Pivot to Active Wellbeing (PAW) – Robin Park Indoor Sports Centre (RPISC) 

Briefly describe the initiative/ project/service; please include your aims and objectives

Be Well (Wigan Council) has a vision to transform leisure assets from the traditional sport and leisure offer to wellness hubs which serve and become focal parts of the community, in a very different way to help tackle health inequalities across Wigan Borough. The desire to host NHS services enables Be Well to attract segments of the population that would not normally be active or access the Be Well services. We will collectively improve population health by supporting our health partners to utilise our facilities to increase the availability of clinics, out of hours appointments and take advantage of the premium location, thus allowing those we are targeting to become accustomed to accessing services with the leisure facilities. To maximise the benefit of increased footfall we are transforming and upskilling our workforce.

This application sets out the learning journey we have taken since 2021 and how this has resulted in the successes, we have seen at Robin Park Indoor Sports Centre in 2023. We will explain some of the decisions taken, by whom, and the impact they have had. In November 2021 senior leaders within Wigan Council and Wigan Borough Clinical Commission Group (CCG) agreed to test new approaches to increase engagement at Howe Bridge Leisure Centre (HBLC). Two theories of change were being considered: –

1. If we work with different stakeholders Then we will introduce new audiences to health & wellbeing opportunities and improve population health Because more people will get the support, they need to lead a happy, healthy life.

2. If more people understand the health and wellbeing offer, Then more people will visit their local leisure centre which will improve sustainability of the leisure industry Because we will be able to prove concept to enable future investment.

Since December 2021, a stakeholder group including Wigan Council and Voluntary Community, Faith & Social Enterprise (VCFSE) organisations formed to look at developing the Howe Bridge Leisure Centre (HBLC) facility in partnership with the Tyldesley, Atherton, Boothstown and Astley (TABA) Primary Care Network (PCN). HBLC was identified as having a significant amount of space that could be utilised to test and learn new approaches to attracting new customers. £10k was secured to pump prime opportunities within the current facility. In addition to leisure and health partners, the VCFSE sector became involved and several groups such as Carers Centre, Start Well Family Centre and Well Women CIC took up opportunities to deliver sessions on site. Whilst Community Link Workers were able to offer a drop-in service several medical opportunities came and went as the funding could not be secured to meet Clinical Quality Commission (CQC) standards. IT access for those needing access to patient records also stalled progress.

Learning 1: Stakeholders should focus on delivering services they can (non-clinical) with the space available to prove concept before investing large amounts of time/money in re-developing space.

Learning 2: Whilst all stakeholders contributed to the design of the programme and permission was granted to implement an action plan it was Be Well that ended up with sole responsibility for driving the opportunities forward. Permission needs to be given and acted upon equally.

In January 2023, a similar stakeholder group formed at Robin Park Indoor Sports Centre (RPISC). Whilst the stakeholder organisations were the same, the individuals within those organisations were different. At RPISC the opportunities were again developed as a collective but this time, Anne Humphreys, Quality Nurse Manager, Wigan Borough Federated Healthcare and member of Wigan North and Central Primary Care Network and Gary Highton, Be Well Manager were empowered to drive forward the implementation. With shared responsibility as lead stakeholders the outcomes and impact achieved by Anne and Gary were a stark contrast to what was initially possible at HBLC. Robin Park Leisure Centre has become a hub for both our Cardiac and Pulmonary Rehabilitation teams. We have aligned Be Well instructors to co-deliver with the clinical staff to provide an effective service for the residents of the borough. Both the Phase 3 (clinical team) and Phase 4 (Be Well) stages of cardiac rehab are delivered on a rolling programme within our studios. And the Pulmonary Rehab group is co-delivered by Be Well and Wrightington, Wigan & Leigh (WWL) NHS Foundation Trust staff in 6-week cohorts across the year.

In addition to key personnel RPISC afforded other recognisable advantages including: –
• A central location within the catchment of at least 5 GP surgeries
• Located next to a popular retail park and adjacent to DW Stadium (home to Wigan Warriors RLFC and Wigan Athletic FC).

Continuing to work towards proving or disproving our initial theories of change, the partnership took the learning from HBLC and as you will see below made things happen.

What are the key achievements?

The 1st meeting between Be Well Management Team and the Wigan North & Central PCNs took place on the 24th of January 2023. By the end of May, we had jointly run 3 health roadshows and with the evidence collected 4 Pivot Rooms had been created by the end of June enabling a wide range of (non-clincal) services to be run from the Centre. By the end of August, Pivot Rooms 2,3 and 4 were at 90% occupancy and funding had been secured to upgrade Pivot Room 1 to a clinical space that is CQC compliant. This clinical space will enable PCN teams, GP’s and other health professionals to host clinics at site with a range of services include infant and adult vaccinations, pre- and post-natal checks, full health screening and cervical screening (including targeting underrepresented patient groups such Learning Difficulties and LGBTQ+). Alongside the above a consultant was appointed to design a masterplan for the whole site with the plans presented in the Autumn.

The 3 health roadshows reached out to over 5000 patients and enabled the Wigan Central / North PCN to provide a blood pressure check to more than 500 patients who had not previously visited the GP in the previous two years. As a result, 41 patients are on a ‘watch list’ and from the 100 patients that attended on the 24th of May, four patients were identified to be in hypertensive crisis and one with arterial fibrillation. Essentially 5 lives saved!

The financial impact of this intervention on the local health system is £15,500 income (£30 per appointment for 512 appointments) for the Federation to re-invest in health improvement services. The number that failed to show up for their appointments was negligible meaning that the offer had a positive effect on missed appointment costs that also have an impact on GP surgeries.

In addition, the 512 appointments saved over 85 hours of GP surgery time (or 2 weeks, 1 ½ days of appointments based on 10minutes per appointment) enabling patients with more serious health conditions to get an appointment in a timelier manner. Our Cardiac and Pulmonary Rehab work clearly demonstrates the benefit of having a multi-disciplinary team on one site and how the skill set of the Be Well staff can be used effectively in the clinical system and provides constant interaction and feedback, without the need for unnecessary phone calls, emails and meetings. In 2023 we have had 565 attendances to our Cardiac Rehab classes and 403 to the Pulmonary Rehab class.

As the PAW approach grows, we are now offering pre chronic disease management including all stages for pre diabetic assessment in one location; Covid booster sessions, nasal flu sessions, Health and equalities team care coordinator sessions, and ride the rapids via the Learning Disabilities Team all via either drop in or appointment including evenings and weekends. Numerous patients and their loved ones are walking through our doors for the first time and are experiencing a different feel and warmth to our venues – a key goal for the PAW – and have been referred to other local support services, such as the carers network, Shared lives team, the Alzheimer’s association and our own Be Well activities such as nordic walking and walking football/netball.

Below are some of the messages and comments we have received:-
1. Anne, I just wanted to take the time to thank you for seeing me a couple of weeks ago at RPISC. I think it’s a wonderful initiative. I never make time for my health but you really inspired me to have a re-think. I appreciate your time and I wanted to thank you for listening to my woe’s. Thanks, Sarah F.
2. Anne, I really appreciated your help with my blood pressures at your event at RPISC. Thanks for making me go to hospital. You did scare me by saying how serious it was and that I was so young. I’ve started the tablets the doc gave me and I’m walking more to lose weight. James.
3. And from a patient who attended one of our late night follow up clinics… “Nurse Annie, I think you’re doing a smashing job with those blood pressure clinics. I’ve ignored the texts from the GP as you well know but being self-employed I could never close the shop”. Barrie is on medication and has been linked up with an Apprenticeship scheme to get help in his shop.
4. “I had severe heart failure. After a consultation with Carol, she enrolled me up for a six-week cardiac rehab course at RRISC, I loved it. The transition to the exercise classes was so easy as it was at the same time in the next room but I knew Carole’s door was always open to pop back for medical advice. I now do 2 classes a week, feel connected to my community again and have signed up as a volunteer to help others. I am so grateful!” Susan, Aged 61. 

How Innovative is your initiative?

Strategic Leaders in Wigan Borough were talking about ‘Pivot to Wellbeing’ before it was nationally recognised as a direction of travel for the sport and leisure sector and in particular the role that the physical activity sector must play in improving health outcomes. We know that momentum is gathering across the country in this area and that there are examples of multi-disciplinary stakeholders coming together to design solutions to challenges within population health. That said, others are building brand new facilities that include GPs, leisure provision, libraries and much more on the same site.

Wigan is different. We do not currently have the investment available to build new ‘fit for purpose’ facilities. We do, however, have some excellent community assets that sit within some of the most disadvantaged communities in the country with the capacity to be adapted to meet new priorities. This is supported by a forward-thinking workforce with delegated leadership that have permission to work in different ways. Much of our leisure stock, like other areas across the country, was built in the 1960s, 70s or 80s and is arguably not fit for purpose. Many of our sites, Robin Park being a prime example, have significant areas of under-utilized space that could be doing so much more to increase income and provide a significant benefit to the local community. As a recent winner of an APSE Award for Neighbourhood working for our initial work at HBLC, we have presented at a number of national workshops our work at both HBLC and RPISC and are aware that many local authorities are looking at the Be Well Team at Wigan Council to help them provide solutions for the long term viability of their aging leisure stock.

The things that we know are different include: –
• Modification of current assets – creation of new flexible and specialist spaces within leisure centres that are not just forphysical activity programmes
• We have proven concept to secure the capital investment required to create rooms that meet Clinical Quality Commission (CQC) standards within non-traditional settings
• Delegated leadership to key individuals working in target neighbourhoods
• Provision of a flexible space that can respond to demand within the health system, e.g. extended hours for GP appointments that enables more patients to be seen and pressure can be released on GP surgeries.
• A more flexible workforce that can connect patients to the support they need at the point they make the decision to make a lifestyle change.

Our customers have told us the following which helps to illustrate why we think our approach is innovative:-
• “at a really anxious time the whole process was simple, no referrals needed, no wait time between my rehab phases”
• “you could see that the Be Well and clinical teams worked together so well, which put me at ease”
• “loved how the transition was so easy and that I could still pop my head in to see the cardiac nurses at any time. No phone calls or appts needed”.
• “Accessing the leisure centre was never something I had ever thought about, but I felt so at ease”
• “its connected my with my community again and I am even a volunteer in the class now, helping others”

What are the key learning points?

We highlighted in the opening response some pre-learning that contributed to the design of the RPISC Pivot to Wellbeing approach. The key learning points specific to the RPISC work are set out below. These learnings are currently helping to re-design services across all Be Well Leisure assets including leisure centres, Outdoor Adventure and parks.

Strategic Learning
1. Stakeholder organisations need to be empowered by Senior Leaders to try something different.
2. Stakeholders need to identify specific individuals within their organisations and give them the resources to take action. Time is the single biggest factor in the success at RPISC.
3. Each individual has an equal part to play in delivering system change no matter what level they are within their own organisation.
a. Gary and Anne jointly led the initiative
b. Both provided the drive, determination and inspiration to make things happen at RPISC. The pace at which the Health Roadshows were introduced was rapid and connections to other services made easier through the success demonstrated.
c. In doing this they led from the front and motivated colleagues (including management) and wider stakeholders to implement the plan.
4. Be Well offers a range of health improvement services from children and adult weight management to falls prevention and managing long term health conditions. If a patient reaches a critical point in life where they have a light bulb moment in relation to managing their lifestyle then services that can help them need to be available to support them in that very moment. If a patient is added to a waiting list for support, then the opportunity to change someones life could be missed. Learning from the PAW has helped to re-design our staffing structure in relation to neighbourhood work. Our staffing model is now more flexible to be able to meet local demand where it is needed most and help to close some of the health inequalities that exist within the Borough.
5. Be Well is committed to professionalising and upskilling our workforce. We have been linking with leading fitness industry training provider Health and Fitness Education (HFE) to increase our instructor’s knowledge of obesity, diabetes and other conditions such as hypertension, arthritis and back pain. 30 staff have already completed or begun training programmes leading to industry recognised qualifications which are aligned with the Chartered Institute for the Management of Sport and Physical Activity (CIMSPA) Professional Standards. This adds to the large number of instructors who already hold these and other specialist qualifications increasing the resource to support people with health conditions and extra support needs.
6. Building confidence and trust in our sectors physical and virtual space for our residents.

External Conditions Learning
7. RPISC sits centrally within the Primary Care Network and therefore centrally within the cluster of GP surgeries meaning that c. 6000 patients were within catchment area of the leisure centre.
8. The venue needed to be somewhere that the patients/customers felt comfortable to attend. RPISC was used as a Covid vaccination centre for Wigan meaning many of the patients had a previous relationship with the Centre if they had not visited for physical activity reasons. The Centre is also a local / regional hub for events including cat shows, Comicon, model railway exhibitions and beer festivals for which patients may have a relationship with the building.
9. Relatively high footfall – RPISC is next to a popular retail park and adjacent to the DW Stadium – home of Wigan Warriors Rugby League Team and Wigan Athletic Football Team.

Operational Learning
10. Start by offering what is possible within the constraints of the current venue to prove concept prior to significant investment.
a. The first health checks too place in the café area, a second session again used the café and the reception area used to promote complimentary services that help health improvement including stalls provided by VSCE groups including Weight Management services, Carers Centre, Dementia Friends and Diabetes UK.
b. Footfall at those two initial events enabled a small investment into the creation of 5 Pivot Rooms that could be used initially for non-medical procedures such as blood pressure checks and mental health consultations.
c. The subsequent bookings and interest in 3 of the 4 pivot rooms resulted in Be Well securing significant capital investment to convert one of the Pivot Rooms into a space that meets Clinical Quality Commission (CQC) standards and means that health professionals can carry out medical procedures such as taking a blood sample.
11.The Leisure Centre is open from 7am until 10pm each weekday and at weekends. This extends the window for appointments currently available through GP surgeries. Health services have been offered during the daytime, in the evening and at weekends. 

Additional Comments

Each PCN has one leisure asset sitting within it, as well as multiple parks and open spaces. We continue to explore opportunities and not just in the health system including a National diabetes prevention programme; Liver Screening; a +1 offer for staff from The Brick Homeless Charity and Barclays bank offer banking services. Our new pricing policy for rooms subsidises rates for the top 5 health conditions and we have secured a further £90k to help us understand needs of new customers.