Sport and leisure: promoting health and wellbeing through public services

It is well evidenced that being physically active contributes to better health and wellbeing outcomes: it helps to reduce the risk of developing major illnesses and manages existing health conditions. It also has a much wider value to society and the economy. Research commissioned by Sport England found:

The value of sport and physical activity

• £85.5 billion: is the annual contribution community sport and physical activity makes in social and economic benefits (2018 prices).
• £72 billion: in social value is created through healthier population, consumer expenditure, greater work productivity, improved education attainment, reduced crime and stronger communities.
• £9.5 billion: is the value physical activity makes to the economy through the prevention of several serious physical and mental health conditions including the prevention of 900,000 cases of diabetes and 93,000 cases of dementia. Of this amount £5.2 billion is in healthcare savings and £1.7 billion in social care savings. 
• £20 billion: in value is created from stronger and safer communities, including: 10,000 fewer crime incidents, improved levels of social trust, belonging and community engagement.

Increasing physical activity levels has been a key policy focus for several years. Public Health England (replaced by the Office for Health Improvement and Disparities in 2022) has led the charge since 2014, producing guidance such as Health Matters: getting adults active everyday, Physical activity: applying all of our health and  ‘Everybody Active Every Day’. ‘Everybody Active Every Day’ lays out a whole system approach that is designed to address inactivity, promote health and tackle inequality, with regards to physical activity, and support councils and professionals to work in partnership to increase the population’s physical activity levels. Furthermore, in 2019 the Chief Medical Officer refreshed physical activity guidelines across all ages and for the first time included specific guidelines for recommended activity levels for pregnancy and disabled adults. 

Yet, despite the evidence, inactivity levels have remained stubbornly high in the past few years. This has been exacerbated by the COVID-19 pandemic and now the cost-of-living crisis. Data from the 2021-22 Active Lives survey shows that 25.8 per cent of the adult population and 30.1 per cent of 5 – 16 year olds in England are classed as inactive. This equates to 11.9 million adults and 2.2 million school aged children doing an average of less than 30 minutes of physical activity a week. 

Increasing activity levels is a win/win for individuals, society, for local and national government and the health and social care system. However, getting there can be complex and will take a concerted and joint effort between all partners to overcome the barriers preventing people to be active.  

The Government’s new sports strategy “Get Active: a strategy for the future of sport and physical activity” (August 2023) sets new targets to get 2.5 million more adults and one million more children active by 2030. This includes specific targets for the least active groups. The strategy seeks to improve the nation’s health and fitness, enhance corporate governance, and make the sector more resilient to future challenges at elite and grassroots level. It aligns with Sport England’s ten-year strategy “Uniting the Movement” (2021), which puts movement at the heart of the strategy and focuses on making sport and physical activity a normal part of life for everyone, regardless of who they are. 

Both strategies call for greater collaboration and innovation between councils, professionals, different sectors and organisations to encourage more people to be active and reap the benefits. Specifically, the Government’s new strategy calls on councils to work with their partners to develop local plans that go beyond traditional leisure venues to encourage people to be active in their everyday lives.

This guide looks at the contribution public sport and leisure services make to promoting health and wellbeing to encourage communities to be active and how this can be achieved through working with a range of partners. It builds on the joint report between the LGA, the Association for Public Service Excellence (APSE) and the Chief Cultural & Leisure Officers Association (CLOA)  report “Securing the future of Public Sport and Leisure services” which consulted with over 250 councils and a wide range of stakeholders to seek their views on what needs to change so that public sport and leisure services can operate sustainably and deliver the best outcomes for communities. This guide shares learning from councils who are making progress in this area and builds upon other guides in the series such as ‘Identifying additional financing options for public sport and leisure services’ and ‘Supporting community ownership of leisure and sports assets’.

When it comes to why councils, health and wider partners should invest in creating the conditions and opportunities for communities to be active, the evidence is very clear. Not only does movement, physical activity and exercise reduce the risk of major illnesses, improve mental wellbeing and help manage existing health conditions, being physically active leads to better outcomes, including: 

• improved learning and attainment
• increasing productivity in the workplace
• stress management 
• self-efficacy
• the development of social skills
• better social interaction 
• improved air quality 
• increasing social cohesion
• reducing the burden on social care and NHS services.

Significantly, many of these wider universal benefits are typically seen when activities are undertaken in a community setting such as walking and cycling routes, through active recreation, sport and play opportunities. This is where public sport, leisure and park services make a significant contribution to this agenda.

Crucially, public sport, leisure and park services provide free, subsidised, and affordable universal and targeted services which are simply not provided elsewhere at such scale. The breadth of offer spans from ‘cradle to grave’, supporting all ages to be active. In addition to supporting individuals with long term health conditions through exercise programmes and delivering NHS services like rehabilitation services for cancer treatment patients. 

Prior to the pandemic councils were collectively responsible for: 

• 2,727 leisure centres
• 924 publicly accessible pools
• 27,000 parks and green spaces
• 3.21 million leisure centre members.

Beyond facilities, councils play a key role in promoting sport and physical activity. They deliver campaigns at a local level and bring people together through events and public screenings to celebrate national sporting events like the recent successes of the Lionesses in the FIFA world cup and Euros. 

Their broad scope makes them a unique part of the local ‘ecosystem’ of physical activity and mental wellbeing. But despite this, partners do not always recognise the opportunities sport and leisure services offer to other council departments or partners like the NHS and are underutilised. This is partly because traditionally sport and leisure provision was commissioned for direct service delivery and used to generate income to subsidise other council services. 

However, the COVID-19 pandemic prompted a renewed recognition by the sector of its contribution to communities, tackling inequalities and for a more sustainable approach to facilities. Essentially it recognises the need to move towards an active wellbeing service. Making now the right time to align with health and wider partners.

Sector insights

In a survey of councils and leisure providers:

• Ninety-seven per cent of respondents said that sport and leisure services could be commissioned to do more by achieving greater alignment with wider stakeholders. 
• Eighty-six per cent of respondents ranked health and wellbeing as the most important driver for providing leisure centres. Tackling inequalities, inclusion and diversity is the second main driver.

Sport, leisure and park services can be used to promote and deliver physical activity, health and wellbeing activities to communities through:

• Community assets: leisure centres, swimming pools, gyms, sport halls, parks and green spaces, green gyms, playgrounds.
• Outreach activity that targets underserved sections of the community and the least active groups.
• Providing and maintaining publicly accessible sports facilities like tennis courts, sport pitches.
• Leadership role in facilitating and brokering partnerships with key strategic and delivery partners e.g. schools, NHS, voluntary sport clubs, National Governing Bodies, the private sector and voluntary and community sector and wider council led services like public health, adult social care, planning to take a place based approach.
• Unblocking barriers to participation and improving the local sport delivery system.
• Delivery of national campaigns at the local level e.g. We Are Undefeatable and This Girl Can. 
• Taking a strategic approach to ensuring the right services, opportunities and facilities are available based on the needs of communities. 
• Moving Communities data to understand how well facilities are used and by whom to tailor provision. 
• Putting local people at the heart of the decision-making process and ensuring the needs of individual communities are considered to address inactivity.

The proliferation of agencies and stakeholders involved in the provision of health and wellbeing services can present a challenge. From council provided public leisure, social care, children and sport services to the NHS to the voluntary and community sector and community groups, as well as the commercial health and wellbeing sector. 

The role of councils is vitally important in this mix. Creating greater cooperation between agencies to create a joint vision to enable communities to be physically active will be an important component in the fight against inactivity and ill health. 

Complex healthcare systems 

Health systems are complex with many different organisations leading on different parts of care. New Integrated Care Systems (ICS) are not necessarily coterminous with council boundaries making navigating them tricky. The culture and language used by health partners differs, making it important to be able to talk in health terms and to be able to demonstrate savings to the healthcare systems in order to unlock funding. Many ICSs have developed at different rates across the country, some have more established and better partnership working in place than others. This can pose a challenge for outside influencers. 

District councils can find this problematic because they do not have statutory duties for primary, secondary health care or public health which means they are not statutory members of existing health systems. However, district councils have statutory powers for, and influence over, the most significant determinants of health including planning, housing, benefits and leisure and green spaces, and close links to communities, making them a valuable strategic partner to Integrated Care Systems. 

Breadth of the challenge 

Despite good progress in improving the health of some groups, the health challenge facing children and adults still requires complex solutions.

• A quarter of year 6 pupils are classed as obese, and less than half of all children in the UK are meeting Chief Medical Officer (CMO) guidelines for taking part in sport and physical activity (Youth Sport Trust).
• Forty per cent of teenage girls are not actively participating in sport (Women’s Sports Foundation).
• Evidence suggests an increase in depression and anxiety amongst 5-15-year-olds (Sport England).
• One in three working age adults now live with a long-term health condition, this is predicted to rise to 40 per cent by 2030 (Sport England).
• Despite life expectancy increasing over the last 20 years, people are spending more time in poorer health (Sport England).
• The pandemic led to unprecedented decreases in activity. Activity levels for women, young people aged 16-24, people living in the most deprived places and Black, Asian people have not yet fully recovered to pre-pandemic levels (Sport England).
• Psychological factors play the biggest role in preventing disabled people from taking part in sport, and 4 in 5 disabled people want to be more active (Activity Alliance).
• One in four adults experiences at least one diagnosable mental health problem in any given year. People in all walks of life can be affected and at any point in their lives. Mental health problems represent the largest single cause of disability in the UK (NHS).

Public health tools and interventions, data from Moving Communities, building relationships with partners, integrating services and tackling the wider determinants of health will be key to tackling the challenge and are covered in the ‘opportunities’ section.

Get active: a strategy for the future of sport and physical activity

The Government’s strategy presents several opportunities to refocus local priorities. It provides a blueprint, encouraging councils to take a key strategic and leadership role and to: 

• co-develop a clear and well evidenced facilities plan with partners that considers informal spaces for participation as well as the role that the local leisure estate plays in contributing to physical activity and wider wellbeing
• take greater accountability for integrating physical activity into their local priorities and strategies 
• include a strategic objective to improve the health and wellbeing of its population in addition to the local facilities plan
• work with schools and sector partners to establish a local plan of need to help develop a pipeline for delivery and evidence to underpin funding requests across government
• consider adapting the built and natural environment to encourage people to be active through their everyday lives and adopt the principles of Active Design to help ensure local planning decisions create more organic opportunities to be active
• having a coherent Local Cycling and Walking Infrastructure Plan (LCWIP) for the local area to help facilitate active travel and support children to have active school journeys
• considering co-location of community facilities to deliver cost effective public services and improve health outcomes
• join-up and coordinate local thinking to ensure that bids for government funding, such as the Levelling Up Parks Fund maximise the potential for individuals to get active
• tackle inequalities and health disparities.

It aims to empower the public sport and leisure sector to realise its ambition to pivot towards an active wellbeing service and to become a key strategic leader within healthcare systems and to wider partners. 

It sets out an overarching target to get 2.5 million more adults and one million more children and young people active by 2030 and sets out specific targets to get the least active groups more active by 2030. This includes: 

• 1.4 million more active adults from those in NS-SEC 6-8 (NS-Sec is the National Statistics Socio-economic Classification that provides an indication of socio-economic position based on occupation).
• 0.7 million more active people who identify as having 1 or more disabilities. 
• 1.5 million more active adults aged 55+. 
• 1.25 million more active women. 
• 0.19 million more active Asian adults, particularly people from Indian, Pakistani and Bangladeshi ethnic groups. 
• 0.09 million more active black adults.

Influencing healthcare systems

Recent reforms to the health system means it will be imperative for councils of all tiers to quickly adapt and respond by defining their place and role within the new structures. This presents opportunities to forge new relationships and partnerships, and to build on existing relationships. 

Some of the key players in the health and care system include: 

In order to successfully engage with these bodies it is important to have a familiarity with the language and terms they use, which differs from those commonly used in the leisure and physical activity sectors. It is also important to be well briefed on data and evidence that will resonate with these colleagues, recognising that health standards for acceptable data tend to be much higher than those used in councils or by community groups. 

Data

Moving Communities provides data on facility performance enabling councils to understand how effective the service is and for whom, and its impact on local communities. This data will enable councils, leisure providers and policymakers to understand their performance and enable benchmarking against national and local neighbours. It also identifies the least active groups in communities, enabling partners to develop targeted interventions to increase activity levels. Insights will inform strategic decisions about where time, effort and money are best invested to benefit local communities and the audiences most in need of help.

Councils can measure the wider social impacts of physical activity taking place in their leisure centres. The ambition is to integrate place-based data of non-facility provision into Moving Communities to give a full picture of what is available locally. 

The Office for Health Improvement and Disparities produces Public Health Profiles for every council. These profiles together with indicators in the Public Health Outcomes Framework (which sets out a vision for public health) and local area’s Joint Strategic Needs Assessment (JSNA) and local Joint Strategic Health and Wellbeing Strategy (JHWS) can help to identify the current challenges facing the local area and shared priority areas between public health and sport and leisure services.

In addition, Active Lives data from Sport England alongside other intelligence and guidance such as the Strategic Outcomes Planning Model can support the design and planning of health and wellbeing initiatives and wider transformation including co-location of services.

The National Institute for Health and Care Excellence (NICE) produces evidence-based recommendations developed by independent committees and consulted on by stakeholders. Their reports carry significant weight with health colleagues and provide a useful distillation of key evidence that supports interventions. They have a number of guides related to physical activity, including walking and cycling, and there is also a guide on parks and green spaces.

Working with communities

The pandemic highlighted the value communities place on leisure and park services and being active. Councils were able to connect with communities in new and innovative and increasingly virtual ways, adapting services to meet needs during national lockdowns and beyond. For example when the Government announced on 23 March 2020 that parks will remain open during the national lockdown to enable individuals to do one hour of exercise a day, 30 per cent of people were more active during the first national lockdown. It also propelled parks into the nation’s hearts and minds, proving their status as lifelines for local communities. They remain a lifeline for many, recent polling by the Fields in Trust shows that 91 per cent of respondents agreed that parks have become increasingly important during the cost of living crisis and 55 per cent are concerned their local green spaces would be lost to development. 

Councils are in a unique position to work with their local communities to develop and adapt spaces in a way that increases physical and mental health and wellbeing whilst also creating great places to live, work and play. For example, Stockton-on-Tees Borough Council are undergoing a radical transformation of Stockton town centre that will reconnect the High Street to the river and build an urban park in the heart of Stockton. The council launched the Let’s Talk About Our Town public consultation to allow the general public and stakeholders to identify key priorities and a shared vision for the development of Stockton. An engagement campaign took place to allow residents, businesses and visitors to provide input on the concept plan for an urban park, before a final design was created. Key public services will also be relocated to the High. This includes the development of a new more modern leisure centre with a pool, gym and studios, which will replace the existing splash leisure centre, a library, customer service and register building.

Councils know their communities best and have established relationships with local community leaders who are able to support the council to adapt messaging and develop projects so they are culturally appropriate and empower communities. In the case of Ealing Council it is an example of how resident-enabled leadership via a Social Movement has been able to unlock new resources and work with the system for common goals. 

Schools

The work with schools is especially important in encouraging an early habit of physical activity and movement that can be sustained throughout adult life and for its positive impacts on mental health. The updated School Sport and Activity Action Plan reasserts the cross-Government commitment to collaborate at a national level to ensure that PE and sport are an integral part of both the school day and after-school activities. It encourages all schools to deliver a minimum of 2 hours’ PE time during the school day every week alongside equal access to sport for girls and boys. The Government has confirmed that the Primary PE and Sport Premium will continue for academic years 2023/24 and 2024/25 with a total of over £600 million across the two years, with funding provided by the Department for Education and the Department for Health and Social Care. 

The plan also focuses on encouraging more children and young people to be active in their journey to and from school. Based on 2021 travel data, under half of children and young people are regularly walking (43 per cent) or cycling (3 per cent) to school. Clearly this is an area councils can work with and engage schools, young people, parents and carers to ensure there are safe routes to be active in their school journey. This could include councils using their powers to use traffic management orders to temporarily turn a street into a pedestrian and cycle zone, creating a School Street. Additionally councils can support local residents to establish ‘play streets’ these are low cost resident led initiatives that temporarily close roads for short periods to enable children and young people to play outside safely. Councils can support this by promoting the idea to communities and making it easier to apply. The benefits include positive impacts on public health, community cohesion, children’s physical activity and mental health and the active travel agenda, improving air quality.

Sport England’s 10 year strategy ‘Uniting the Movement’ pledges to focus on:

• Working collaboratively to improve sport and physical activity messaging, experiences and opportunities, experimenting with different approaches to tackle inequalities. 
• Work with partners who have trust, credibility and reach among those least active in poorer health. 
• Share evidence of the benefits of physical activity to health and advocate to those who can strengthen policies, messaging, delivery or investment.
• Supporting meaningful links between the sport and physical activity sector and health systems at every level, driving changes addressing barriers and supporting local solutions. 

There is a clear opportunity across all of these areas for councils. 

Integrating and co-locating services

In many places public sport and leisure is already being combined with other core council services such as public health, social care, GP services, social prescribing, libraries, culture and community hub services. It is becoming more relevant because of NHS England’s new Major Conditions Strategy, which represents a significant opportunity to improve the lives of millions of people by tackling major conditions that lead to years of ill health. 

Ukactive is piloting a programme to transform leisure centres, swimming pools, and gyms into musculoskeletal (MSK) health hubs. Figures show 70 per cent of the NHS budget is spent on such preventable conditions, while lost mobility also forces many people to enter care homes early. Launched across 15 sites in 2022, the pilot will show how the programme could reduce pressure on acute healthcare services in primary and secondary settings, by managing conditions in community settings which are more easily accessible. Helping to reduce health inequalities in the process. 

The fitness and leisure sector can help reduce the burden on the NHS, social care, and the economy by providing a national activity therapy service, keeping patients out of hospitals and surgeries by encouraging them to use health programmes at their local pool, gym or leisure centre. As well as benefits to individuals through improved health, improved productivity via a reduction in the number of people unable to work due to long term health conditions. 

Learning from the pilots show that good relationships between the council, NHS and leisure providers, with regular meetings, is essential to the ongoing good practice in delivery. Aquatic programmes have been highly valued by participants who find land exercise challenging due to mobility and pain. The ‘familiar face’ of physiotherapy staff is an important element, helping to build trust and removing barriers to the first visit.

The following ideas and issues draw on the experience of other councils working in this area, which you may wish to consider:

• Public sport and leisure services can play a vital strategic, coordination and delivery role in the provision of health and wellbeing services. The extent to which this is understood amongst partners will vary and be dependent on how well developed and strong partnerships are, resources and knowledge. It may not always be obvious to your partners what public sport and leisure services can offer and the ROI to their services e.g. the NHS. Developing a strong and well-evidenced business case including the ROI to partners, taking time to build relationships and understanding of the service and develop champions inside and outside the council will be important when seeking to successfully influence the local eco-system.
• You have to do things differently to reach different people. One size does not fit all and straight forward leisure provision will not encourage significant numbers of inactive people to be active. There will be cost implications and restrictions to how you do this, so it is important to have a dialogue about the purpose of your leisure and physical activity services, what they are intended to achieve, and who they should support. 
• Create a joint vision. This can open doors to additional opportunities and sources of funding. 
• Councils and public sport and leisure services are one of the largest employers in a local area. Wellbeing starts internally with staff wellbeing, understanding the experiences people have been through during the pandemic and the pressures they are currently facing and creating opportunities to be more active in the workplace and social opportunities to connect with others can have a positive impact on workforce health and wellbeing. 
• Identify and promote opportunities to encourage communities to take the lead for being more active. Making it as easy as possible for people to sign up and get involved in initiatives like the daily mile, play streets and school streets. Utilising online systems and technology where possible and using social media to create energy behind initiatives but recognising not everyone will have access to or know how to use technology. 
• Invest in the workforce. Having the right people with the right skills delivering activities at the right time is crucial. Friendly and knowledgeable leisure centre staff are often highly ranked in customer satisfaction surveys. With the right training, knowledge and support they can support people with barriers to participating in leisure centre settings to use them. To deliver health interventions, it may be necessary to create different roles and provide training from the health sector, rather than traditional leisure sector training. 
• Use different methods to inform service improvements, rationalisation and investment. Including engagement with communities to ensure services are based on their needs along with data from Moving Communities. 
• Concentrate efforts. Trying to do everything for everyone and having programmes that serve everyone is not realistic. Looking at the data from JHWS, the JSNA, Moving Communities and the targets set by the Government to increase activity levels in certain groups by 2030 will give a much better steer on which groups are the one to focus efforts on.
• Play ‘the long game’! It takes years to see the benefits from investment in preventative approaches. Being able to articulate the benefits to health and wider partners backed with strong evidence on the ROI will be key to getting their buy in. NHS services by their design are focused on clinical and acute services. Prevention is not widely recognized in the NHS. However, public health on the other hand is by its design understands and delivers a preventative approach and are skilled at articulating this. They are a key ally to breaking down barriers and influencing the NHS.  

As outlined in the  District Councils Network report Fit For the Future: The Health Value of Wellbeing and Leisure Services | District Councils' Network, improving physical activity (especially amongst the most deprived) should lead to a reduction in diseases, improved quality of life, a reduction in health inequalities and the associated economic returns – savings to the NHS and also economic returns related to productivity.

At the individual level, many aspects combine to create a healthy lifestyle such as diet, exercise, sleep and so on and it is everybody’s responsibility to take ownership of this.

Collectively, public sport and leisure services and physical activities have a huge part to play in enabling the improvement of the health and wellbeing of the population, and the exact role will be different in each area.

For councils there is a promotional, enabling, funding, advocacy, brokering, commissioning, delivery and strategic role. 

In summary, in order to move into a more strategic role and to advocate utilising public sport and leisure services in the promotion of health and wellbeing, teams need to:

• Identify the key health issues and priorities locally and the shared priorities with partners.
• Identify key health and wider partners, build their understanding of the opportunities and benefits and develop relationships and champions.
• Develop a joint vision and strategy to utilise sport and leisure to promote physical activity, health and wellbeing.

The key is for councils to help co-ordinate and join together a systems approach in a local area with all the relevant and key players.

As the sector recovers from the pandemic but enters new challenges related to cost of living and increasing energy prices, it will be more important than ever to work with partners to find innovative and cost effective solutions and programmes to ensure that everyone, and particularly the least active groups have access to suitable and affordable opportunities to further their physical and mental wellbeing.