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Ben Allen

What Matters In Wellbeing – Engagement Vs Outcomes

By Community

Last week I attended the first International Conference for Social Prescribing at Salford University. Discussions there recognised the fundamental challenge of creating interest and motivation for people to start participating in physical activity and maintaining their participation in the long term. This difficulty is encapsulated in the idea of ‘behaviour change’, which has been a key phrase for many community health and exercise programmes over the past few years, alongside having a clear ‘theory of change’ that articulates the outcomes we expect a programme will create, and how. This is not an easy thing for organisations of any size to achieve.

While potential methods of driving behaviour change were discussed, there seemed to be an overwhelming emphasis on measuring it. This leads me to make a suggestion: we need to stop focusing so much on the outcomes. If people are being physically active and participating in socially inclusive and meaningful activities, there will be wellbeing and clinical benefits. Yes, this will vary from programme to programme and activity to activity but fundamentally, positive things tend to happen. What we haven’t cracked yet is the right design, implementation, promotion and sustainability of these programmes.

The shift needs to be away from the singular and reductionist question of ‘Do physical activity programmes work?’ to a more pragmatic and realist question: ‘What works, for whom, and under what circumstances?’

Initially this sounds like the outcome evaluation of exercise has become even more complex… and it has. Exercise is a complex intervention; it’s difficult to standardise. 11 people participating in the same game of football for 90 minutes will each have a unique experience and outcomes. The right outcome measurement tool for community services may capture a proportion of the true outcomes, but it will miss incredible, unique benefits. Like a person who was reunited with their best friend from 60 years ago during a bowls match. Or another with long-term mental health problems whose participation in an art class catalysed a shift from being in crisis to leading change in mental health care and becoming medication free.

Community health and wellbeing programmes work. It will always depend on individual circumstances, but fundamentally, they work. What we haven’t figured out is how to make them work operationally. The rhetoric behind ‘demonstrating the outcomes’ is often to reach the holy grail of a community health and wellbeing programme: being commissioned and paid for by the public purse. But the reality is that this isn’t being achieved on anywhere near a grand scale – even the largest charities with considerable budget and skills for evaluation struggle to achieve this.

I’m not suggesting we ignore outcomes. I’m proposing that we channel more focus on gaining knowledge to create a system of greater outputs (numbers of people who access and benefit from the activity, product or service). The people taking part in Oomph! sessions around the country are not doing it because they heard in a research study that exercise improves quality of life, and that strength and balance programmes reduce the risk of falls. They are taking part because it is fun. They will have outcomes – physical, mental, social, emotional, economic, personal. But to me the most powerful achievement is that people WANT to take part. They don’t drag themselves to sessions because they’ve been prescribed it as part of a 12-week programme; they turn up early, they have a brilliant time, and they look forward to the next one.

That’s behaviour change. That’s a system change creating a service that operationally works following a theory of change.

The question I ask myself daily is how can we make the services and offerings in the community as appealing as a cold pint and a burger? How do we make them so fun, rewarding and even naughty that people can’t help but take part? No GP practice or hospital was prescribing Pokémon Go, but 5.3 million people in the UK played it, with the average ‘Pokémon Trainer’ walking an extra 2,000 steps every time they played the same. Importantly, people with the lowest levels of activity walked an additional 3,000 more steps a day after playing the game.

We need to shift our focus from measuring outcomes to fostering engagement. By harnessing the same strategies that international conglomerates use to make that cold beer and burger so appealing and addictive, we can make radical behaviour change desirable. The activities that make up our health and wellbeing services will cease to be called health and wellbeing services: it will just be, ‘you’ve got to come and try this!’.


To find out more, please contact hello@oomph-wellness.org

Driving innovation in care

By Care Home, Community, Out and about

Hosted by the newly formed Department for Health and Social Care, Monday 19th March marked the final of the Care Innovation Challenge – a challenge created to bring young minds with new and innovative solutions to pre-defined sector challenges.

Only a few months ago we (Ben Wilkins, Ashish Goyal, Alex Ramamurthy and myself) launched the challenge for the care sector. We hosted 20 University students for a hackathon weekend in February, put six teams through to the Final and supported those teams with mentorship for the 4 weeks leading up to the final. The CIC Final was held at the Department of Health and Social Care and Hassan Zaidi’s Tumble Alert (http://tumblealert.com/) was chosen as the winner by our expert panel of judges (Avnish Goyal, David Brindle, Charlotte Bright, Vic Rayner, Martin Jones, Annie Webber MHA Annie Webber, and Albert Chong). Hassan has now secured funding from UnLtd to launch his business.

As a sector, social care has more employees and more beds than the NHS and provides the essential services and support to enable older adults in the UK to live independent, fulfilled and dignified lives but historically has struggled with the adoption of innovation. Often described as the valley of doom, the gap between ideation and market adoption is often just too big to bridge and many wonderful, life enhancing solutions never see the light of day. I hope that the Care Innovation Challenge will help bridge this gap.

I wouldn’t pretend that I’m a specialist researcher – or an expert, or a regulator – but, as a relatively layperson, I expect to see a seismic shift as residents (and family members) entering the sector will expect a whole lot more from social care, driving the sector to an entirely new place. In my short time in the sector I have seen a lot of change (not always good), I have seen luxury care home providers grow exponentially, whilst also seeing the direct results of funding cuts in services which are mainly local authority funded – the gap between the two is frightening.

Additionally there has been the launch of a multitude of different technology platforms promising to enhance care, reduce admin, care hours and costs. As the sector continues to develop, I foresee a convergence of the market with domiciliary care, day care, residential care and possibly sheltered housing becoming tightly integrated, often under one roof. I personally see this as one of the most exciting opportunities for disruptive change, ultimately leading to a person-centred approach, rather than a fragmented and disjointed experience.

I hope, like many in the care sector, the work we are doing at Oomph! helps to ensure that everyone (regardless of setting) enjoys a ‘full life for life’.

Ben Allen, CEO, Oomph! Wellness

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