Wellness on Wheels - The legacy network Growing communities from inside out
Foreword As portfolio holder for Sport and Leisure I’m acutely aware of the County Durham’s significant health challenges, and that promoting a healthy heart and weight are key to improving our county’s heath. I’m therefore delighted to see the impact of our Wellness on Wheels (WOW) programme in encouraging an active lifestyle. I have no doubt that each of the 35 different communities across County Durham now visited by the WOW Truck have been inspired to be more active. Indeed the county now has legacy well-being hubs in communities, led and developed by newly inspired local volunteers. Whilst WOW is a programme led and coordinated by Durham County Council, it’s important to say that over the years it has benefitted from the generosity of many. Everyone should be proud of WOW’s achievements and above all the programme’s success is about the energy and investment made on a regular basis by stronger and more empowered communities. The story of the WOW Truck follows and we hope this inspires your continued support. Maria Plews - Portfolio Holder, Culture and Sport
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Wellness on Wheels executive summary
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Introduction
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The Theory
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The Model Close Up l l l l l l
Strategic Approach
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The growing footprints of well-being hubs
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Being inclusive
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Wellness On Wheels Truck
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Growing a well-being hub
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Sustainability
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Measuring Success
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Real People, Real Change l l
Meet Trevor
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Meet Alfred
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Growing the asset based approach
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Learning Points
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The asset based model of provision
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Next Steps
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WOW... and thank you
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16 ‘wellbeing hubs’
400 hours per week of volunteer led services
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Wellness on Wheels executive summary l Wellness on Wheels (WOW) is an award-winning mobile fitness and lifestyle resource l Our commitment to WOW is in recognition of the county’s challenging health inequalities, and the real need to reach out to those who would not otherwise engage in sport and physical activity l The programme is increasing levels of long term participation, providing a wide-range of health benefits l As a consequence of WOW truck visits, a county wide network of legacy ‘well-being hubs’ has been developed
l Locally cultivated programmes of activities are being delivered to help increase physical activity levels in the community l The unique ‘well-being hubs’ are led by the community for the community, which grows confidence and strength to help communities help themselves l The model has proven itself to be a sustainable and successful approach to increasing physical activity l Independent evaluation has shown a £7.11 return to health for every £1.00 invested l The expertise of Culture and Sport and the commitment of the communities will help to shape, develop and deliver a successful physical activity programme in County Durham in the years to come
290 regular volunteers trained and supported
4500 unique participants annually
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Introduction Wellness on Wheels (WOW) is a unique 45ft long truck, which has a range of inclusive fitness equipment, accompanied by a qualified Culture and Sport community action team. The WOW Truck visits communities around the county to inspire an active and healthy lifestyle. The WOW Truck stays in each community for nine weeks. It’s a unique vehicle, which attracts attention of even the most unenthused. However, in many ways, what is more important is what happens when WOW moves on! Over the past 8 years we’ve learnt that the large scale WOW Truck is a powerful catalyst for a more significant process of change in communities. The model of development appears to achieve all the good things that the theory of ‘asset based’ development celebrates. The engagement by the community team is both meaningful and empowering. Initial support in the community allows people to identify their own assets and work collaboratively to develop them.
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“...what is more important, is what happens when WOW moves on!”
400 hours of volunteer led activity, offering opportunities 4-7 days a week.
The outcomes have been staggering with new ‘well-being hubs’ being managed by commited regular volunteers, to deliver a broad range of activities and programmes across the county. Whilst each well-being hub has some commonality (largely through some type of active indoor gym), they exist in varying guises, developed by the community and for the community. Increasingly the community menu includes walking groups, a book exchange and even a community allotment, all emerging from the same flourishing hub with even more opportunities to follow. Quantitative and qualitative feedback, illustrates that the process itself has not only led to more local people being active, but to increased well-being through strengthening control, knowledge and self esteem, providing skills for both life and work. This brochure illustrates the theory and story to date, of WOW and the emerging well-being network. It aims to outline the overall model of support and the team’s next steps to create the conditions in County Durham for well-being to thrive.
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290 active volunteers
The theory The Public Health white paper, ‘Healthy Lives, Healthy People’1 sets out a new approach to improving health through greater emphasis on well-being and prevention, building people’s self esteem, confidence and resilience, ‘shifting power to local communities’ and tackling the wider determinants of health. All too easily communities can be seen as problem areas and people as passive recipients of services. Community spirit and networks dissolve and the poor health remains. An asset based approach provides a different story of a place, that is a positive and outcome focused picture that values what works well and where health and well-being is thriving. It identifies the skills, strengths and capacity of communites. The community pride and spirit is therefore higher and people are engaged in solutions that are more sustainable, with the use of outside support where it is needed most.
‘Communities have never been built upon their deficiencies. Building communities has always depended upon mobilising the capacities and assets of people and place’2
By acknowledging how individuals and communities are currently contributing to health outcomes, their role as co-producers of health and well-being and active participants is truly enabled. Engagement is meaningful and empowering, rather than tokenistic and consultative. People identify their own assets and work collaboratively to develop them.
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The asset approach is not a new concept – but it has become ever more significant as we seek to tackle persistent inequalities. Fundamental to the asset approach is a salutogenic3 focus on health and wellbeing and the factors that enable and protect health, rather than an illness and individual risk factors of disease (pathogenic). We believe the WOW Truck and its model of community developed well-being hubs, builds exactly on this concept. The model provides initial help and support to communities to help stimulate and create the right conditions across communities that promote well-being and enable people to ‘live well’. Good well-being is a goal in itself, but is also a determinant of life expectancy, which in County Durham remains below national average. So what is an asset? A health asset can be defined as any factor (or resource) which enhances the ability of individuals, communities and populations to maintain and sustain health and well-being. These assets can operate at a level of the individual, family or community as protective (and/or promoting) factors to buffer against life’s stresses4. 1
Department of Health (2010) Healthy Lives, Healthy People: Our Strategy for Public Health in England, London: HMG. 2 Kretzman and McKnight (1993) Building Communities from the inside out 3 Antonovsky’s definition of health as wellness rather than illness (pathogenic) 4 NHS NW (2010) - Living well across communities: Prioritising well-being.
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The model close up A strategic approach Over the years, the WOW Truck has visited a range of communities, but predominantly those which are beyond a 5 minute drive time from the traditional sport and leisure centres, positioned in the larger main settlements. The WOW Truck was initially an innovation of the former Wear Valley District Council (with £300,000 funding from Sport England), and helped to address the isolation sometimes experienced by residents within more rural areas of the county. Since this time, the map opposite, illustrates the 35 locations visited by WOW to date, varying from smaller villages to towns. It also shows the current well-being hubs left as a legacy and the planned locations for 2013/14 WOW Truck visits (vision hubs). The map also identifies the main hubs, and other recognised provision. The visited locations and current well-being hubs represent many of the county’s most deprived wards and communities, which indicates WOW is reaching some of our most at risk communities for health deprivation.
Over 200,000 people live within a 15 minute walk time of the well-being hubs 10
The growing footprint of well-being hubs
Figure
Our localities based sports development teams are there to develop local opportunities in sport and physical activity in the following areas: 1 Durham Dales 2 Durham and Chester-le-Street 3 Easington 4 Sedgefield 5 Derwentside (managed by Leisure Works)
l Vision hubs
l Other recognised provision Community hubs
l WOW visits Burnhopefield
Dipton
Consett
North
Stanhope
St John’s Chapel
Middleton in Teesdale
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1
Main hubs
Stanley
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Pelton
3
Seaham West Great Lumley Lanchester Murton Sacriston Rainton Witton Gilbert South Hetton Pity Me Easington Colliery Bearpark Sherburn Esh Winning Durham Peterlee Shotton Tow Law Brandon Wheatley Hill Blackhall Billy Row Bowburn Wingate Wolsingham Crook Willington Coxhoe Cornforth Spennymoor Hunwick Fishburn Escomb Chilton Witton Park Sedgefield Etherley Bishop Auckland Cockfield
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Evenwood
Shildon
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Newton Aycliffe
Staindrop
Barnard Castle
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Being inclusive Prior to any planned WOW Truck visit, a series of community focused meetings are held to agree the location and approach for the truck. The team liaise with a range of local organisations and residents, primarily through engaging the relevant Community Sports Network, Health Network and Area Action Partnership. Together these represent key stakeholders who are often able to comment on behalf of their wider community, including representatives from community safety, schools, parish councils, community associations and sports clubs. This initial process, before any further plans are developed, helps to ensure that any decision to locate the WOW Truck in a community is one which is welcomed and supported. Locating the truck safely and suitably, risk assessing the site and the marketing for the resource, is then a process with which the Culture and Sport Community Action Team engages local stakeholders. Community representatives may also visit the Truck at its previous location, to help understand its scale and approach. Working at least six weeks in advance, it is not unusual for local ward councillors, community wardens, schools and others, to help promote the resource through their local newsletters and word-of-mouth. Combined with local leaflet drops and press coverage, the initial attendances and ‘drop-ins’ to the WOW Truck which are generally well attended.
93% of WOW Truck users are highly satisfied 12
Wellness On Wheels Truck The WOW Truck remains within a community for nine weeks (although this may occasionally vary), during which time it offers over 50 hours a week of direct opportunities, to encourage residents to receive a health check and consider a more active lifestyle. During any one visit, many residents may call by to investigate the inside of the truck. Over 400 residents are targeted per location, to be more fully engaged in exercise during the period and to help change their lifestyle. During the visit, the community action team engage and listen to residents to help to establish the things and people that make it ‘tick’ and ‘excel’. A brief questionnaire is used to help the process, and generally understand the aspirations of the community to improve the well-being of their community. Ideas are offered and solutions discussed as to how we might all work together to develop something which builds upon the local factors. Generally the discussion occurs with a small emerging group of community ‘movers and shakers’ or ‘early converters’ who are invited to meet. These are often the people who possess some authority or peer respect within the community; a ward councillor, a local vicar and a school teacher; an enthusiastic retiree or a local caretaker. Experience shows that the greater the eclectic mix of residents engaged in early discussions, the better. It’s all about active involvement.
Barbara Sewell, Chair of Bearpark Community Centre, was keen to highlight the need to generate local enthusiasm for physical activity: “We were pleased to have the opportunity to have the WOW Truck visit the village as at the time there was no provision available locally. We recognised the benefits that having a local resource would bring in the short term, and could see the potential of building local commitment to taking on responsibility for the creation of a sustainable legacy gym.”
At this stage, our role is often more about channelling the enthusiasm into one place and to support the ideas and opportunities that such an approach provides. It’s not about doing everything for the community, but holding a few hands and gently steering it to reach the agreed and desired aims, to improve local wellbeing.
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Growing a well-being hub During week 4 to 5 of a WOW Truck visit, a community meeting is arranged, and the Community Action Team share the achievements from other communities, and explain how they have taken the legacy well-being hubs forward. The meeting covers roles and responsibilities of any such development, whilst not shying away from the fact, that such an approach relies on time and commitment from community members to achieve success. The meeting seeks to establish a small working group, with an action plan of tasks, normally to include: l A venue for the well-being hub and lease issues l Feasibility and business plan l Choosing equipment and designs l Programme of activities and prices l Normal and emergency operating procedures l Volunteer training, uniform and DBS (disclosure information) checks l Marketing and promotion l The launch event The action plan may take up to 6 months to be fully completed, but the process itself and how the volunteers work together, is vital to help build confidence and strength. It’s really important that the community feels excited about their new development. The opening days of legacy gyms are always a fabulous showcase, with all the volunteers and committee members present to welcome their communities and VIP’s.
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Malcolm recognised the benefit of using the local enthusiasm and interest in the WOW Truck: “Initially about 13 volunteers showed an interest in developing a local legacy gym and formed a committee. This group took on the responsibility of fund raising and ultimately have provided the core of local residents who ensure that it is open for business.”
Sustainability This approach is not a way of getting communities to provide public services that are being cut. It is a way of valuing contributions of everyone involved, acknowledging and building what people value most and ensuring that public services are shaped and targeted where they are most needed. Sustainability is therefore very much at the heart of the model. One of the most critical parts of the process is the support and guidance we offer to the early enthusiasts who want to ‘make it happen’. The initial investment is when a community needs it most. The nine week (this may occasionally vary) visit from WOW, combined with the community development support for a period of 6 months, can be seen as a ‘start up’ package. It’s a relatively long process of support to establishing a well-being hub, however it is not a sprint race, we are in this for the long haul.
67% of residents engaged through WOW remain active at six months
Once the well-being hub is established, with volunteers trained and the community feeling confident and in control, the Community Action Team gradually move into the background. We don’t disappear overnight; we understand that it’s a journey in which small hic-ups can seem insurmountable. However, equally the set backs can also be met with increased creativity, resilience and a positive response from the community itself. As months and years pass, we still remain a helping hand, a phone call away and be the provider of intermittent training, mentorship and perhaps occasionally an opportunity for something new. Since 2007 when the first hub emerged, all have succeeded in meeting their targets within their business plans, with just one which has closed due to too few volunteers or community resilience. We have learnt to extend and add additional community development support to those that need it. 15
Measuring Success Changing the Physical Activity Landscape (CPAL) programme was a large scale county-wide investment of ÂŁ4.5 M by NHS County Durham and Darlington Primary Care Trust (PCT) between April 2010 and March 2013. The programme placed particular emphasis on encouraging adults aged 40-74 years of age, with an estimated or actual risk of CVD greater than 20% to increase their levels of physical activity and consequently reduce their CVD risk. The programme had a clear focus on just three groups of participants: l the CVD group l their associated family members l a smaller other group (allowing projects to identify local priorities outside the CVD groups and family audience). Culture and Sport have benefitted from part investment in the WOW Truck and legacy gym model, which has helped us to reach more communities. In particularly, it has helped pilot some additional community development capacity, which has been a significant help to the asset based approach. It has also part-funded some capital costs.
Exceeded our retention targets for the cardio vascular disease group by 50%
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The funding stream required us to recruit and retain individuals, and see an improvement in physical activity levels in at least 58% of the participants 6 months later. In addition, it required us to apply an established health sector tool (the Stanford 7-day recall) to track usage and improvement amongst our beneficiaries, which was consistent with all the other projects.
2,722 clients recruited; largest single contributor to the CPAL’s overall targets Against the key measures the independent evaluation (supported by Helmepark Ltd) has illustrated that the WOW approach to improving well-being is incredibly positive. We have outstretched our original targets and also been a high performer against the overall programme performance as detailed in Table 1.
Table 1 Group
Original Programme Target
Programme Stretch Target
WOW Project ‘Stretch’ Target
WOW Actual
CVD group recruited
3300
7369
805
1034
CVD group increasing activity at six months
1914
4576
466
697
Family group recruited
1500
1994
570
449
870
1212
330
308
1000
4735
1010
1239
580
2987
586
809
5800
14908
2385
2722
3364 (58%)
8775
1383 (58%)
1814 (67%)
Family group increasing activity as six months Other group recruited Other group increasing activity at six months Total recruited Total increasing activity at six months Information correct at time of print (August 2013)
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Measuring Success In addition to the above attendances, we can confirm that the original legacy gyms have also continued to contribute, through recruiting and retaining beneficiaries with over 2,500 additional participants in 2012/13. The consistent application of measurement tools required by CPAL under Helmepark’s watchful eye, has also led to the establishment of an economic model to illustrate the impact of the programmes on track. The model looks at a range of economic outcomes linked solely to CVD. It reallocates family and other group members (as CVD risk, in the absence of other factors, is most closely determined by age group). Based upon the catchment areas visited with CPAL funding, this model indicates the WOW Truck programme has achieved: l £2.271m return on investment to the NHS and the community l £4.00 health return for every £1 NHS invested on average Table 2
l l l
£4.69-£7.11 return for every £1 invested in CVD groups £2.97-£4.50 return for every £1 invested in over 40’s £1.09-£1.65 return for every £1 invested in under 40’s
This individual project has provided almost double the return offered by the overall programme, illustrating its success in tackling actual and estimated CVD risk. In addition this model does not include many additional returns; the wellbeing hubs developed in the last two years operate 400 hours weekly, providing 21,000 volunteer hours. Volunteers have also received training and support; enhancing self-esteem and well-being. In addition to the quantitative analysis after the CPAL programme, DCC has commissioned some additional qualitative reviews of the WOW Truck and well-being hubs, to evidence the wider impacts and to help understand where we can improve and to celebrate success. 18
£7.11 return for every £1 invested in CVD groups.
Real People, Real Change Meet Trevor: Benefits for all the family Trevor is a County Durham resident who is seeing the long-term benefits of using WOW as a catalyst to re-engage with physical activity. Trevor had been a keen rugby player until he retired from the game at the age of 38. Work and family commitments began to take precedence and Trevor was restricted to an occasional trip to the park, in terms of being physically active. This started to have significant repercussions for his health. A blood test at his GP surgery revealed that he was in danger of being diagnosed with type 2 diabetes and was consulted with in relation to the need for medication. The thought of having to take insulin for the rest of his life was a wakeup call and motivated him to give serious consideration to how he could get back to being more physically active and healthier. Thankfully, Trevor saw the WOW Truck was advertised in his local village and made a commitment to himself to give it a go. He booked an induction and the instructors worked out a programme for him which he has continued over the past 18 months. Having been a rugby player, he enjoyed working with weights and began to appreciate the feeling of being fit again. Trevor comments: “I even found myself running between places rather than walking, just because I could.�
Trevor used the weight machines, treadmill and exercise bike several times a week. Trevor feels the affordability, the local proximity and the chance to get back into a routine are all key factors which motivated him to use the WOW Truck. Staff are friendly and approachable and he finds his familiarity with the equipment helps. The system of having a personal key which records his level of exercise is very useful as it enables him to see his progress, to set time challenges and monitor his performance. Trevor feels his self confidence has increased as he has become fitter and he is happy that he has taken control of his health. He likes knowing that his health has improved and that he does not need to take as much medication as previously. He feels happy to be more active with the children and feels all the family benefit from him being less stressed and anxious. The time to concentrate on his own health has benefits for all the family. Having been fit in the past, he appreciates the return to fitness. He has recently joined a gym and will be able to exercise regularly; he will use the WOW Truck when it returns. He has also encouraged his sons to attend – they are a little young however, but he hopes he is instilling positive habits in them.
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Real People, Real Change Meet Alfred: An inspiration to us all Alfred’s story should be an inspiration to us all. Aged 79 years young, Alfred is a regular user of the legacy gym in Middleton-in-Teesdale and an active volunteer encouraging and enabling other local residents to benefit as he has done. 18 months ago his GP recommended that he start to exercise to help lose weight and manage his type 2 diabetes. When the legacy gym opened in Middleton-in-Teesdale, Alfred was its first member. Although he has found exercising hard work he has enjoyed it and feels immeasurably better, losing 5 stones in weight and he no longer needs diabetes medication. Alfred also mentioned that since being widowed, he had started to feel like a prisoner in his own home and his GP also believed that becoming more physically active would relieve his feeling of isolation and sadness. This has definitely been the case and having started to use the legacy gym, Alfred now volunteers by showing other local residents how to use the equipment. This has all been an important trigger to Alfred feeling that he has got his life back. Alfred believes that without the WOW Truck being a catalyst to the establishment of the legacy gym, the local community would not now be benefitting physically and emotionally. He is at pains to explain that it has changed his life completely. Physically, people don’t recognise him and socially he is confident and happy. “What price is that?” he concludes. The WOW Truck has taken exercise to the people. Barriers of time, cost and opportunity have been addressed. The state-of-the-art equipment and a warm and friendly environment created by knowledgeable staff is resulting in more and more residents being able to engage in physical activity, becoming fitter and healthier. The innovative use and impact of the WOW Truck, as a catalyst for empowering local communities, cannot be underestimated. Through partnership working with local residents and other organisations, a growing footprint of local physical activity opportunities is being established.
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Growing the asset based approach – leading by example.
Delivering a multi-award winning programme across the county
Once an asset based approach has taken hold, there appears a critical mass, which means new ideas emerge and opportunities presented are more easily adopted by the community. Part of Culture and Sports leadership role is to support individuals, communities and agencies best placed to improve the well-being hubs further, to bring to the network and scales of economy together. One example of this has been the partnership work with The Ramblers. The Ramblers benefitted by being supported with Durham County Council (DCC) administration and infrastructure, but most importantly from contacts on the ground. DCC has been able to ‘match make’ The Ramblers with a number of the county’s well-being legacy gyms. The result has been a number of new walking groups. A match made in movement! Each well-being hub now has an emerging menu of opportunities to improve activity levels within the community. Some are based upon the creativity and enthusiasm of the members of the new well-being hub, whilst others on their ability to seize opportunities, presented by other agencies (Refer to figure 2 Asset Based Model of Provision, page 23).
One leader from the Witton Gilbert walking group commented: “Without the Wellness on Wheels Truck visiting the Community Centre and generating local interest and enthusiasm, this walking group would never have got off the ground and our lives would have been less rich as a result.”
The oldest well-being hub is now six years old, and in the time since 2005, The WOW Truck and its resultant legacy set ups has been awarded prestigious awards including: l Sports Industry Award (2006) l Shine Awards for Public Service Delivery (2008) l County Durham Sport and Physical Activity Awards for Contribution to physical activity in: l 2010 - Trainers, Coundon l 2011 - Fit and healthy gym l 2012 - Middleton-in-Teesdale 21
Learning Points l The model of development is proving to be incredibly successful. Culture and Sport are committed to its continued development within resources available. l The asset based approach recognises the need to support growth rather than ‘spoon feed’ a set solution. However, there is clearly a need to recognise the value of consistent community development resource, as the initial catalyst for change and to ensure a ‘phone a friend’ and mentorship programme remains. l Culture and Sport are strong local leaders and have shown success in connecting smaller agencies to support a local solution.
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Return on investment to health for clients with CVD risk is £7.11 to every £1 invested
l 93% of beneficiaries and partners are highly satisfied. l The CPAL programme has provided a robust assessment of the programme. This has illustrated that the programme is making outstanding impact on tackling CVD in communities. l The return on investment model shows significant return to health investment (Table 2).
4,500 regular participants at legacy well-being hubs
l Impact shows that the Culture and Sports local and tailored marketing within communities, linked to the wider local marketing from the service is highly successful. Maximum scales of economy and synergy in the marketing of a range of related services is useful and affordable. l The project is supported by additional mainstream Culture and Sport expertise, connected programmes and funding. The additional funding from the NHS has benefitted from current leadership, investment and commitment. l Channelling resource into a single system and network has shown that NHS investment has received scales of economy and has a greater impact. l The insistence of communites developing robust business plans helps ensure the maintenance, replacement and operations are secured for the long term. Figure 2 (page 23) illustrates Culture and Sports’ view of the emerging asset based model.
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Asset Based Sport
Physical Activity
Play
Aquatics
Main Hubs (Leisure Centres, Libraries and Culture)
Culture
Information
Learning
Referrals and Health Checks
Process of inspiring 22 24
Model of Provision
New legacy gym
Figure
2 Exercise classes
Walking groups
Well-being Hubs (Community locations) Cycling groups
Running groups
Health checks
community involvement 22 25
Next steps - 2013/14 focus l Develop a new partnership well-being brand to enhance the promotion and development of the full network and a symbol of quality assured well-being services and support. l Establish a further 4 new well-being hubs developed by the community, for the community, in line with the vision map (Figure 1). l Prioritise support for the implementation of a more robust data monitoring system across the full well-being legacy network. l Explore opportunities in connecting ideas and skills from the wider spectrum of Culture and Sport, eg. increased adult learning opportunities. l Commit to enhanced network training and mentorship programmes. l Three new ‘Big Challenge’ events, for the well-being network to plan and deliver alongside other providers county-wide.
90% satisfaction rates of partner organisations 26
l Continue to celebrate locally and nationally the success of WOW in changing the physical activity landscape.
WOW... and thank you! The WOW Truck programme and network of legacy well-being hubs has been to date highly successful. This could not be possible without the support of the following agencies and people: l l l l l l l l l l l l l
Durham County Council Sport England Big Lottery Inclusive Fitness Initiative Technogym Wear Valley Sport Action Zone Durham Dales Primary Care Trust One North East Everyday Sport County Durham and Darlington Primary Care Trust County Durham Sport Local elected Members Anyone involved in establishing and the management of WOW Truck visits and well-being hubs.
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Wellness on wheels
The legacy network Growing communities from inside out