Top tips for councillors and health commissioners
These ‘top tips' are drawn from the case studies and lessons learned in linking cultural and sporting activities with health improvement.
1. Use culture and sport as a cost effective way to tackle the social determinants of health
All the case studies show how cultural and sporting assets have been key to their success. The added value these assets bring to participants means a much greater investment than project budgets suggest. Using museum collections, leisure facilities or libraries, for example, adds significant value at no direct additional cost to an activity.
A study commissioned by the Museum of East Anglian Life in Suffolk quantified this ‘hidden' investment in the work based learning programme it delivers. It shows that using the museum's resources ‘leverages in' investment of £18,000 of museum assets and £4,000 of volunteering time. Commissioners of the programme are therefore getting £53,000 worth of investment for a £31,000 budget.
This means a little money can go a long way.
A budget of just £1,500, boosted through use of Brighton Museum and Art Gallery collections, helped young carers feel more confident in dealing with the transition between primary and secondary school.
For every £800 it spends to train a member of staff or volunteer, Westminster City Council can run a specialised reading group in one of its libraries every week. This improves the wellbeing of some of the city's most isolated and vulnerable residents.
By making the most of the cultural and sporting infrastructure, funders can get more back than they put in. The value of volunteer time to Shropshire Council through its Parish Paths Partnership scheme exceeds the cost to the council of running the scheme.
Some initiatives can become self-financing following initial public investment. Trafford Community Leisure Trust expects to cover the running costs of its female participation project – which strengthens communities through increased female participation in physical activity – through the additional income the project generates.
2. Achieve health-related cashable efficiencies through culture and sport
Culture and sport not only increase the level of investment in participants above what project budgets suggest, they can achieve actual savings too.
The study commissioned by the Museum of East Anglian Life quantified savings from reductions in welfare payments – Job Seekers Allowance, incapacity and housing benefits – resulting from the success of its work based learning programme in getting long-term unemployed people into work.
By helping people make healthier lifestyle choices culture and sport can reduce demand for high-cost services.
Sport Lincs in North East Lincolnshire helps young people overcome challenging behaviour and turn their lives around. Analysis by Humberside Police of savings attributable to Sport Lincs is expected to show a reduction in its operating costs amounting to tens of millions of pounds.
Effective prevention and early intervention through culture and sport help reduce longer-term costs to health services too.
3. Bear in mind that the cost to the public purse can increase in the short term
Tackling the social determinants of health through culture and sport can have unintended consequences.
Extra demand on public services in the short term may be one of them. As disadvantaged or vulnerable people increase in confidence and take more interest in their future, they may be more active in taking up services and support – through more GP visits and training, for example – before there is a return on any investment.
This means it is important to consider whole-life costings of planned activities.
4. Ensure ongoing investment in cultural and sporting assets needed to deliver
The case studies show how cultural and sporting assets enrich activities to deliver outcomes other approaches fail to achieve. Participants describe how the cultural or sporting dimension has added value to their experience that would not otherwise have been possible.
It follows that if these benefits are to continue to be realised, maintaining and developing the cultural and sporting assets that deliver them is essential.
5. Talk to your local community
Local people know what they need and want, and will say if asked in the right way. The case studies show the value of face-to-face contact, of talking to people on their door step, in their home, on the street and in places where they like to gather.
Ward councillors who are in tune with their local residents, as well as frontline workers can engage those who are hardest to reach. The hard-to-reach can often identify the best solutions to tackling health determinants locally.
6. Reach deep into communities through culture and sport
Cultural and sporting facilities are a major community resource. They provide an extensive network of buildings and services at the heart of communities. Some are open every day of the week from early in the morning until late at night. They are places people can go for free, to spend quiet time, socialise or take part in activities. Few other sectors can rival the access culture and sport offers for health promotion.
Cultural and sporting activities can also engage even the most seldom heard groups. They can get deep into the communities of different ethnic groups, homeless people and disaffected teenagers, for example. Opportunities for health promotion can be linked to what communities and individuals are already interested in.
Young people involved in anti-social behaviour in North East Lincolnshire were unlikely to consider attending an NHS clinic or a specific health initiative. They were tested for sexually transmitted diseases in a screening programme that ran alongside football matches on their housing estate.
7. Tell local culture and sport providers what evidence you need from them
Nationally the culture and sport sector recognises that it needs to work harder to gather robust evidence of its contribution to better health and other outcomes. In recent years a number of tools have been developed to help.
The case studies show how well some culture and sport providers evaluate the impact of what they do. But they can still struggle to get their evidence recognised by service commissioners, particularly in the health sector. As one council manager interviewed for these case studies put it:
"It's like we're actually saying the same thing but in a different language, so neither party really understands what the other wants or needs."
It will help commissioners and delivery organisations alike if you:
- tell local culture and sport providers the evidence they need to collect
- agree a clear framework for evidence gathering
- advise on how to present evidence.
Health services can also help by monitoring the medium to long term impact of cultural and sporting activities on individuals in their care.
As the new public health partnership arrangements develop, councillors can play an important role by using this evidence to promote culture and sport as a contributor to local health priorities.
8. Think about how to open up services to a wider range of providers
Councils moving quickly to outsource services can risk opting for a small number of very large commissions that only attract major companies.
Culture and sport providers are often small, independent organisations or council services. Most are not resourced to deal with complex, protracted or overly bureaucratic procurement processes. They do not operate at a scale that means they can consider large commissions. Some may not even be on a commissioner's ‘radar' to be invited to tender in the first place.
Commissioning organisations have a role in shaping new markets in public service delivery by encouraging a wider range of providers – including from the culture and sport sector. For example, they can:
- make the commissioning process more accessible
- open up a dialogue with local culture and sport providers and encourage them to develop the skills, systems and attitude that will put them in a stronger position to win public sector contracts
- encourage consortia to develop between culture and sport providers – and between culture and sport and other sectors – to bid to deliver elements of larger commissions.
Commissioning organisations can also do more to join up their internal commissioning processes to take account of the outcomes culture and sport can deliver.
9. Be innovative
Using familiar approaches is safe but embracing different ones can pay off. New and productive relationships can be established by:
- working with a different sector
- putting resources into areas that do not seem to have an obvious connection with core work
- setting up new structures
- pooling resources to enable fully integrated partnership working
Using culture and sport is not just a viable option, it can be a better option. The councils and their partners that helped get the case study projects off the ground understood this. They also recognised that investment through culture and sport could deliver programmes that are both innovative and low risk.
Suffolk County Council routed Skills Funding Agency funding to the Museum of East Anglian Life for its work-based learning programme. The programme has succeeded in getting long-term unemployed people into work where other, more traditional, routes failed. Every £1 invested in the programme creates social value of £4.30.
Trafford Safer Partnership backed Trafford Community Leisure Centre's female participation project. Women and girls from different ethnic communities are now participating regularly in physical activity and interacting with each other. The project is expected to be self-financing in two years time.
North East Lincolnshire Council, Humberside Police and Grimsby Town Football Club pooled core budgets, external grants and staff to deliver Sport Lincs. This has proved a highly effective multi-agency response to overcoming challenging behaviour among young people through sport and arts activity. Humberside Police estimate that the project has achieved savings of tens of millions of pounds.
10. Use the motivational power of culture and sport
In times of diminished resources public services face increasingly difficult decisions. It can be tempting to focus on what must be done and to view culture and sport as something that would be nice to support in better times.
People participate in cultural and sporting activities because they want to, not because they have to. It is this enthusiasm to take part that enables the culture and sport sector to involve people in activities that benefit health.
Why else would young carers spend time in Brighton Museum and Art Gallery to work through their fears of transition on the only evening in the week they have to themselves? Why else would residents in Bristol take photos in parts of the city they had never seen before, helping strengthen their sense of identity? Or young offenders turn away from a life of crime to become football coaches?
It is precisely because people want to participate in culture and sport that the sector can engage people other sectors find hard to reach and can help tackle the social determinants of health so effectively.
13 August 2012