation and to help spread the discussion by forwarding the BJSM blog to interested contacts via email, discussing the draft strategy on Twitter and retweeting this Twitter debate.9

BJSM helped to develop an online poll, accompanying the blog, to enable readers to leave direct feedback. While appreciating BJSM blog readers may be better informed than most on physical activity science and exercise medicine, a convincing 98.4% of BJSM online poll voters (n=126) felt that Hertfordshire should tackle the problem of physical inactivity as a top priority for health and well-being.

Furthermore, the Engagement Response report (October 2012) to the consultation speaks for itself:

• 3373 responses were received (we believe that this may have demonstrated an unprecedented level of interest)

  • 180 responses received from groups or organisations

  • 2880 responses from a written survey and 433 from an online survey

  • 2582 response were received from individuals

The report suggests that ‘the majority of responses felt that there should be a greater reference to healthy lifestyle. In particular, many recommended that physical activity to be included as a priority on its own’.

ENGAGEMENT RESPONSE REPORT FEEEDBACK INCLUDES

“Promoting physical activity for all ages should be a priority.”

East and North Hertfordshire NHS Trust

“Increasing levels of physical activity has many benefits, and can contribute to several of the proposed priorities…District and Borough Councils have a major role in providing and promoting physical activities, and could make a big contribution to delivery of a priority centred on this issue.”

Broxbourne Borough Councils

In addition, to the written consultation there was also considerable debate on Twitter about the Hertfordshire's draft Health and Well-being strategy.

We were invited to present a case for a physical activity priority to members of the St. Albans (one of the district councils in Hertfordshire) Health and Wellbeing Partnership; the audience included the chair of the countywide shadow H&WB Board, which was opportune.

The result

Hertfordshire's new Health and Wellbeing Strategy for 2013-16 was launched on Monday 11 February, 2013 and now includes the following priority in the revised strategy (http://www.hertsdirect.org/docs/pdf/h/hwbstrategy.pdf): “Increasing physical activity and promoting a healthy weight.”

Despite the evidence supporting public health focus on increased physical activity (and hence fitness) over weightloss,10 ,11 we think this local priority inclusion demonstrates evidence-based public health progress in recognition of the importance of physical activity in health and well-being.