Physical activity has long been recognised as one of the most important determinants of outcome both in the prevention and treatment of disease and as a predictor of wellbeing. It has consistently been highlighted by the National Institute of Clinical Excellence as a core component of treatment pathways. Health care environments provide a unique and powerful opportunity to influence inactive patients to change behaviour in terms of physical activity.
Prevention should be at the heart of everything the NHS does. This has been emphasised in the NHS Long Term Plan  and in the Secretary of State’s Prevention Vision,  both of which stress the core role of the NHS in preventing disease and improving population health. The Long Term Plan highlights the importance of preventing disease as a route to better health and lower inequalities and to controlling demand management and maintaining sustainable finances.
On a local level, there are variable levels of service in this area. Recent scoping work across OUHFT and 2 other Trusts show:
- Some pathways have well established rehabilitation teams working in disease specific silos such as cardiac and respiratory teams.
- Some pathways are providing a level of intervention often through small pockets of dedicated professionals attempting to respond to NICE guidelines.
- Most pathways do not offer any consistent level of physical activity intervention. A common feature of interventions, where they exist, is that they are under-resourced. Interventions tend to be disease specific, rather than determined by the symptoms of disease, many of which are common to more than one condition. The nature and characteristics of interventions are disparate across pathways and outcomes are variably collected. It is therefore difficult to measure the impact of services.
Nationally, few health care professionals (HCP) discuss physical activity with their patients as a core component of their disease management.  Numerous studies have shown that HCP’s lack the skills and confidence to intervene on this agenda . There is, however, substantial evidence to support the use of behavioural change techniques in health care settings.
As an example, physical inactivity during hospitalisation is an independent predictor of negative outcomes. In older patients, typical of patients admitted to complex medical unit wards, it leads to longer stays, deterioration in quality of life  and deterioration in functional ADL’s Hospitalised patients currently spend over 80% of their time in bed and 12% in a chair. This published data resonates closely with data collected from CMU wards locally.
Patients exposed to mobilization during hospitalization show significant improvement in physical function, shorter hospital stays and fewer complications such as pulmonary embolism. They also have no greater risk of falling while in hospital. The Long Term Plan commits to reducing the delayed transfer of care figure to 4000, or fewer, delays over the next 5 years. As part of the package of care to achieve this, it suggests that therapy teams should be placed at the start of inpatient journeys.
In recognition of this problem, and of the priorities of the Long Term Plan, Public Health England have commissioned a programme of work across healthcare. This programme, the ‘Moving Health Professionals Forward programme’  (MHPF) is aimed at changing the consultation behaviour of all healthcare professionals in relation to physical activity – Making Every Contact count (MECC). As a key component of that programme of work they commissioned the ‘Active Hospital Pilot’ to test the feasibility, acceptability, sustainability and transferability of a consultant led, exercise medicine service following a defined model of delivery. This pilot has been independently tested and shown to be feasible, acceptable and transferable to other Trusts. More information on this can be found in this evaluation document
This new service will work across the Trust to support physical activity in all pathways. It will support and build on excellent work already happening in some pathways. It will support high risk pathways through standardising care in an evidence based way, through providing resources already developed to support physical activity change. It will work with inpatient pathways to ensure therapy intervention on admission, rather than waiting for discharge planning. It will provide a robust governance structure ensuring consistent data collection, clinical audit and quality improvement. It will provide an ongoing training programme to key staff to ensure they feel empowered to provide impactful support to encourage physical activity. It will work with pathways to ensure that physical activity is an integral part of all patient pathways both on admission, during hospital stay and on discharge to the community. It will create a collaborative network of professionals from across the Trust to learn from experiences and improve service delivery.
This service has the potential to deliver measurable impact on delayed transfer of care, inpatient falls and re-admission rates. Patient benefit though Trust level input on the social prescribing agenda, the integration and rationalisation of rehabilitation services, the identification of high risk and frail patients through physical activity levels and improved impact of re-enablement teams are all outcomes which can and should be realised.
Through this service we will raise the profile of physical activity as an integral and essential component of patient care and ultimately change the culture of OUHFT to a physical activity permissive environment. Through this service, OUHFT can, with confidence, state; ‘We are Active Hospitals’.
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