Northampton Leisure Trust - Social Impact Report March 2018 Professor Richard Hazenberg Institute for Social Innovation & Impact Overview
University of Northampton
Contents 1.
Executive Summary ........................................................................................................................ 2
2.
Methodology .................................................................................................................................. 3
3.
NLT Membership ............................................................................................................................ 3 3.1 - Overview: .................................................................................................................................... 3 3.2 - Social Deprivation: ...................................................................................................................... 4 3.3 – General Social Impact Across Membership: ............................................................................... 6
4.
Health Check Programme .............................................................................................................. 6
5.
Adult Weight Management ........................................................................................................... 9
6.
Activity on Referral....................................................................................................................... 10 6.1
– Hypertension: ..................................................................................................................... 10
6.2
– Depression/Anxiety: ........................................................................................................... 11
6.3
– Obesity: .............................................................................................................................. 11
7.
Healthwalks .................................................................................................................................. 12
8.
Street Sports ................................................................................................................................. 12
9.
Sports Employability Project ........................................................................................................ 13
10.
Training ..................................................................................................................................... 14
11.
Volunteering ............................................................................................................................. 15
12.
External funding ....................................................................................................................... 16
13.
Financial Situation .................................................................................................................... 16
14.
Summary ................................................................................................................................... 17
References ............................................................................................................................................ 18
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1. Executive Summary This research report has been produced following meetings between Ian Redfern and Lawrence Kay (Northampton Leisure Trust - NLT) and Richard Hazenberg (Institute for Social Innovation and Impact). The research seeks to assess the social impact delivered by NLT so as to provide robust data on the impact that NLT delivers to society and the savings that it provides to the state through its work. The report also provides NLT with an organisational development tool to assist in the targeted delivery of services and the maximisation of social impact, by demonstrating areas of significant impact and areas requiring additional work and/or data capture. This report represents a snapshot of social impact captured through quantitative data gathered by NLT between February 1st 2017 and January 31st 2018, with the data also supplemented by qualitative case-studies and prior research commissioned by NLT focusing on specific services. The research also, where possible, makes comparisons with national secondary datasets so as to demonstrate both cost-savings to society, and identify likely outcomes for NLT beneficiaries without the Trust’s support. The report begins by exploring NLT’s membership base, with specific reference to demographic data (monthly membership breakdown); age of members; membership by site; social deprivation data for members; and long-term membership. The report then moves on to focus on specific programmes run by NLT, including: health check programme; adult weight management; activity on referral; Healthwalks; Street Sports; Healthy Heroes (child weight management); grant income; Employability Skills; training and education; volunteering; financial income; and finally a summary of the social impact delivered (including a Social Return on Investment ratio). Throughout the report, recommendations are also made around additional areas of data capture and how NLT can improve the work that it does to deliver on its social impact and support to beneficiaries. In summary, the overall impact delivered by NLT between February 1st 2017 and January 31st 2018 is displayed below in Figure 1.1.
Total Social Impact = £3,581,181.07 General Membership = £167,933.12
Health Checks = £46,263.04
Adult Weight Management = £9,750.20
Activity on Referral = £26,199.87
Healthwalks = £23,833
Street Sports = £1.47m
Sports Employability = £18,024.24
Training = £691,215
Volunteering = £21,510
External Funding = £645,000
Financial Impact = £462,154
Figure 1.1 – Overall social impact of NLT for period February 1st 2017 to January 31st 2018
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2. Methodology The research utilised a mixed-methods approach to the data collection that consists of data collected by NLT through its various programmes, as well as from its accounts and partner work. This is embedded in the University’s bespoke approach to impact measurement, the ‘Social Impact Matrix©’. Impact was also calculated for NLT where possible based upon the direct financial impact of the interventions delivered, including savings in: health care costs; social care costs; employment and social security benefits; and donative income raised through corporate engagement/grant funding proposals. In the main counterfactuals have not been explored and so we are unable to base these calculations on what would have occurred anyway and so the impact figures represent estimations of the maximum financial impact that NLT could have delivered. However, a caveat can be applied here in that many of the impact calculations made relate to financial cost-savings that are based on NHS and other public health research studies that have identified (including the use of randomised control trials and counterfactuals) the impact of interventions and care costs. Therefore, the data reported here does have significant rigour and validity despite the lack of randomised control trials or direct causality. It is recommended that future research engaged in by NLT seeks to utilise counterfactual analysis where applicable and where quasi-control groups (such as through NHS data) cannot be identified.
3. NLT Membership 3.1 - Overview: The data gathered by NLT in relation to membership shows that the Trust had as of January 2018, 10,826 adult members and 5,297 junior members. Whilst this number fluctuates over time, the underlying membership size is relatively stable (see Figure 3.1).
Membership per month 12,000 10,000 8,000 6,000 4,000 2,000 Feb-17
Mar-17
Apr-17 May-17
Jun-17
Jul-17
Adults
Figure 3.1 – Membership base over a 12-month period.
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Aug-17 Juniors
Sep-17
Oct-17
Nov-17
Dec-17
Jan-18
When exploring the membership base by age group, the data reveals that the largest group is adults aged 25-49 years of age (35%); with children and young people (aged 1-18 years) also being a major client group (32.1%). The elderly (those aged over 60 years) represent only one-tenth of the membership base (see Figure 3.2 below).
10.8%
4.4% 4.5% Not Known 1 - 4 years
9.8% 16.8%
5 - 10 years 11 - 13 years 14 - 15 years
3.5% 2.6%
4.7% 35.1% 7.9%
16 - 18 years 19 - 24 years 25 - 49 years 50 - 59 years 60 - 100 years
Figure 3.2 – Membership base by age group in years. These members are based across 7 different sites, including: Mounts, Lings, Danes, Duston, Cripps, Berzerk, and the Forum Cinema. In total members made 1,186,548 visits across the last 12 months, equivalent to an average of nearly 74 visits per annum by members (1.42 visits per week). However, data is not held by NLT as to what all of these visits equate to, although 31.1% of all visits are for swimming or swimming lessons (and so have a physical fitness element). 3.2 - Social Deprivation: Analysis of the postcode data for members also reveals that NLT does significant work in the most socially deprived areas of the UK (ranked in the top 20% most deprived areas on the Index of Multiple Deprivation database), with 23.9% of members coming from the top 20% most deprived wards. In addition, this figure rises to 40.7% for the top 40% most deprived wards (see Figure 3.3). In relation to the data relating specifically to health inequality, the figures are 20.8% for the top 20% most deprived areas, and 40.7% for the top 40% most deprived wards (see Figure 3.4). NLT is therefore conducting its social impact work in a large proportion of disadvantaged wards across Northampton.
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IMD 10
6.7%
IMD 9
16.3%
IMD 8
11.7%
IMD 7
10.2%
IMD 6
5.3%
IMD 5
9.1%
IMD 4
6.0%
IMD 3
10.8%
IMD 2
14.4%
IMD 1
9.5% 0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
Figure 3.3 – NLT Members by IMD Decile (general inequality)
IMD 10
3.9%
IMD 9
10.1%
IMD 8
11.3%
IMD 7
11.2%
IMD 6
9.4%
IMD 5
13.4%
IMD 4
9.3%
IMD 3
10.6%
IMD 2
11.8%
IMD 1
9.0% 0%
2%
4%
6%
8%
Figure 3.4 – NLT Members by IMD Decile (Health inequality)
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10%
12%
14%
16%
3.3 – General Social Impact Across Membership: Whilst it is difficult to explore the membership dataset at this high level due to the lack of data on what specific visits were for in relation to activity type, we can explore the social impact of the regular swimming/swimming lessons on the membership base in relation to Cardio-vascular disease (CVD) morbidity rates amongst the general population. Indeed, swimming has been identified in prior research to reduce the risk of death from CVD events by 41%1. We can equate the number of swimming visits to active users by assuming an attendance rate of twice per week, which gives a figure of 3,553 swimmers engaging regularly in swimming through NLT per year [(369,533 individual visits/2 x week) / 52 weeks]. Given that the average CVD related morbidity rate for people across all ages is 296 per 100,000 people in the UK per year (equivalent to a 0.3% rate)2, then these regular swimming sessions reduce this CVD morbidity rate to 0.17%. Across the sample of 3,553 swimmers this therefore relates to a reduction of 4.62 deaths through NLT’s swimming work. Research by the British Heart Foundation has demonstrated that premature death through CVD events costs the UK £6.31 billion in lost productivity (based upon 40,000 premature deaths or £33,128 per death)3, whilst each CVD event costs the NHS £3,221.664 in treatment costs (including rehabilitation). Therefore, just focusing on the treatment costs for these potential prevented deaths amounts to £14,884.07 in savings to the NHS, and as much as £153,049.05 in wider societal costs. This provides a total saving to society delivered by NLT in relation to its general membership base and site visits of £167,933.12
4. Health Check Programme NLT also runs a Health Check service in partnership with the Northampton General Practice Alliance, as part of the wider drive in health care to target early interventions. Health checks are targeted at those aged 40 years to 74 years of age, and are generally carried out every five years, but offer the opportunity for individuals to understand their risk of CVD events across the next 10 years, and to make changes in lifestyle to help mitigate these. These changes in lifestyle if carried out through a moderate, but regular exercise regime, can reduce CVD mortality. However, research studies are inconclusive as to by how much this reduction might be. Indeed, whilst some research identifies that the reduction in CVD events brought about through regular exercise could be as much as 30-40%5, others have argued that when the effects of other factors such as treatments are stripped out, that this actually equates to around 14%6. Therefore, this lower figure will be used here in relation to those individuals who are engaged in health checks, with the assumption that all stick to their new exercise plans. For future impact studies, it is recommended that NLT follow-up with health check beneficiaries 1
Swim England, (2007), The health and wellbeing benefits of swimming, available online at http://www.swimming.org/swimengland/new-report-shows-health-benefits-swimming/ 2 British Heart Foundation, (2014), Cardiovascular disease statistics 2014, Nuffield Department of Population Health – University of Oxford, available online at https://www.bhf.org.uk/~/media/files/research/heart-statistics/bhf_cvd-statistics2014_web.pdf (data adjusted for inflation to 2016 levels). 3 British Heart Foundation, (2014), Cardiovascular disease statistics 2014, Nuffield Department of Population Health – University of Oxford, available online at https://www.bhf.org.uk/~/media/files/research/heart-statistics/bhf_cvd-statistics2014_web.pdf (data adjusted for inflation to 2016 levels). 4 This is inflation adjusted to 2016 levels from a 2004 report into CVD costs for the NHS. Original publication: LuengoFernandez, R., Leal, J., Gray, A., Petersen, S. and Rayner, M., (2006), Cost of cardiovascular diseases in the United Kingdom, Heart, 92(10), pp. 1384-1389. 5 Myers, J., (2003), Exercise and Cardiovascular Health, Circulation, 107(e2-e5). 6 Taylor, R.S., Unal, B., Critchley, J.A. & Capewell, S., (2006), Mortality reductions in patients receiving exercise-based cardiac rehabilitation: how much can be attributed to cardiovascular risk factor improvements, European Journal of Preventive Cardiology, 13(3).
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to understand how their lifestyles have changed (if at all), so that the impacts reported here can be calculated more robustly. Crucially however, for those identified as medium to high risk, the individuals can also be prescribed statins to help reduce their likelihood of undergoing a CVD event over the following decade. The costsavings to the NHS for this group can deliver savings in healthcare costs. This will be combined with the impact of exercise data outlined above, to produce overall social impact figures. Figure 4.1 below outlines the different groups worked with by NLT and the sample-size for each group/sub-group.
35-39%
6
30-34%
9
25-29%
9
20-24%
33
10-19%
81
0-9%
150 0
20
40
60
80
100
120
140
160
Figure 4.1 – Total number of health check beneficiaries by risk group. For those in the low risk grouping, where no statin prescription will take place, the impact of a moderate exercise regime only will be explored. For this group, the risk of a CVD event over a 10-year period is 5% or 5/1007, and so a 14% reduction would reduce this to 4.3%. Therefore, assuming that the 150 people who engaged in NLT health checks and were then given lifestyle advice and exercise regimes stuck to these, then this would prevent 1.05 CVD events from the 150 individuals in the lowrisk category. This would equate to a £3,382.74 (unit healthcare cost saving per CVD event £3,221.668 including rehabilitation) saving for the NHS in reduced healthcare costs. For the 10-20% risk category, for health checks identifying 100 people at medium risk, the prescription of statins (Atorvastatin) will reduce heart attack and strokes by 40%, which given that 15 people in every 100 from this group would have a CVD event over a 10 year period without treatment (assuming a median risk of 15%), is equivalent to 6 CVD event preventions per 1009. Given the 14% reduction that regular exercise would also bring, this would be equivalent to an additional 2.1 CVD event 7
NICE, (November 2014), Taking a statin to reduce the risk of coronary heart disease and stroke, Patient Decision Aid Document, available online at https://www.nice.org.uk/guidance/cg181/resources/patient-decision-aid-pdf-243780159 8 This is inflation adjusted to 2016 levels from a 2004 report into CVD costs for the NHS. Original publication: LuengoFernandez, R., Leal, J., Gray, A., Petersen, S. and Rayner, M., (2006), Cost of cardiovascular diseases in the United Kingdom, Heart, 92(10), pp. 1384-1389. 9 NICE, (November 2014), Taking a statin to reduce the risk of coronary heart disease and stroke, Patient Decision Aid Document, available online at https://www.nice.org.uk/guidance/cg181/resources/patient-decision-aid-pdf-243780159
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preventions (8.1 overall). For NLT this is equivalent to 6.56 preventions, which equates to an average social impact saving of £21,134.09 for the NHS in reduced healthcare costs. For the high-risk category the risks can be spread across 5 percentile groupings, and calculated in relation to these, to account for the statin impact and the impact of the exercise regime. For the 2025% risk category, for health checks identifying 100 people at this risk, the prescription of statins (Atorvastatin) will reduce heart attack and strokes by 35%, which given that 20 people in every 100 from this group would have a CVD event over a 10 year period without treatment, is equivalent to 7 CVD event preventions per 10010. Given the 14% reduction that regular exercise would also bring, this would be equivalent to an additional 2.8 CVD event preventions (9.8 overall). For NLT this is equivalent to 3.23 preventions, which equates to an average social impact saving of £10,405.96 for the NHS in reduced healthcare costs. For the 26-30% risk category, for health checks identifying 100 people at this risk, the prescription of statins (Atorvastatin) will reduce heart attack and strokes by 36%, which given that 25 people in every 100 from this group would have a CVD event over a 10 year period without treatment, is equivalent to 9 CVD event preventions per 10011. Given the 14% reduction that regular exercise would also bring, this would be equivalent to an additional 3.5 CVD event preventions (12.5 overall). For NLT this is equivalent to 1.13 preventions, which equates to an average social impact saving of £3,640.48 for the NHS in reduced healthcare costs. For the 31-35% risk category, for health checks identifying 100 people at this risk, the prescription of statins (Atorvastatin) will reduce heart attack and strokes by 37%, which given that 30 people in every 100 from this group would have a CVD event over a 10 year period without treatment, is equivalent to 11 CVD event preventions per 10012. Given the 14% reduction that regular exercise would also bring, this would be equivalent to an additional 4.2 CVD event preventions (15.2 overall). For NLT this is equivalent to 1.37 preventions, which equates to an average social impact saving of £4,413.67 for the NHS in reduced healthcare costs. Finally, for the 36-40% risk category, for health checks identifying 100 people at this risk, the prescription of statins (Atorvastatin) will reduce heart attack and strokes by 37%, which given that 35 people in every 100 from this group would have a CVD event over a 10 year period without treatment, is equivalent to 13 CVD event preventions per 10013. Given the 14% reduction that regular exercise would also bring, this would be equivalent to an additional 4.9 CVD event preventions (17.9 overall). For NLT this is equivalent to 1.07 preventions, which equates to an average social impact saving of £3,447.18 for the NHS in reduced healthcare costs. This total social impact delivered by health checks is £46,263.04.
10
NICE, (November 2014), Taking a statin to reduce the risk of coronary heart disease and stroke, Patient Decision Aid Document, available online at https://www.nice.org.uk/guidance/cg181/resources/patient-decision-aid-pdf-243780159 11 NICE, (November 2014), Taking a statin to reduce the risk of coronary heart disease and stroke, Patient Decision Aid Document, available online at https://www.nice.org.uk/guidance/cg181/resources/patient-decision-aid-pdf-243780159 12 NICE, (November 2014), Taking a statin to reduce the risk of coronary heart disease and stroke, Patient Decision Aid Document, available online at https://www.nice.org.uk/guidance/cg181/resources/patient-decision-aid-pdf-243780159 13 NICE, (November 2014), Taking a statin to reduce the risk of coronary heart disease and stroke, Patient Decision Aid Document, available online at https://www.nice.org.uk/guidance/cg181/resources/patient-decision-aid-pdf-243780159
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5. Adult Weight Management NLT also provides support to individuals who have been referred from their GP or other healthcare professionals in relation to weight management, having been diagnosed as clinically obese (a BMI > 30). To date the Adult Weight Management programme (AWM) has worked with 100 individuals. Unfortunately, data relating to these individuals as a broad sample (i.e. starting BMI, weight reductions, blood pressure and current lifestyle data) is not collated by NLT, which makes calculations of impact difficult to make here14. However, it is possible to infer an indicative impact through some general data relating to the cost to the NHS of clinically obese individuals and the longitudinal success rates of weight reduction programmes. In relation to the costs of obesity, the NHS spends as much as £8 billion treating obesity and related health conditions (obesity defined as a BMI > 30) 15. Given that 24.9% of the UK population is clinically obese, this means that the annual cost to the NHS of obese individuals is £487.51 per person16. Data also reveals that 20% of all obese adults who engage in weight reduction programmes actually achieve a BMI of under 3017. For NLT this therefore means that as an average, of the 100 adults supported through the AWM programme to date, 20 will achieve a BMI of below 30. Therefore, the total saving to the NHS of these interventions is £9,750.20 per annum18. In order to also provide some rich narrative data around how the AWM programme impacts on lifestyles and weight management, the following case-study is also presented below.
Mark, aged 48, joined the weight management programme in Sept 2017 and weighed 98.7kg. He has since worked hard and changed his life, and he is still attending now in order to have further impacts on his weight. As of the 19th February 2018, he now weighs 77kg (a 22% reduction in weight). Mark has achieved this through a change in eating habits, increasing his exercise regime, and receiving motivation within the class and within the group. “I first noticed that I was seriously overweight when I visited the Doctor about some health issues at the start of September, stepping on the scales and hearing the doc say I was obese, this was a real wakeup call and I knew something needed to be done, I had decided to join the gym and when I saw the class advertised, I thought I would give it ago. The class is great, and I have changed my life through making healthier choices and increasing my exercise levels, I often work away during the week and this makes it hard to eat healthily, the discussions we have at the end of each session has really made me think differently about the way I look at food, I now look at food labels and am more aware of what I am eating. The support I get from Dan and the other regulars in the group is great. I now feel much fitter and healthier and when I look at old holiday photos I can now see the difference; I am going to carry on attending as this has really helped me make positive changes to the way I look at things”.
The total social impact delivered by AWM is £9,750.20. 14
It is recommended that these data points are collated in future, specifically in relation to longitudinal changes in weight and BMI (and blood pressure). 15 McKinsey Global Institute, (2014), Overcoming obesity: An initial economic analysis, MGI Discussion Paper, available online at https://www.mckinsey.com/~/media/McKinsey/Business%20Functions/Economic%20Studies%20TEMP/Our%20Insights/H ow%20the%20world%20could%20better%20fight%20obesity/MGI_Overcoming_obesity_Full_report.ashx 16 Based upon a 2016 UK population figure of 65.64 million people. 17 McKinsey Global Institute, (ibid). 18 Accurate data relating to BMI reductions for all participants below 30, could greatly enhance the impact calculations if NLT’s AWM programme is more effective than the national average.
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6. Activity on Referral NLT also operates its Activity on Referral (AoR) scheme, whereby people in need of increasing their exercise regime, lifestyle and general fitness are referred by their GP (or other partner organisations) to engage with NLT in relation to improving their health. These referrals can be for a wide range of conditions including: Hypertension; depression; smoking; obesity; neurological disorders; muscular/skeletal problems; diabetes; asthma; and cholesterol. These wide-range of issues present significant problems (and costs) to the NHS and society as a whole, and so NLT’s work here is of the utmost importance. In relation to the AoR programme, NLT have engaged with 83 individuals, and Figure 6.1 below provides a breakdown of the conditions presented by these beneficiaries. The data reveals that obesity and muscular/skeletal issues are by far the largest referral reason, accounting for over half of the sample; whilst depression and anxiety (16.8%) and Hypertension (11.5%) were also significant proportions.
0.8% 5.3%
11.5%
8.4%
Hypertension Depression/Anxiety 16.8%
Smoking Obesity Neurological
21.4%
Muscular/Skeletal 3.8%
Diabetes
Asthma Cholesterol 2.3%
29.8%
Figure 6.1 – AoR by Health Condition In addition to the sample breakdown, NLT also measured the wellbeing of participants that engaged with the AoR programme. This will then be explored longitudinally when participants have completed their engagement, although to date no longitudinal data is available for analysis. Whilst it is not possible to ascertain the social impact of all of conditions and NLT’s work in supporting beneficiaries with them, this section where possible will present the social impact delivered by NLT for those areas for which data exists in sufficient quantity (hypertension; depression/anxiety; obesity). The impact for each of these three quantifiable areas will now be explored. 6.1 – Hypertension: In relation to NLT’s work on hypertension, data reveals that high blood pressure affects 12.5 million people in the UK, and costs the NHS £2.1 billion per year through related illnesses. In addition, if the 10 | P a g e
average population could reduce their blood pressure by 5mmHg then the NHS would save £850 million over a 10-year period19. Further, a review in the Lancet demonstrated that for every 10mmHg reduction in blood pressure, there was: a 17% reduction in heart disease; 27% reduction in strokes; 28% reduction in heart failure; and 13% reduction in overall mortality20. NLT does capture data on beneficiary blood pressure, BMI and wellbeing, but to date no longitudinal data is available, hence estimations need to be made as to the impact that AoR has on those with Hypertension. The data above reveals that reductions in Hypertension reduce CVD events by 24% on average for every 10mmHg reduction in systolic blood pressure (the top figure on a blood pressure reading). Regular aerobic exercise can lower systolic blood pressure by up to 10mmHg21, hence providing the reduction required to reduce the CVD events identified above. Given that 15 of the AoR beneficiaries presented with Hypertension, and assuming that they are at a medium risk of a CVD event over the next 10 years (15% chance), then the exercise regime provided by NLT could reduce CVD events by 3.6/100, or in this sample of 15 individuals 0.54 CVD events. Therefore, the impact that NLT provides here equates to a saving to the NHS of £1,739.70. 6.2 – Depression/Anxiety: Depression/anxiety is a significant problem in the UK, with an estimated 19.7% of people suffering with it22, and the cost to society equates to £8,065 per individual including health costs and wider societal costs23. Research has shown that regular exercise can reduce symptoms of depression by up to 13%24. An assumption is therefore made that this reduction can be monetised in a linear fashion alongside the costs above (this in reality will not be the case, so further data needs to be collected in future to explore longitudinal changes in depression amongst clients). This means that for every patient engaged in regular exercise, NLT can save society an average of £1,048.45. Therefore, the social impact of NLT’s work with the 22 people suffering from depression/anxiety on the AoR scheme, is £23,065.90. 6.3 – Obesity: As was noted earlier for the AWM programme, obesity costs the NHS an average £487.51 per person25. For obese adults that engage in moderate levels of exercise through a structured programme, the average weight loss is 2kg26. For NLT this therefore means that across the sample of 27 individuals who engaged with the AoR due to obesity, there will be an average reduction in their BMI (based upon their starting weight) of 2.1%. The reality is that the BMI reduction might be significantly more than 19
Public Health England, (November 2014), New figures show high blood pressure costs NHS billions each year, Press Release available online at https://www.gov.uk/government/news/new-figures-show-high-blood-pressure-costs-nhsbillions-each-year 20 Ettehad, D., Connor, A., Emdin, A.K, Anderson, S.G., Callender, T., Emberson, J., Chalmers, T., Rodgers, A. & Rahim, K., (2016), Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis, The Lancet, 387, pp. 957-967. 21 Nieman, D.C., (1998), The Exercise-Health Connection, Human Kinetics Publishers. 22 ONS, (2016), Measuring National Wellbeing: Life in the UK 2016, available online at https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/measuringnationalwellbeing/2016#howgood-is-our-health 23 McCrone, P., Dhanasiri, S., Patel, A., Knapp, M. & Lawton-Smith, S., (2008), Paying the price: The cost of mental health care in England to 2026, Kings Fund Publication, available online at https://www.kingsfund.org.uk/sites/default/files/Paying-thePrice-the-cost-of-mental-health-care-England-2026-McCrone-Dhanasiri-Patel-Knapp-Lawton-Smith-Kings-Fund-May2008_0.pdf 24 Dimeo, F., Bauer, M., Varahram, I., Proest, G. & Halter, U., (2001), Benefits from aerobic exercise in patients with major depression: a pilot study, British Journal of Sports Medicine, 35, pp. 114-117. 25 Based upon a 2016 UK population figure of 65.64 million people. 26 Swift, D. L., Johannsen, N. M., Lavie, C. J., Earnest, C. P. and Church, T. S., (2014), The role of exercise and physical activity in weight loss and maintenance, Progress in Cardiovascular Diseases, 56(4), pp. 441-447.
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this, but without the longitudinal data gathered to date, we cannot make that calculation. However, this reduction in BMI from the starting BMI value, as a proportion of the individual distance to a BMI of <30 (i.e. an individual with a starting BMI of 40 would be 10 from not being classified as obese), is equivalent to a 13% reduction27. Assuming that the relationship between reduced BMI is linear to the costs of obesity (again this will not be the case and so further longitudinal data is required here), means that for the 22 individuals with a starting BMI of over 30, the saving to the NHS delivered here is £1,394.28. The total social impact delivered by AoR is £26,199.87.
7. Healthwalks NLT also provides support to individuals through its Healthwalks programme, whereby individuals can participate in walks delivered in the community by volunteers and trainers (these volunteers also receive training support, see Section 13 for more details on this). The benefits of walking can be significant for long-term health outcomes, with World Health Organisation (WHO) research identifying that regular walking and/or cycling (2 x 20 minutes per week) can reduce morbidity rates by up to 10%28. The data gathered from the NLT Healthwalks scheme identifies that over a 12-month period the following outcomes were achieved: 155 individual walkers (98 females/57 males) were engaged. o 9 participants were referred by a health professional o 7 participants have a long term illness/disability 2,208 hours of walking completed across the scheme, with a combined distance of 6,840 miles assuming an average walking speed of 3.1 mph. Utilising the WHO’s ‘Health Economic Assessment Tool’ (HEAT – more information can be found at http://www.heatwalkingcycling.org) tool to assess the economic impact of these classes through improved health outcomes reveals that £23,833 per year saving29. Total social impact delivered by Healthwalks is £23,833.
8. Street Sports The NLT ‘Northampton Street Sports Programme’ (NSSP) is a community-based sports intervention designed to follow the Street Games ‘door-step sport’ model that has been run since 2005. The programme is part funded by Street Games, Northampton Borough Council and The Wilson Foundation, and is primarily football based. It aims to engage children and young people in ‘priority wards’ in Northampton to help reduce anti-social behaviour and improve social inclusion in these areas30. The impacts noted for street sports interventions with young people are significant. Indeed, prior research has identified that such projects reduce the risk of disadvantaged young people engaging in substance misuse by 33%, resulting in a cost saving per participant per year of £2,26531. 27
Individuals with a starting BMI of <30 were removed from this analysis. WHO, (2018), Health Economic Assessment Tool (HEAT) 4.0, available online at http://www.heatwalkingcycling.org 29 Based upon a calculated impact of 27,100 euros, converted to Sterling on 27/2/18 through www.xe.com. 30 MacLeod, M. & Lusted, J., (2017), An evaluation of the impact of the Northampton Street Sports Programme, University of Northampton Research Report, July 2017. 31 Sported, (2013), Sportworks, Substance, available online at http://sported.org.uk/file/2016/07/Sportworks-Full-Reportlow-res.pdf 28
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Furthermore, street sports programmes can also reduce crime and anti-social behaviour (ASB) by 16%32. Data on the cost of ASB is limited, but a government study in 2003 estimated the daily cost at £13 million nationally across 66,000 incidents33. This gives an annual cost of £4.75 billion across 24.09 million incidents, or £6.89 billion inflation adjusted to 2016 levels (£286.01 per incident average). In Northampton Central alone, there were 2,789 incidents of ASB in 201734, making ASB a significant problem for the Police and local authorities. Total engagement in the NSSP over the last year was 581 individuals (523 males; 58 females), who in total attended 10,873 times (nearly 19 visits per person average). The NSSP is a free provision service delivered in disadvantaged wards of Northampton (11 out of the 12 wards are in the IMD top 20% most deprived areas) and these cost NLT £3.45 to deliver per individual attendance. Therefore, the total impact delivered here by NLT through the free provision is £37,511.85 (10,873 visits x £3.45 per head cost). However, as was noted above, the savings to society could be wider than this. Indeed, given that street sports programmes reduce substance abuse amongst disadvantaged young people by 33% saving the state £2,265 per individual attendee, the impact delivered by NLT here is £1,315,965 [581 individuals x £2,265 participant saving]. Furthermore, previous research by the University of Northampton identified that 69.7% of NSSP participants stated that the programme had ‘kept them out of trouble’. Assuming one incidence of ASB per year per individual this means that the NSSP’s impact on reducing the costs of ASB is £115,821.75 [(581 individuals’ x 0.697 success rate) x £286.01 cost of one ASB incident]. Total social impact delivered by NSSP is £1,469,298.60 per annum.
9. Sports Employability Project NLT has also been working to deliver employability services in partnership with Prospects Northampton. Prospects seek to provide employability support to individuals, which NLT provided through its own Sports Employability Project. This was designed to provide young people with an interest in sport with the opportunity to learn new skills, develop their knowledge, access a formal qualification and become work ready for a role in the sports sector. It was run through the Street Sports project outlined above and provided support to 17 young people around employment, education and training. Each participant engaged in a six-week course (3 hours per week) to enhance their skills, with session’s including: a 1 hour sports coaching session where young people were given the opportunity to participate in a sport of their choice; a 1-hour mentoring session with the Sports Delivery Development Officer; and a 1-hour employability workshop covering a wide variety of employability skills (interview skills, creating a CV etc.). During the final week of the course all participants are booked onto a nationally recognised sports activator course. Once completed, this provides all participants with a formal qualification that is widely recognised within the sports sector. The outcomes for the course are presented below: 5 participants of the two courses have gone on to secure employment. 90% participants reported that they felt more confident to secure a job as a result of the course. 85% of participants reported that they would recommend the course to a friend. 85% of participants reported that they felt more employable as a result of the course. 32
Sported, (ibid). BBC, (2004), Q&A, Anti-social behaviour, available online at http://news.bbc.co.uk/1/hi/uk/3565619.stm 34 Northamptonshire Police, (2018), Crime Comparisons by Type, available online at https://www.police.uk/northamptonshire/SCT162/crime/stats/ 33
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In assessing the impact of the course, it is the five employment outcomes delivered that provides the impact to society through savings in welfare payments (Job Seekers Allowance) and increased tax revenue (income tax and National Insurance)35. Figure 9.1 below outlines the impact:
£0k
+£2,970
+£15,000
Total Savings of £18,000
Figure 9.1 – Employability impact The work engaged in by the five young people does not deliver income tax payments as it falls below the £11,000 tax free threshold at minimum wage. However, the employment did lead to £2,970.24 in National Insurance payments; and £15,054 in reduced JSA payments. Based upon these calculations we are able to demonstrate that NLT delivered a maximum direct financial benefit to the UK state of £18,024.24 through its employability work. Total social impact delivered by NLT’s employability work is £18,024.24 per annum.
10. Training NLT also provides many of its volunteers with training as and when required, in order to allow them to do their roles effectively and also as part of NLT’s commitment to skills development and career development for its volunteers. The training is all provided for free and paid for out of NLT’s trading surplus and/or reserves. The impact here can be calculated in two ways. First, the total cost of training provided to volunteers can be calculated; second, where that training is upskilling a volunteer (based upon a higher NVQ equivalent qualification gained) this has a direct average impact on the lifetime career earnings of the volunteer. For example, Department for Business, Innovation and Skills (BIS) data reveals that for an individual whose previous highest qualification is NVQ Level 1 to then attain an NVQ Level 2 qualification, the average increase in their lifetime earnings potential is £48,00036. Table 10.1 below details the training delivered to volunteers over the last 12 months.
35
These savings are based upon an income tax rate of 20% paid over £11,000 per year; an NI rate of 12% paid over £5,824 per year; the value of JSA claimed per week (£57.90); and an assumption that all five employed young people remain in work for 12 months post-NLT at minimum wage (5.60 per hour at the 18-20 years of age rate). 36 BIS, (2011), Returns to intermediate and low-level qualifications, 11/1282, available online at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/32354/11-1282-returns-intermediateand-low-level-vocational-qualifications.pdf
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Training Course
Number of hours
Play Ranger Buddies - The Arbours (for children in primary school) Play Ranger Buddies - St Mary's Inspired Lunchtimes - East Haddon (for school employees including lunchtime assistants) Healthy Heroes37 – Millway Healthy Heroes38 – The Arbours Health Walk Leader Training 1 Health Walk Leader Training 2 Health Walk Leader Training 3 Football Activator Course Multi Skills Activator Multi Skills Activator Multi Skills Development Level 2 Sports Employability Course Sports Employability Course Managing Challenging Behaviour Totals Table 10.1 – Breakdown of training delivered and costing’s
Number of Cost to NLT Participants 6 6
15 27
£475 £475
6 9 9 6 6 6 3 3 3 24 18 18 3
5 15 14 10 9 10 16 16 7 14 12 5 9
£465 £475 £475 £150 £150 £150 £600 £600 £600 £9,000 £2,500 £2,500 £600
126
184
£19,215
From the above data we can see that the total added value provided through training is £19,125. However, the Multi Skills Development Level 2 (shaded in green) is an NVQ Level 2 equivalent qualification. Therefore, assuming that all of the 14 volunteers who were awarded the qualification had previously not achieved a Level 2 equivalent qualification or higher39, then the total impact delivered through this upskilling is £672,000 in increased lifetime earnings. Total social impact delivered by NLT’s volunteer training is £691,215 for this year.
11. Volunteering The volunteers also however, provide significant resource to NLT through the provision of their time, which is directly leveraged into the delivery of social impact on projects that may not otherwise occur (or at least occur to the same scale) without this volunteer support. Whilst the true value of this support is difficult to calculate as the value that they deliver will be greater than their mere wage value (if they were paid), the minimum wage40 can be used here as a base calculator for volunteer impact leveraged by NLT into its projects41. The volunteers for NLT have supported the delivery of its Street 37
This is a healthy lifestyles programme, aimed at educating primary school children and their parents. This is a healthy lifestyles programme, aimed at educating primary school children and their parents. 39 The reality of this assumption is that some of these volunteers will have already received higher qualifications, and so the overall impact will likely be lower. Therefore, it is recommended that NLT capture this data from volunteers in future so as to ensure the accuracy of these claims. 40 The national minimum wage for those over 25 years of age is £7.50. 41 The value of this support is likely much higher than the minimum wage figures used as a proxy here. 38 38
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Sports programme, Healthwalks scheme, gymnastics classes, the 50+ programme, as well as general volunteering. In the last year these volunteers have provided 2,868 hours of volunteering support, at a combined value to NLT’s beneficiaries of £21,510. This resource provides a significant boost to programmes run by NLT that they would otherwise have to resource financially. Total social impact delivered by NLT’s volunteers is £21,510 for this year.
12. External funding However, NLT also works to leverage additional funding in addition to its volunteer resources, through applications to grant funding bodies and sponsorship, that provide funding that is then used to support community regeneration and projects. In one instance NLT also used its trading surplus to match-fund a grant, further supporting impact in the community. Figure 12.1 below provides an overview of the money leveraged in by NLT to the county through this work.
£75,000 in small grants & sponsorship
£300,000 Sport England grant
£270,000 NLT match-funding
Figure 12.1 – Grants, sponsorship and match-funding resourced by NLT The £300,000 Sport England grant and £270,000 NLT match-funding (alongside match-funding from Northampton Borough Council of £130,000) is being used to refurbish the Mount Baths changing rooms, including associated pipework, water quality improvements and the cost of temporary changing facilities. This will greatly enhance the experience of beneficiaries at the Mount Baths site. Total social impact from leveraged grant funding, sponsorship and match funding is £645,000
13. Financial Situation The final area to explore in this report is the financial position of NLT at the end of this impact year, so that surplus and assets carry over can also be accounted for in the impact calculations (as these will be directly used to deliver impact in the coming year). This is a feature of NLT’s social mission orientated trading model that means that despite all of the impact generated above, there is still financial surplus that can be used by the organisation to deliver impact. The below positive impacts, as well as the other impacts covered in this report, are set against an overall expenditure/running costs base of £6,181,514. In summary, at the end of January 2018 NLT had: £58,724 profit for year carried over for further social impact. £1,341,396 in funds carried forward (excluding pension assets). £202,519 VAT paid to the state (direct tax contribution). £200,911 in Income Tax and NI paid by staff and NLT. Total impact contribution from miscellaneous finances is £462,154.
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14. Summary In sum, the impact outlined above in Sections 3-13 amounts to a total social impact of £3,581,181.07. It is clear from the evidence that has been presented in this report that NLT delivers a significant social impact in relation to the work that it delivers to its beneficiary groups. However, there is much that still needs to be collected in relation to the research evidence gathered in order for the data to be further strengthened and the analysis to therefore be more robust. Additional data on beneficiary outcomes and conditions, on the effectiveness of NLT interventions, and, if possible, on the deadweight (i.e. what would have occurred anyway), would only strengthen the impact calculations presented in this report. Nevertheless, a total social impact of over £3.5 million from one-years’ activity demonstrates a significant social value contribution to society. Figure 14.1 below summarises the impact reported in this paper.
Total Social Impact = £3,581,181.07 General Membership = £167,933.12
Health Checks = £46,263.04
Healthwalks = £23,833
Street Sports = £1.47m
Volunteering = £21,510
Adult Weight Management = £9,750.20
Sports Employability = £18,024.24
External Funding = £645,000
Activity on Referral = £26,199.87
Training = £691,215
Financial Impact = £462,154
Figure 14.1 – Overall social impact of NLT for period February 1st 2017 to January 31st 2018
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13. Northamptonshire Police, (2018), Crime Comparisons by Type, available online at https://www.police.uk/northamptonshire/SCT162/crime/stats/ 14. ONS, (2016), Measuring National Wellbeing: Life in the UK 2016, available online at https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/measuringnational wellbeing/2016#how-good-is-our-health 15. Public Health England, (November 2014), New figures show high blood pressure costs NHS billions each year, Press Release available online at https://www.gov.uk/government/news/newfigures-show-high-blood-pressure-costs-nhs-billions-each-year 16. Sported, (2013), Sportworks, Substance, available online at http://sported.org.uk/file/2016/07/Sportworks-Full-Report-low-res.pdf 17. Swift, D. L., Johannsen, N. M., Lavie, C. J., Earnest, C. P. and Church, T. S., (2014), The role of exercise and physical activity in weight loss and maintenance, Progress in Cardiovascular Diseases, 56(4), pp. 441-447. 18. Swim England, (2007), The health and wellbeing benefits of swimming, available online at http://www.swimming.org/swimengland/new-report-shows-health-benefits-swimming/ 19. Taylor, R.S., Unal, B., Critchley, J.A. & Capewell, S., (2006), Mortality reductions in patients receiving exercise-based cardiac rehabilitation: how much can be attributed to cardiovascular risk factor improvements, European Journal of Preventive Cardiology, 13(3). 20. WHO, (2018), Health Economic Assessment Tool (HEAT) 4.0, available online at http://www.heatwalkingcycling.org
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