The head of SLM’s Everyone Health talks to Kate Cracknell about the huge opportunity that lies in preventative healthcare – if you tick all the boxes and do it right

I think ‘leisure’ as a term underrates what operators provide,” says Annie Holden, head of Everyone Health, which was launched in early 2014 as a division of management contractor SLM. “It certainly underrates what SLM provides: it’s been in the business of health and wellbeing for many years.

“With the Health and Social Care Act of 2012, which opened things up for a range of providers to deliver community health services, SLM realised there was an opportunity to further grow and diversify its business in relation to public health. It was a natural extension to future-proof the business by creating Everyone Health to sit alongside its existing Everyone Active brand.”

Not only that, but the new business had a head-start: a receptive ear among the 37 local authorities with which SLM already had a relationship through its Everyone Active leisure centre brand. “Everyone Health is fortunate to operate under the wider umbrella of a very successful business with 27 years’ strong trading history, a huge national infrastructure and an existing relationship with local authority client officers,” confirms Holden.

Championing activity
Holden joined SLM in February 2014 with the specific brief to set up Everyone Health, bringing with her 15 years’ experience in the healthcare sector and having already set up Mytime Active.

Her background, though, was in teaching: “I started out as a PE teacher and have always championed physical activity. I worked first in secondary and then further education, where I taught physical education but also taught about fitness, exercise, special populations and chronic disease management through exercise.

“I became caught up with the politics of education though, and had an opportunity to get out and pursue the avenue of physical activity for cardiovascular health at a local council. I was then seconded to a European research programme focused on preventive cardiology. It took a very multi-disciplinary, lifestyle approach to managing risk, with physical activity as an integral component. I was responsible for the physical activity element of the study.

“It was a very successful trial and was published in The Lancet. That integrated model was subsequently rolled out into local communities with some great success stories. The project gave me an insight into the huge opportunities out there to apply academic rigour to local settings.”

All of which brought her to her current role – although she has yet more strings to her bow. She explains: “I also work for the BACPR – the British Association of Cardiac Prevention and Rehabilitation – and have done so for about 20 years. I qualified as an exercise instructor 18 years ago in the pilot course for working with cardiac patients, so I now course direct, assess and tutor. Although that’s more of a sideline for me, it nevertheless contributes to my day-to-day work.”

Single access approach
Holden is excited about the growth potential of Everyone Health. Although it’s yet to penetrate all 37 local authorities with which Everyone Active has a contract – its key contracts are in Cambridgeshire and Nottinghamshire, with smaller projects dotted around the country – as Holden explains: “People are living longer but with more chronic, long-term conditions, and the NHS is overly stretched when it comes to acute care and treatment. Prevention is therefore critical.”

She continues: “Prevention is at the heart of the Everyone Health offering. But crucially, it has to be scalable. That means providing integrated, holistic solutions that are very much client-centred and focused around local needs – accessible community services delivered to the right person at the right time in the right way.

“Key to that is a single access approach, which means the patient only has to tell their story once.

“Once a client or a patient is interested in our service, or referred into the service, we have a triage process: they’re assessed to determine what stage of behavioural change they’ve reached, to identify their needs and to decide which service or which expert colleague is best placed to support them through their period of change.

“That’s the principle behind the services we offer in Nottinghamshire and Cambridgeshire. It’s ultimately all about wrap-around care that embraces the full extent of someone’s needs, as opposed to the silo approach whereby an individual goes to one service here one day, and over there the next, resulting in a disjointed approach.”

Care where it’s needed
She continues: “A lot of our work is also underpinned by the need to address health inequalities. Even though specific solutions are required within Cambridgeshire and Nottinghamshire, we have to demonstrate a more intensive input into those socially deprived areas county-wide. We also have to encompass the wider determinants of health and provide solutions across the full life course.

“To deliver a solution that’s scalable and meets all these needs, firstly you need a robust model – underpinned by evidence, national recommendations and NICE guidance – that’s compliant with all the relevant policies, procedures, governance, clinical and quality assurance.

“Secondly, you have to provide robust data, and we report across the full mental, physical and psychological spectrum.

“We’re now being approached by a number of research bodies with a view to publishing data, as we’re getting good results. For example, of the 5,000-plus referrals and self-referrals into our programmes in the last year, 4,500 went on to take up our services. Just from a physical activity perspective, at the outset only 20 per cent were meeting activity guidelines; by the end of their respective programmes, that figure was more than 50 per cent.

“Thirdly, we have a highly expert workforce, guided by us as technical experts behind the scenes. All of our colleagues are experts in behaviour change – whether they’re a dietician, nutritionist, community-based health trainer or physical activity specialist – but we’re also able to bring on-board specialist expertise via partnerships. For example, in Cambridgeshire we work with specialist obesity teams at Addenbrookes Hospital. We have a physician on a Nottinghamshire programme, and a nurse specialist who we sub-contract from Derby Royal Hospital. We also work with a psychotherapy team. So we have a diverse clinical and healthcare practitioner team.

“Finally, the key is to maintain change for individuals, so we also signpost them towards activities and opportunities offered by local partners to maintain their new behaviours. From a physical activity perspective that might be a gym or it might be outdoor activities: a green gym, or perhaps walking or cycling. You have to adopt a menu approach for variety and choice.”

In practice that menu approach means, although Everyone Health will work with sister company Everyone Active where possible, it’s also fully open to working with other leisure providers. “In the end, we’re here for the good of the individual and the local community. We want to make sure people remain physically active. It doesn’t matter who the provider is – we have to work positively, collaboratively and in harmony,” confirms Holden.

A collaborative approach
Nevertheless, the relationship between Everyone Active and Everyone Health is increasingly reaping rewards. So if the launch of Everyone Health was a natural progression for SLM, not to mention complementary to its existing Everyone Active brand, why has the company been reluctant to overtly connect the two in public thus far?

“The decision to keep it separate was directed by us at Everyone Health as much as anything. In the health world, people are a bit disdainful of leisure delivering healthcare. The credibility of leisure is improving, and in its Level 3 and Level 4 qualified staff it actually has a very strong base, but there’s still a way to go in terms of providing the sort of evidence and data and rigour that the medical world will acknowledge. We were therefore very keen to develop our own identity first, separate from Everyone Active.

“We also had a lot of development to do – setting up the robust clinical and information governance procedures and quality control that I mentioned before. We wanted to get that properly established.

“But now, with the Health and Social Care Act firmly embedded – and simultaneously public health within local authorities – we’re finding authorities are approaching us for ideas on how to develop a joint offering.

“They want to know how Everyone Active’s offer can extend beyond leisure to meet the indicators within the public health outcomes framework, and that’s where Everyone Health comes in.

“One example: we’ve worked with Everyone Active in Fareham, training the staff to deliver NHS health checks. That’s a great example of Everyone Active extending its offer. It’s opening its doors, going out to the community and working collaboratively with public health to deliver a specific mandatory health service.

“We’re also supporting Everyone Active in a number of tenders at the moment, looking at how to add value to the leisure tender by providing other health opportunities or health services.

“Everyone Active has recognised that, in its centres, it’s dealing with the 20 per cent of the population who are currently physically active. It’s therefore looking to take its services out to where the 80 per cent are. In doing so, it will also create pathways to bring those people back into the leisure centre.

“In addition, it’s aiming to work with us to create more of a community hub around the leisure centres themselves. We’ll help them deliver more and more preventative healthcare services within the leisure centre space, bringing in more people who might eventually decide to get active while they’re there.”

A huge opportunity
Holden concludes: “Ultimately there’s a huge opportunity in preventative healthcare. There’s a real chance now to diversify and extend the offer, and these conversations are being started by local authorities and Everyone Active alike.

“Scalability, getting out into the community and diversifying to meet the needs of the local population – that’s the opportunity we have at the moment. And if, through initiatives such as CIMSPA’s drive to professionalise the sector, we can simultaneously raise the profile and credibility of the sector.... I’d love to see that day come.”