Cumbria Chief Executives Group: Carlisle Sands

The co-location of health and leisure services in Carlisle and roll out of an integrated service across the county.

View allOne Public Estate articles

The challenge

A significant programme of work around the theme of ‘Health and Communities’ is underway in Cumbria to move outpatient services off hospital sites and into communities to free up vital hospital space for acute care. This aligns with work to map care pathways for more integrated working between Cumbria’s leisure providers and their NHS counterparts, as some rehabilitation staff may have equivalent qualifications, skills, and experience.

Cumbria’s shared vision is to deliver a holistic approach to rehabilitation, using multi-disciplinary teams to deliver a seamless pathway of care for individuals, whilst enabling teams to work together in a fully integrated way – recognising that this approach requires all partners to work together to achieve the best outcome for the local community. This work is about moving services closer to home whilst also addressing some of Cumbria’s challenging health inequalities.

Integrated working with the NHS musculoskeletal (MSK) physiotherapy services in both the North and South of the county of Cumbria alongside leisure service providers and local authority owners is underway.

This approach is gaining traction at a national level, especially in response to the impact of COVID and the long-term implementation of socially distanced measures and safe working practices. It is clear just how crucial an integrated service model could be to address the long-term health impacts of COVID and relieve the pressure on NHS outpatient services.

The story

Cumbria joined One Public Estate (OPE) in 2017, led by Carlisle City Council, and received funding to develop a Services and Assets Delivery Plan that identified five key workstreams across Cumbria:

  1. Health and communities
  2. Public sector reform and efficiency
  3. Town and city centre regeneration
  4. Housing delivery
  5. Economic growth.

In 2018 the Cumbria Chief Executives Group was established as the governing body for the OPE Programme in Cumbria, embedding collaboration between central and local government departments and expanding engagement to include key local partners like the Riverside Housing Association and the Nuclear Decommissioning Authority.

The Health and Communities theme of work in Carlisle began with the co-location of NHS Musculoskeletal (MSK) physios at the Sands Centre in 2017.

This is an exciting and innovative programme of work that aligns with the NHS Confederation’s “Health is the New Wealth” and “The role of health and care on the local economy” initiatives that form part of their NHS Reset campaign.

Sands Leisure Centre

Orthopaedic patient referrals managed by the North Cumbria University Hospital Trust MSK physiotherapy service were relocated to the Sands Centre Carlisle to enable fire safety works to be carried out at the Cumberland Infirmary Carlisle (CIC).

The facilities at the Sands centre were due to be redeveloped by Carlisle City Council with plans to commence in spring/summer 2019 – the team took the opportunity to look to redevelop and relocate some of the current MSK services based in Carlisle which was provided by three separate services:

  1. Orthopaedic Outpatients (NCUHT) – relocated to the Sands Centre from CIC
  2. Core Physiotherapy Service – providing MSK services for GPs and self-referred patients (CPFT) – located at the Carleton clinic
  3. North Cumbria MSK Service (NCMS) – an intermediate MSK interface operating from both the above locations where any clinical space is available.

The new centre will include a dedicated suite of NHS treatment rooms to co-locate the three MSK physiotherapy services into one site.

Designer’s artwork of the new SANDS centre

Image 1: Designer’s artwork of the new SANDS centre

It also provides the chance to work innovatively with the current Leisure provider Greenwich Leisure Limited, a not-for-profit organisation, through the use of a shared gym space and working with them to provide an early patient pathway to access leisure centre and community-based activities.

The Sands Leisure Centre Development is set to be completed by autumn 2022.

Following on from this success, a Health & Leisure Round Table meeting was held with partners to explore scaling up the approach across the rest of Cumbria. A potential further three districts were identified as being ready and willing to develop. Lancashire and South Cumbria NHS team are already actively engaged in Kendal and work to move the MSK physiotherapy services into Kendal Leisure Centre was completed in January 2022.

The outcome

The Sands Centre project has freed up bed space at Acute Hospitals and combined disparate services under one roof. The co-location has resulted in a 50 per cent increase in capacity for MSK services locally.

Longer term savings for the wider healthcare economy are set to be realised as a result of positively impacting upon population health and wellbeing and reducing demand on NHS Community and Secondary Care services such as MSK Physiotherapy, Trauma and Orthopaedics and mental health services.


Providing MSK physiotherapy services in a leisure facility brings service users into an environment which promotes healthy lifestyle choices, improving individual self-management and reducing unnecessary demand on NHS services”

Andy Reilly – NHS Transformation Lead for MSK services for North Cumbria Integrated Care

Service user Olive holding her sponsorship poster by a treadmill

Image 2: Service user Olive

OPE funding for Health and Communities work is set to benefit people, place, and communities through:

  • Sharing physical space more effectively through the co-location of health and leisure creating community health and wellbeing hubs
  • Improving screening to ensure the right place, right person, right time
  • Encouraging self-efficacy, improved patient outcomes and community cohesion through a seamless transition of patients from NHS care to leisure activities
  • Releasing pressure on NHS outpatient services
  • Promoting health in the correct environment to sustain healthy behaviour change through physical activity (Sport England estimate an ROI of £3.91 for every £1 spent)
  • Living longer with a better quality of life - reduction on the impact of long-term conditions and healthy life expectancy
  • Building resilience in communities
  • Integration of systems and pathways, reducing delays in treatment
  • Creating new employment opportunities. Consideration of a Leisure Team career development pathway is underway
  • Improving accessibility and becoming more socially cohesive
  • Supporting economic growth and improved health and wellbeing through local collaboration.

The programme of work is set to deliver over £1 million in reduced running costs savings in the next 10 years, with agreements in place to co-locate in four out of the six districts in Cumbria.

Region: North West & West Midlands

Theme: Health and social care (in OPE) and Integrated Public Services