Wellbeing 2 programme evaluation. A final report to the Big Lottery Fund Louise Scott, Jenny Williams, Jenny Molyneux, James Whitley.

Transcription

1 Wellbeing 2 programme evaluation A final report to the Big Lottery Fund Louise Scott, Jenny Williams, Jenny Molyneux, James Whitley.

2 Contents Executive Summary... i 1.0 Introduction Setting the scene Aims of the evaluation Note on terminology Report summary Methodological statement Physical Activity Impact of the Wellbeing 2 programme on Physical Activity Assessment of the approach and influence of the Wellbeing 2 programme on Physical Activity Healthy Eating Impact of the Wellbeing 2 programme on Healthy Eating Assessment of the approach and influence of the Wellbeing 2 programme on Healthy Eating Mental Wellbeing Impact of the Wellbeing 2 programme on Mental Wellbeing Assessment of the approach and influence of the Wellbeing 2 programme on Mental Wellbeing Cross-cutting approaches and their value for money Holistic approaches Wider impacts on wellbeing and the community Cost benefit analysis Conclusions and recommendations Summary of key findings Recommendations Annex One: Big Lottery Fund Wellbeing 2 Portfolio summaries... A1 Annex Two: Local evaluation evidence... A4 Annex Three: Evaluation framework...a10

3 List of figures Figure 2.1 During the last 7 days, on how many days did you do vigorous physical activities? (Adults) Figure 2.2 In the last week, on how many days did you take part in activities that make you feel warmer, make your heart beat faster and make it difficult for you to carry on a conversation at the same time? (Young people) Figure 2.3 In the last week, on how many days did you take part in activities that make you feel warmer, make your heart beat faster but you can still carry on a conversation at the same time? (Young people) Figure 2.4 In the past month, on how many days have you done a total of 30 minutes or more of physical activity which was enough to raise your breathing rate? (Adults) Figure 2.5 Have you made changes to your level of physical activity as a result of being involved in this project? (Adults) Figure 2.6 Have you made changes to how much sport and exercise you do as a result of being involved in this project? (Young people) Figure 2.7 Percentage of people in England participating in at least 30 minutes of sport per week Figure 3.1 On average how many portions of fruit and vegetables do you eat a day? (Adults) Figure 3.2 On average how many portions of fruit and vegetables do you eat a day? (Young people) Figure 3.3 Eating and health; Which statement do you agree with most (Adults) Figure 3.4 Have you made changes to your eating habits as a result of being involved in this project? (Adults) Figure 3.5 Average (mean) consumption of "five-a-day" portions Figure 3.6 Sustainability through commercial partnerships Figure 4.1 Have you experienced changes in your mental wellbeing during your time participating in this project? (Adults) Figure 4.2 Have your thoughts and feelings changed as a result of being involved in this project? (Young people) Figure 4.3 Personal wellbeing in England , measured on a scale of Figure 4.4 Life satisfaction (England and Wellbeing programme participants) Figure 4.5 Feeling worthwhile (England and Wellbeing programme participants) Figure 4.6 Happiness (England and Wellbeing programme participants) Figure 4.7 Anxiety (England and Wellbeing programme participants)... 56

4 List of tables Table 1.1 Learning from the Wellbeing programme Table 1.2 Cost benefit analysis framework... 6 Table 2.1 Key messages... 9 Table 2.2 Average number of days in the previous week spent doing moderate and vigorous physical activity (young people) Table 2.3 For the following statement indicate on a scale of 1-7 the point that best describes your feelings around physical activity. (Adults) Table 2.4 How much do you like doing sport and exercise, things like running, riding your bike, dancing or taking part in sports? (Young people) Table 2.5 Change in the average number of days on which gentle, moderate and vigorous activity was undertaken (by those reportedly undertaking at least some activity of this type) Table 2.6 Change in the average number of days on which gentle, moderate and vigorous activity was undertaken (including inactive respondents) Table 2.7 Incorporating physical activity into participants lifestyles Table 2.8 Community cohesion promoted through physical activity Table 2.9 Systems change through developing volunteering skills Table 2.10 Influencing national and local policy makers Table 3.1 Key messages Table 3.2 In an average week, how often do you eat a meal that has been prepared and cooked from basic ingredients, either by yourself or someone else? (Adults) Table 3.3 In an average week, how often do you help a grown up cook a meal? (Young people) Table 3.4 Eating fruit and vegetables; Which statement do you agree with most? (Young people) Table 3.5 Peer-led healthy eating activities Table 3.6 Promoting behaviour change through healthy eating Table 3.7 Training staff and individuals to sustain activity Table 3.8 Raising food production and consumption standards in public settings Table 4.1 Key messages Table 4.2 Average ratings for personal wellbeing questions (scored on a scale of 0 to 10) (Adults). Green shading denotes positive change Table 4.3 Average ratings for personal wellbeing questions (scored on a scale from 0 to 10) (young people). Green shading denotes positive change. Red denotes negative change Table 4.4 Peer-led approaches: young people Table 4.5 Peer-led approaches: general public Table 4.6 Community approaches to support mental wellbeing Table 4.7 Beneficiary testimony: the impact of volunteering and physical activity on mental wellbeing Table 5.1 Integrating the Wellbeing themes... 70

5 Executive Summary Introduction Following the success of the Big Lottery Fund s first Wellbeing programme, which invested 160 million across England to encourage healthy lifestyles and improve wellbeing, an additional 40 million was made available to fund a second phase of the programme until July Grants were made to 14 portfolios with activity spread throughout England and reported grant expenditure ranged from 1.79 million to 3.77 million per portfolio 1. Ecorys was commissioned to deliver the evaluation and learning contract for this second Wellbeing programme in This is the final report of the evaluation and follows an interim report which was produced in late This work builds upon the evaluation of the first programme which was undertaken by CLES Consulting and the New Economics Foundation 2. The overall aim of the Wellbeing 2 programme was to continue to support communities to create healthier lifestyles and improve their wellbeing in three key areas: Physical activity children, adults and the wider community being more physically active and experiencing improved access to physical activities. Healthy eating children, adults and the wider community eating more healthily. Mental wellbeing children, adults and the wider community having improved mental wellbeing and greater social contact. Each portfolio was made up of individual projects covering one, two or all three of these outcome areas. Some portfolios also supported the Big Lottery Fund s England strategic themes, namely people with multiple and complex needs, young people, local food growing, older people and early intervention in pregnancy and first years. Key findings This section presents the key findings for each of the three themes in turn. 1 Portfolio summaries are provided in Annex One. 2 Big Lottery Fund National Wellbeing Evaluation. Final report prepared by CLES Consulting and new economics foundation, published June i

6 Theme 1: Physical activity Approaches that work Participant-led activities - participants design, plan and deliver activities. Taster sessions and residentials. Small grants so participants could buy small items of exercise equipment. Building physical activity into daily routines. Making physical activity enjoyable and fun, including competitions and community events. Training local people as volunteers to help deliver activities and sustain activities in the longer term. Additional support for participants with physical or learning disabilities, or poor mental health, to participate in physical activity. Sustaining outcomes Three months after participating in Wellbeing activities: The proportion of adults undertaking no vigorous activity decreased from 61% to 45%. The proportion of adults who wholly agreed that as well as being important for my health, physical activity is something I enjoy increased from 15% to 28%. The proportion of young people undertaking no moderate activity decreased from 36% to 21%. Theme 2: Healthy eating Approaches that work Giving participants ownership to design and deliver activities. Shorter courses for families and longer term courses to support skills development. Peer-led activities creating relevant content and imagery (apps etc.). Making healthy eating activities enjoyable and fun. Demonstrating healthy eating can be achieved on a budget. Providing clear, simple recipes that only use a few ingredients. Group activities that promote social interaction. Culturally appropriate activities. ii

7 We experimented with some of the recipes It introduced us to new spices and flavours that we hadn t used before. I definitely eat and enjoy fruit and vegetables more now, it s made me realise that is easier and cheaper to eat healthily (Participant). The lasting legacy is a group of young people with a passion for food (Club leader). The activity of cooking changed people s opinion of themselves. Activities like feeding other people can be life changing for people; they engender confidence and a sense of community, and they feel they are helping people (Delivery staff). Sustaining outcomes Three months after participating in Wellbeing activities: On average adults ate 3.6 fruit and vegetable portions a day, compared to 3.2 portions before becoming involved in the programme. The proportion of participating adults agreeing that eating is important for their health, and they were doing something about it, increased from 67% to 75%. 43% of adults reported that they had made positive changes to their eating habits as a result of being involved in the activities. The proportion of young people agreeing that they always like eating fruit and vegetables increased from 34% to 37%. Theme 3: Mental Wellbeing Approaches that work Transferring ownership and a sense of responsibility to participants. Training and supporting peer educators. Identifying leaders to continue the work in their schools and workplaces. Engaging people with lived experience of mental health problems to convey key messages and help reduce stigma. The activities whether they are physical activities, healthy eating or mental health have all got mental health outcomes which are positive (Portfolio lead). The portfolio has shown the impact of physical activity and healthy eating on mental wellbeing. A more holistic approach shows the three strands are equally important in contributing to overall wellbeing. This has been achieved through the delivery of joint activity (Portfolio lead). iii

8 Sustaining outcomes Three months after participating in Wellbeing activities: Reported levels of life satisfaction amongst adults increased from 6.2 to 7.0 (rated on a scale from 0 to 10; compared to a national average of 7.6). The proportion of adults feeling optimistic about the future, either often or all of the time increased from 41% to 51%. The proportion of adults stating they had been feeling useful often or all of the time increased from 40% to 53%. 54% of adults reported positive changes in their mental wellbeing. Approaches The Wellbeing 2 programme was under-pinned by a co-production approach which strengthened communities by investing in the skills development of local people; encouraging them to develop the confidence and drive to help design, deliver and sustain activities in the longer-term. Massively important in the success was working with a steering group of people from those communities (Community Engagement manger). We have seen huge benefits in volunteering and peer to peer mentoring across the whole portfolio. Most of the people that have engaged in the projects, regardless of what the project is about, have come for a social reason (Portfolio lead). Health outcomes are most successfully achieved through a community development approach by getting participants involved in the design of interventions. Allowing individuals to develop their social and personal wellbeing assets (confidence, self-esteem, motivation) leads to changes in health outcomes - you can t just jump in to get the health outcomes you need to do some groundwork. What is clear is that it is the approach and staff that are most important in achieving these outcomes rather than the specific type of project (Portfolio lead). iv

9 1.0 Introduction 1.1 Setting the scene Following the success of the Big Lottery Fund s first Wellbeing programme, which invested 160 million across England to encourage healthy lifestyles and improve wellbeing, an additional 40 million was made available to fund a second phase of the programme until July Grants were made to 14 portfolios with activity spread throughout England and reported grant expenditure ranged from 1.79 million to 3.77 million per portfolio 3. Ecorys was commissioned to deliver the evaluation and learning contract for this second Wellbeing programme in This is the final report of the evaluation and follows an interim report which was produced in late This work builds upon the evaluation of the first programme which was undertaken by CLES Consulting and the New Economics Foundation (NEF) 4. Table 1.1 Learning from the Wellbeing programme Key findings from the Wellbeing programme evaluation CLES Consulting and the Centre for Wellbeing at the New Economics Foundation (nef) evaluated the Big Lottery Fund s first Wellbeing Programme from The evaluation concluded that the Wellbeing programme had yielded a significant impact on all three strands of wellbeing: mental health, physical activity and healthy eating, in addition to improving participants social and personal wellbeing. CLES Consulting and nef also concluded that these improvements were sustained by participants in the longerterm. The evaluation of the Wellbeing programme from reported: Personal wellbeing: Mean life satisfaction rose from 6.5 at the beginning of the programme to 7.1 at the end of engagement. These improvements were largely sustained beyond engagement with the programme. The evaluation reported that participants often described feeling more confident and able to interact with others and take on new responsibilities after participation. Gaining new skills, either interpersonal skills or more vocational skills, was found to contribute to improvements in participants personal wellbeing and self-esteem. Social wellbeing: Significant improvements to social wellbeing were often sustained beyond the project as participants maintained their friendships and organised their own social activities. The evaluation concluded that the social aspect of an activity motivated participants to keep attending the sessions more than the activity itself Mental health: Around one in three people who reported symptoms of depression at the beginning of the programme no longer had symptoms of depression by the end of their participation. Significant reductions in stress and anxiety were commonly recorded three to six months after their engagement with the programme had ended. Participants described how having a routine, a purpose and increased social interaction helped them to feel happier, more energetic and generally better about themselves. Healthy eating: Large improvements in eating behaviour were evidenced amongst participants, with significant and lasting improvements for secondary school pupils and adults in all three components 3 Portfolio summaries are provided in Annex One. 4 Big Lottery Fund National Well-Being Evaluation (June 2013). CLES Consulting and New Economics Foundation. 5 Big Lottery Fund National Wellbeing Evaluation. Final report prepared by CLES Consulting and New Economics Foundation, published June v

10 Key findings from the Wellbeing programme evaluation of healthy eating (behaviour, enjoyment, and attitudes). Participants reported particularly enjoying activities that involved cooking and tasting new foods and cooking food that they had grown themselves. Physical activity: An overall increase in physical activity amongst adults and secondary school pupils was recorded. Significant increases in physical activity were identified for those aged 35 and over and for primary school children. The percentage of people who had a high level of physical activity increased from 27% at the beginning of the programme to 30% at the end of the programme, and increased further to 36% three to six months beyond engagement with the programme. Gentle exercise, such as walking groups and gardening, encouraged people with low confidence levels to become more active. The evaluation also reported strong connections between the different strands of wellbeing. The strongest correlation was found to be between improved personal wellbeing and improved mental health. Improved mental health and personal wellbeing were very important factors in enabling participants to make and sustain changes to their eating and exercise habits. Increased self-confidence was found to be central to improving all areas of an individual s wellbeing. The overall aim of the Wellbeing 2 programme was to continue to support communities to create healthier lifestyles and improve their wellbeing in three key areas: Physical activity children, adults and the wider community being more physically active and experiencing improved access to physical activities. Healthy eating children, adults and the wider community eating more healthily. Mental wellbeing children, adults and the wider community having improved mental wellbeing and greater social contact. Each portfolio was made up of individual projects covering one, two or all three of these outcome areas. Some portfolios also supported the Big Lottery Fund s England strategic themes, namely people with multiple and complex needs, young people, local food growing, older people and early intervention in pregnancy and first years. This final evaluation report reflects on both the quantitative and the qualitative evidence of the impacts of the Wellbeing 2 programme. The qualitative evidence has helped to highlight the building blocks for bringing about change, demonstrating the processes involved in setting up, delivering and sustaining successful activities. These activities, in turn, impact on participant behaviour by encouraging people to make changes to their lifestyles in terms of healthy eating, physical activity and mental wellbeing. These changes have been explored in quantitative terms using a participant survey. Details of the evaluation methodology are provided in Section 1.5 below. 2

11 1.1.1 Policy context The Big Lottery Fund commissioned the Wellbeing 2 programme following the end of the original Wellbeing programme in 2011, which had coincided with uncertainties in the commissioning landscape. The government had introduced a package of austerity measures in response to the recession which was followed by a comprehensive restructuring of the health sector. These uncertainties reduced the sources of funding available to sustain the activity of the original portfolios. Health and Wellbeing Boards were introduced under the Health and Social Care Act Heath and Wellbeing Boards came into effect on 1 April 2013 and were tasked with improving the health and wellbeing of people in their area, reducing health inequalities and promoting the integration of services. Health and Wellbeing Boards are responsible for producing Joint Strategic Needs Assessments (JSNAs), which identify the current and future health and social care needs of the local community, and feed into a Joint Health and Wellbeing Strategy (JHWS) setting out joint priorities for local commissioning. Local authority, Clinical Commissioning Group (CCG) and NHS England commissioning plans are then informed by these documents 67. Commissioning in the NHS in England is now managed locally, via the 211 CCGs (which involve local GP practices). CCGs commission all hospital activity and some community services. The majority of public health services, such as sexual health, are also commissioned locally by Public Health England and local authorities 8. Some health and social care budgets also moved from NHS budgets to local authority control. CCGs and local authorities now hold some of the NHS budget for delivering community health, mental health and learning disability services, rehabilitative care and social care services. The Wellbeing 2 programme was therefore commissioned to support the original Wellbeing portfolios to diversify and enhance their activities in order to meet community need and generate the evidence required to secure sustainability funding from the new commissioning structures. This report demonstrates a range of sustainability approaches achieved by portfolios funded through the Wellbeing 2 programme. Approaches include securing follow-on funding from a variety of external sources including local authority Public Health teams, CCGs, private sector investment, trusts and other charitable sources. The report also highlights the internal sustainability mechanisms developed by portfolio lead organisations and delivery partners, including enhancing core/ mainstream delivery, creating social enterprises and developing products with a commercial value. The report also highlights how portfolios supported the development of community-led models including asset-based approaches and volunteering mechanisms, designed to be self-sustaining with some central coordination, training and support from the host organisation. 6 Health and Wellbeing Boards (England) Standard Note: SN Last updated: 13 March Author: Sarah Heath, Social Policy Section, House of Commons Library. 7 HWBs do not themselves hold a budget and allocating funding for public health remains the responsibility of the local authority in line with its commissioning plan. Health and Wellbeing Boards (England) Standard Note: SN Last updated: 13 March Author: Sarah Heath, Social Policy Section, House of Commons Library. 8 Commissioning: What s the big deal? Produced by the Faculty of Medical Leadership and Management on behalf of the National Medical Director s Clinical Fellows

12 1.2 Aims of the evaluation The aims of the Wellbeing 2 programme evaluation and learning contract were to: Generate evidence about wellbeing impacts and cost-benefits to society. Promote lessons about why some wellbeing interventions are more or less successful than others, for whom and in what circumstances. Provide virtual and events-based learning opportunities to a) improve practice and b) deepen understanding about good practice amongst stakeholders seeking to achieve wellbeing outcomes in society. Support portfolios to design strong communications strategies which will use their evidence to promote sustainability of their interventions and influence future wellbeing provision. 1.3 Note on terminology We have used the following terminology throughout the report: Programme this is the collective term for the different activities undertaken under the Wellbeing 2 funding stream. Portfolio refers to the overall management and coordination of a group of projects operating in a particular area or theme. Wellbeing 2 programme funding was awarded to 14 portfolios. Projects the level at which activity is delivered to participants. Each portfolio consisted of a number of projects, ranging from three to Report summary This report explores each of the three programme themes (physical activity, healthy eating and mental wellbeing) in turn, bringing together both quantitative and qualitative evidence of impact and presenting examples of the approaches and activity delivered. This is followed by an analysis of wider impacts, including cross-cutting approaches and systems change, the influence of project settings, and value for money. Conclusions and recommendations are provided to support future programme design. 1.5 Methodological statement This report is based on findings from a number of evaluation activities which are described in further detail below. The evaluation framework is set out in Annex One Portfolio scoping visits An initial round of scoping visits took place with the portfolio leads to explore the intended focus of activities to be funded through the Wellbeing 2 programme Participant survey A survey was designed to measure changes brought about by the activities funded by the Wellbeing 2 programme. The survey collected data at three key points: the start of the intervention (T1), the end of the intervention (T2), and approximately three months after completing the activity (T3). Each portfolio selected a minimum of two projects to participate in the Wellbeing 2 programme survey. Projects were selected from across the programme to ensure coverage of the three programme themes. Two versions of the survey were designed; one for use with adults and one with children aged 8-14 years. 4

13 The survey analysis presented in this report is focused on the sub-set of responses from participants who completed the questionnaire at all three stages. The use of this matched data allows for comparison of outcomes in a specific cohort of individuals at different stages of involvement, rather than the comparison of different (albeit overlapping) groups which is provided by the unmatched survey data Survey limitations Twelve of the 14 portfolios were able to take part in the programme-level evaluation survey and just under 1,000 completed T1 surveys (adults and children) were received, declining to approximately 560 at T2 and 360 at T3. However, further investigation revealed that the number of individuals who had completed all three surveys was 166 adults (representing four portfolios) and 62 children (representing one portfolio) 9. Although a decline in the number of responses at each stage is to be expected (for example, given the potential for individuals to drop out or lose contact with the project over time), the low matching rate is disappointing and the contribution of only a minority of portfolios to the matched sample means that the results of the survey analysis should be treated with some caution. Reference to the unmatched data has been provided to give a wider comparison of trends. The survey analysis provides details of reported changes in a number of key outcomes. However, it is recognised that participation in the Wellbeing programme is just one of a multitude of factors which could have influenced the behaviour of survey respondents. In an attempt to assess additionality, respondents were asked to report the extent to which they thought that the programme was responsible for any changes which took place. It is recognised that stronger evaluation designs for estimating the counterfactual do exist but it was not possible to implement a more robust approach within the context of this study. The survey for young people was designed for those aged Participants aged 16 and over were asked to complete the adult survey, including the young people who took part in the Foyer Federation s Healthy Conversations portfolio Case study research Case study research took place throughout the evaluation to explore process and impact and also to inform the development of good practice guides and policy documents. In particular, qualitative research has been undertaken with every portfolio in the final phase of the evaluation in order to collect information on topics such as successful delivery approaches, communications activity, making links with commissioners, sustainability planning and lessons learnt. The evaluation team has also produced a series of video case studies which are available to view online: Enable East This Enable East film focuses on their work around influencing and developing strategic links with commissioners, and includes interviews with the portfolio lead, a Harvard Professor on change management, a local commissioner and delivery partners (local project leads). Well London The Well London video focuses on their work with hard to reach groups in Woolwich Dockyard and includes interviews with the project coordinator, the local authority Public Health team, volunteers, and some project participants. 9 The Soil Association was the only portfolio that provided matched data from the three surveys (T1, T2, T3) for children. 5

14 Altogether Better The Altogether Better case study video explains the role of the Practice Health Champions; volunteers who work in GP Surgeries and the local community helping to reduce pressure on GP appointments by promoting preventative health and healthy lifestyle activities. Food for Life Partnership The Soil Association case study video focuses on improving healthy eating in schools and hospitals in Yorkshire. Activities include training for school cooks and hospital chefs and working with school and hospital managers to improve standards. Time to Change (forthcoming) The Mind video will focus on 300 Voices, a project working with African and Caribbean men in Birmingham to tackle mental health stigma. Mind is working with the Police, local NHS Trust and Local Authority on this project. This report also draws on case study evidence collated by the portfolios themselves through their selfevaluation and other local evaluation activities Meta evaluation The meta evaluation involved a systematic review of the available portfolio (and project) level evaluation outputs and monitoring reports prepared for the Big Lottery Fund. This review highlighted that a diverse range of approaches and methods had been used in the local evaluations. The Big Lottery Fund required portfolios to produce local evaluation reports to answer specific research questions set by each of the individual portfolios. The local evaluation reports therefore sat outside of the national programme evaluation, but were reviewed to provide information on context and achievements. At the time of drafting this report, local evaluation outputs were not available or still in draft form from four of the portfolios Comparative data analysis A review of available national datasets relating to the three programme themes of healthy eating, physical activity and mental wellbeing was undertaken in order to provide some benchmarking of the survey findings Cost benefit analysis Cost benefit analysis is a systematic approach to assessing the impact of an intervention and how that compares to the costs involved in terms of a benefit cost ratio or return on investment. The framework for this analysis is set out below. Table 1.2 Cost benefit analysis framework Cost Measurement Valuation Financial cost of programme (funding to portfolios and administration costs) Non-financial costs of programme 10 Amount of Big Lottery funding provided to programme (broken down by portfolio and project), as well as any other funding Non-financial inputs such as volunteer time or free use of premises Provided by projects/ the programme in monetary terms Proxy wage rates or rents to value these inputs 10 It was not possible to quantify non-financial or wider costs of the Wellbeing programme (see Section 5.3). 6

15 Cost Measurement Valuation Wider costs Improved health and wellbeing outcomes due to increased physical activity Improved health and wellbeing outcomes due to increased healthy eating Improved mental wellbeing Other costs generated by the programme, including any costs incurred by participants, or costs incurred through greater take-up of followon services Increase in physical activity (number of 30 minute physical activity sessions undertaken), as measured from the survey Increase in the number of portions of fruit and vegetables consumed per day, as measured from the survey Increase in the average wellbeing scores (based on the short Warwick-Edinburgh Mental Well Being Scale or ONS personal wellbeing questions ) as measured by the survey Considered on a case-bycase basis where relevant Value of the number of quality adjusted life years (QALYs) gained by participants Value of the number of disability adjusted life years (DALYs) gained by participants No suitable valuation could be found Information on costs and participant numbers was sourced from portfolio reporting. Information on benefits was provided by the survey and combined with evidence from the research literature to provide an estimate of the value in monetary terms (where possible) Lessons for evaluation design The process of undertaking the evaluation has generated a number of lessons for future evaluation design which are summarised below: Portfolio (or project) versus programme level evaluation grant recipients should be given clear guidance on the Big Lottery Fund s expectations for evaluation, including the degree of participation expected in the programme evaluation and the extent to which portfolio/ project-level work should be designed to complement the programme evaluation framework. Where possible a commonality of approach should be mandated and local evaluations should compliment the broader programmatic evaluation. Use of surveys for data collection participant surveys are important as a means of demonstrating impact across the programme. Initially the evaluation had defined periods for completion of T1, T2 and T3 surveys but this was replaced by a rolling programme of survey distribution in order to accommodate the differing timeframes of the funded activity. It is essential that grant recipients commit to participation in the survey at an early stage in order to maximise the likelihood that response targets are met. Incentives could be used to encourage commitment to the process. Survey response targets should also form part of the contracted deliverables as appropriate (including guidelines for the expected level of completion, for example by 10% of participants). Communication in this case, particular problems seem to have occurred as a result of the portfolio nature of the programme which meant that portfolio teams were essentially managing the survey administration process across a number of projects. Were this approach to be repeated it would be preferable for the evaluation team to have direct contact with those projects distributing the surveys in order to ensure that this is being done in accordance with the instructions and to allow more careful monitoring of returns. 7

16 Scheduling of portfolio and programme evaluation outputs portfolio/project evaluation outputs need to be produced and signed off in an agreed contractual timeframe to feed into the programme evaluation. 8

17 2.0 Physical Activity 2.1 Impact of the Wellbeing 2 programme on Physical Activity This chapter explores the impact of the Wellbeing 2 programme on the physical activity theme. Key messages are identified below. This is followed by presentation and discussion of survey findings then a detailed examination of how the impacts were brought about in relation to several key areas: engaging hard-to reach groups, sustainability, and communicating with commissioners and policy stakeholders. Table 2.1 Key messages Key delivery messages from the case studies: what works Participant-led activities which give participants the opportunity to design, plan and deliver activities and take part in physical activity challenges in a supportive environment. Encouraging people to participate in taster sessions and residentials. Small grants which enable participants to buy small items of equipment to support their exercise programme. Building physical activity into the daily routines of participants. Making physical activity enjoyable and fun. Training local people as volunteers to help deliver activities and sustain activities in the longer term. Additional support is required by some hard-to-reach group, particularly those with physical or learning disabilities, or poor mental health, to participate in physical activity Behaviour change amongst participants The survey findings presented below demonstrate how participant behaviours changed during and after their involvement in the Wellbeing 2 programme. It is important to note that whilst this behaviour change may have been brought about by participating in the programme, the impacts should be viewed with caution as they could also have been brought about by external factors outside the scope of this evaluation. The interim report outlined the impact of the intervention based on the surveys undertaken at the start of the intervention (T1) and those undertaken at the end of the intervention (T2). This report also includes analysis of the follow up surveys undertaken three months after a participant s last involvement with the activity (T3). The analysis has focused on those individuals who responded to all three surveys (referred to as the matched dataset), these results have been reviewed to see what they can tell us about the changes occurring over the course of participation in the programme, and the degree to which any reported changes in behaviour have been sustained. Unless stated otherwise, the analysis that follows reports on this matched data set. Key findings relating to physical activity are outlined in the following box. 9

18 Impacts on physical activity Adults The proportion of participating adults undertaking no vigorous activity decreased by 16 percentage points between T1 and T3 (from 61% to 45%). The proportion of participating adults undertaking no moderate activity fell by over 10 percentage points between T 1 and T2 (from 35% to 25%) then decreased by another 4 percentage points between T2 and T3 (from 25% to 21%). Of those undertaking vigorous activity, the average number of days across which participants reported having done vigorous physical activity (in the previous week) decreased between T1 (3.4 days) and T2 (3.3 days) then increased between T2 and T3 (to 3.6 days). Of those reporting having done moderate physical activity, the average number of days across which participants undertook this in the previous week increased between T1 and T2 from 3.6 days to 4.2 days, then remained stable between T2 and T3 (4.2 days). The proportion of adults reporting having done no walking for exercise, over and above their normal routine, in the preceding week decreased across the survey period from 12% (T1) to 9.6% (T2) to 6.6% (T3). Of those adults reporting to have undertaken gentle physical activity in the previous week, the survey suggests that respondents undertook at least 10 minutes of walking on 5.1 days a week on average at T1, which increased to 5.3 days on average at T2 and T3. Overall, the matched data does suggest an increase in physical activity amongst adult participants, although the level of impact is more notable for moderate activity. The proportion of adults who wholly agreed that as well as being important for my health, physical activity is something I enjoy increased by over 12 percentage points between T1 and T3 (from 15% at T1 to 16% at T2 to 28% at T3) suggesting that attitudes around physical activity had shifted somewhat during the survey period. Young People As with adults, the survey indicates an increase in gentle, modest and vigorous physical activity levels amongst participating children, with the most marked increase applying to moderate activity levels. Of those reporting having done some degree of vigorous activity, there was an increase in the average number of days on which this was undertaken by young people between T1 and T3, from 4.5 days (at T1 and T2) to 4.7 (at T3). Similarly, moderate activity levels can be seen to have increased amongst young people by 0.9 days on average between T1 and T3 while the data suggests that gentle exercise was undertaken on an average of 4.5 days a week at T1, increasing to 4.8 at T2 and 4.7 at T3. The survey highlighted a mixed picture around how young people s views on sport and exercise had changed over the course of participation. Young people and adults Moderate physical activity levels appear to have been more impacted by participation than vigorous activity levels amongst both young people and adults. Young people s moderate activity levels appear to have increased to a greater extent than for adults (by 0.9 days on average between T1 and T3 compared to 0.6 average days amongst adults). 10

19 Percentage of adults Vigorous physical activity The proportion of participating adults undertaking no vigorous activity decreased by 16 percentage points between T1 and T3 suggesting that participants have been encouraged to take up physical activity at this level. When the whole sample of participants is reviewed (including those reporting not having done any vigorous activity), the average number of days on which participants reported having done vigorous activity showed a consistent increase between T1 (1.3 days), T2 (1.7 days) and T3 (2 days). Of those undertaking some vigorous activity, the average number of days across which participants reported having done vigorous physical activity in the previous week actually decreased between T1 (3.4 days) and T2 (3.3 days), then increased between T2 and T3 (to 3.6 days). Figure 2.1 During the last 7 days, on how many days did you do vigorous physical activities? (Adults). 70% 60% 61% 50% 48% 45% 40% 30% T1 T2 T3 20% 10% 0% 13% 16% 12% 8% 9% 9% 9% 9% 7% 9% 4% 6% 7% 6% 6% 3% 4% 3% 1% 2% Number of days 5% Base: 160 (T1), 144 (T2), 128 (T3). Matched data. The young people s survey data also showed a positive change in the average level of vigorous physical activity between T1 and T3, with this increasing from 4.5 (at T1 and T2) to 4.7 (at T3). 11

20 Percentage of young people Figure 2.2 In the last week, on how many days did you take part in activities that make you feel warmer, make your heart beat faster and make it difficult for you to carry on a conversation at the same time? (Young people). 25% 20% 21.0% 23.3% 22.6% 21.7% 21.3% 15% 18.0% 16.1% 17.7% 16.4% 15.0% 14.8% 10% 10.0% 8.3% 8.2% 11.7% 9.7% 11.5% T1 T2 T3 5% 5.0% 4.9% 4.9% 4.8% 1.6% 3.2% 5.0% 3.2% 0% 0.0% Don't know Number of days Base: 60 (T1), 62 (T2), 61 (T3). Matched data. Moderate physical activity The survey data suggests that levels of inactivity amongst participating adults at this level decreased as the proportion of those undertaking no moderate activity fell by over 10 percentage points between T1 and T2 (from 35.5% to 24.7%) then decreased by another 4 percentage points between T2 and T3 (from 24.7% to 20.5%). Looking at the whole set of respondents (that is including those that reporting having done no moderate physical activity), participants were seen to have increased moderate activity levels from 2.1 days a week (T1) to 2.9 (T2) and then 3.1 days (T3). Of those reporting having undertaken some moderate physical activity, the average number of days across which participants did this in the previous week increased between T1 and T2 from 3.6 days to 4.2 days on average, then remained at this level between T2 and T3 (at 4.2 days). The survey data also suggests that levels of moderate physical activity amongst participating young people have increased over time. Young people can be seen to have undertaken moderate physical activity on an average of 3.7 days at T1, increasing to 4.2 at T2 and 4.6 at T3. These results indicate that the impact in terms of increased uptake of moderate physical activity has been more than sustained, increasing by 0.4 days on average beyond the close of the project. 12

21 Percentage of young people Figure 2.3 In the last week, on how many days did you take part in activities that make you feel warmer, make your heart beat faster but you can still carry on a conversation at the same time? (Young people). 35% 30% 29.0% 25% 21.0% 21.0% 20% 15% 10% 5% 17.7% 17.7% 16.1% 16.1% 14.5% 12.9% 12.9% 11.3% 11.3% 11.3% 9.7% 8.1% 8.1% 8.1% 8.1% 8.1% 6.5% 6.5% 1.6% 9.7% 8.1% 4.8% T1 T2 T3 0% Never Don t know Number of days Base: 62 (T1), 62 (T2), 62 (T3). Matched data As with adults, the average increase in moderate activity levels exceeds that of vigorous activity for young people over time. Table 2.2 Average number of days in the previous week spent doing moderate and vigorous physical activity (young people). On how many days across the previous week did you take part in: Young people T1 Young people T2 Young people T3 Moderate physical activity * Vigorous physical activity Base: T1 (62), T2 (62), T3 (62). Matched. * The mean score at this stage was statistically different to that at T1 (p<0.05) 13

22 Percentage of adults Gentle exercise The proportion of adults reporting having done no walking for exercise above their normal day to day routine, within the preceding week decreased over the survey period from 12% (T1) to 9.6% (T2) to 6.6% (T3). This suggests that participants did act to reduce inactivity levels during the time they were involved with a wellbeing project and that these impacts were sustained, and indeed increased beyond the life of the project activity itself. Across the entire matched sample (including those who reported doing no exercise of this type), the survey results show that respondents undertook at least 10 minutes of walking on 4.3 days a week on average at T1, which increased to 4.6 days on average at T2 and 4.9 at T3. When looking only at those who reported doing gentle exercise on at least one day, the average number of days increased from 5.1 at T1 to 5.3 at both T2 and T3. Whilst only a modest impact is suggested here, there is again an indication that the positive impact seen between T1 and T2 appears also to have been sustained beyond the project itself. The proportion of participating adults undertaking physical activity enough to raise their breathing rate on one or more days across the past month increased by 14.4 percentage points between T1 and T3. Whilst only a small increase can be seen to have taken place between T1 and T2 (1.8 percentage points), there was a considerable overall increase between T2 and T3 of 12.6 percentage points. This suggests that the main change amongst participants in this area has been realised after project participation ceased. This perhaps indicates that participation stimulated a change in mindset around the importance of undertaking gentle physical activity, which impacted upon lifestyle decisions taken further along the line. Figure 2.4 In the past month, on how many days have you done a total of 30 minutes or more of physical activity which was enough to raise your breathing rate? (Adults). 30% 25% 24.1% 20% 17.5% 21.1% 16.9% 15% 10% 5% 12.7% 10.2% 10.2% 7.8% 7.2% 7.2% 5.4% 5.4% 2.4% 3.0% 3.0% 5.4% 7.8% 6.0% T1 T2 T3 0% 1 to 5 6 to to to to to 31 Number of days Base: 166 (T1) 166 (T3). Matched data. 14

23 Percentage of adults The young people s survey dataset also shows some positive signs of change, for example, the proportion of young people walking for at least 10 minutes on 6 occasions in the previous week increased from 6.5% at T1 to 9.7% at T2, and 17.7% at T3. The matched data suggests that gentle exercise was undertaken on an average of 4.5 days a week at T1, 4.8 at T2 and 4.7 at T3, therefore showing a similar change to that reported by adults. Changes in physical activity The survey data suggests that the programme has had a positive impact on the levels of physical activity as reported by participants. At T2, one third (33%) of participating adults reported that they had made changes to their level of physical activity as a result of being involved in the project. However, at T3 stage, this had increased to 42.8%, which highlights that not only was there an impact during the time that respondents were taking part in the projects but that this had continued to increase beyond this period. Figure 2.5 Have you made changes to your level of physical activity as a result of being involved in this project? (Adults). 60% 54.2% 50% 40% 42.8% 45.8% 33.1% 30% 20% T2 T3 10% 8.4% 7.8% 0% Yes No Don t know Response Base: 159 (T2), 160 (T3). Matched data. In terms of attributing this change to actual project participation, the matched data indicates that the majority of adults at T2 (60%) felt that they definitely or probably would not have made the same changes to their physical activity had they not participated. At T3, this increased to 66% suggests that participants still regard the project as having impacted upon their physical activity levels even after participation. 15

24 Percentage of young people For young people at T2, unmatched data 11 indicates that just over half (51%) of young people felt that they had made changes to how much sport and exercise they did as a result of involvement in the programme. One-third (34%) felt that they had not made changes as a result of participation whilst 15% indicated that they were unsure or did not know whether the project had made an impact in this area. There was a low response rate for this particular question at T3 stage and so this data has been omitted from the analysis and figure below. Figure 2.6 Have you made changes to how much sport and exercise you do as a result of being involved in this project? (Young people). 40% 35% 30% 30% 34% 25% 20% 15% 10% 21% 15% T2 5% 0% Yes a lot Yes a bit No Don t know Response Base: 47 (T2). Unmatched data. Views on physical activity The survey revealed a positive change in terms of the views of participating adults on physical activity. The proportion of adults who wholly agreed that as well as being important for my health, physical activity is something I enjoy increased by 12.6 percentage points between T1 and T3 (from 15.1% at T1 to 16.3% at T2 to 27.7% at T3) suggesting that attitudes towards physical activity had shifted somewhat over time. 11 The portfolio which contributed the matched dataset excluded this question from the survey which was distributed to participants therefore no matched data is available. 16

25 Table 2.3 For the following statement indicate on a scale of 1-7 the point that best describes your feelings around physical activity. 12 (Adults). Adults T1 Adults T2 Adults T3 Percentage point change (T1-T2) Percentage point change (T1-T3) 1 6.6% 5.4% 4.8% % 3.6% 3.0% % 10.8% 6.6% % 19.9% 14.5% % 24.7% 25.3% % 15.1% 12.0% % 16.3% 27.7% Base: T1 (164), T2 (159), T3 (156).Matched data. The proportion of young people rating 7 out of 7 in response to the question how much do you like doing sport and exercise, things like running, riding your bike, dancing or taking part in sports? increased by 3.2 percentage points between T1 and T2 and 8 percentage points between T1 and T3. Table 2.4 How much do you like doing sport and exercise, things like running, riding your bike, dancing or taking part in sports? (Young people). Young people T1 Young people T2 Young people T3 Percentage point change (T1-T2) Percentage point change (T1-T3) 1 1.6% 1.6% 1.6% % 0% 3.2% % 3.2% 0% % 1.6% 4.8% % 14.5% 12.9% % 19.4% 12.9% a lot 56.5% 59.7% 64.5% Base: T1 (62), T2 (62), T3 (62). Matched data. Summary Overall, the survey data suggests a positive direction of travel in levels of physical activity amongst respondents. Moderate activity levels can be seen to have increased more than vigorous or gentle exercise levels amongst both young people and adults, but young people in particular. These modest changes in the uptake of physical activity appear to have been sustained amongst participating adults, whilst levels of moderate and physical activity amongst young people have also increased beyond the close of project activity. 12 Where 1 = I wish I didn t have to do physical activity but I know it s important for my health and 7 = as well as being important for my health, physical activity is something I enjoy. 17

26 Table 2.5 Change in the average number of days on which gentle, moderate and vigorous activity was undertaken (by those reportedly undertaking at least some activity of this type). Type of physical activity Adults T1 Adults T2 Adults T3 Change in average days on which activity was undertaken (in previous week). T1-T2 T1-T3 Gentle Moderate Vigorous Young people T1 Young people T2 Young people T3 Change in average days on which activity was undertaken (in previous week). T1-T2 T1-T3 Gentle Moderate Vigorous Source: Adults (base: 166), Young people (62).Matched data. Table 2.6 Change in the average number of days on which gentle, moderate and vigorous activity was undertaken (including inactive respondents) Adults T1 Adults T2 Adults T3 Change in average days on which activity was undertaken (in previous week). T1-T2 T1-T3 Gentle Moderate Vigorous Young people T1 Young people T2 Young people T3 Change in average days on which activity was undertaken (in previous week). T1-T2 T1-T3 Gentle Moderate Vigorous Source: Adults (base: 166), Young people (62).Matched data. In general, the unmatched dataset revealed a similar pattern of increases in physical activity levels but with some differences in the level of change and the extent to which this was sustained or increased further at T3. 18

27 Selected findings from the unmatched data set Adults 13 Vigorous activity The unmatched data indicates that adults reported having done vigorous physical activity (in the previous week) on an average of 3.4 days a week at T1, compared to 3.8 at T2 and 3.6 at T3. This indicates a higher increase (by 0.5 days) between T1 and T2 than that seen in the matched data. However, the increase between T1 and T3 was the same in both datasets (0.2 days). Moderate physical activity The unmatched data indicates that moderate physical activity levels increased during the course of participation, before tailing off slightly following the close of the project. Participants reported that moderate physical activity was undertaken on an average of 3.8 days at T1, 4.3 days at T2 and 4.0 at T3. In comparison the matched data showed no change between T2 and T3. Gentle exercise The unmatched data shows a similar picture to the matched data concerning the impact on gentle exercise levels. Changes to physical activity The proportion of adult participants reporting having made changes to their level of physical activity at T2 was higher in the unmatched data (39% compared to 33% in the matched dataset) but lower at T3 (41% compared to 43%). The unmatched data shows a lesser degree of change than the matched in terms of the views of participating adults on physical activity. The proportion of adults who wholly agreed that as well as being important for my health, physical activity is something I enjoy increased by 4.7 percentage points between T1 and T3 from 20.4% to 28.7% (compared to the increase of 12.6 percentage points between T1 and T3 in the matched dataset). Young People 14 Vigorous physical activity Young people indicated that they took part in vigorous physical activity on an average of 4.5 (T1), 4.7 (T2) and 4.7 (T3) days a week. This varied from trend shown by the matched data which indicated that vigorous physical activity stayed the same between T1 and T2, but then increased at T3 (an average of 4.5 days at T1/ T2, increasing to 4.7 days at T3). Moderate physical activity Young people reported that they had undertaken moderate physical activity on an average of 4.1, 4.6 and 4.6 days a week respectively at T1, T2 and T3 based on analysis of the unmatched sample. This shows a higher baseline (T1) figure than the matched sample (3.7 days). The degree of change between T1 and T2 was the same in both samples (0.5 days); however, data from the matched sample showed a further increase at T3 (by 0.4 days) although reaching the same T3 figure of 4.6 days. Gentle exercise The proportion of young people walking for at least 10 minutes on 7 occasions in the previous week increased from 22.2% to 30% between T1 and T3. The results also indicate that gentle exercise was done on an average of 4.6 (T1), 5.0 (T2) and 4.9 (T3) days a week, indicating a slightly greater impact than that shown by the matched data (where the average increased from 4.5 at T1 to 4.8 at T2 and 4.7 at T3). Changes to physical activity On the whole, the unmatched data (matched data is not available for this question) indicated that young people had made changes to how much sport and exercise they did as a result of their involvement. This proportion increased from 46.2% at T2 to 60% at T3 (proportion responding either a bit or a lot ) (note the small base size at T3 for this question). 13 Base: T1=850, T2=423, T3= Base: T1=144, T2=139, T3=100 19

28 2.1.2 Comparative analysis The Sport England Active People Survey measures the proportion of the adult population in England that participates in sport, of at least moderate intensity, 15 for at least 30 minutes at least once a week. In 2014/15, 73% of young people aged met this threshold compared to 32% of adults aged 26 or above. Men have higher rates of participation than women and participation is also higher for higher socio-economic groups. The lowest rates of participation are recorded among those with a long term limiting illness or disability. Evidence from the survey of participants in the Wellbeing programme suggests that activity levels compare favourably to the national averages of participation. However, this comparison should be treated with caution due to differences in the definition of sport/physical activity used in the two surveys (with the broader definition used in the survey conducted as part of this evaluation likely to lead to a higher figure) and the extent to which the survey respondents are representative of the wider population of participants in the Wellbeing programme is unclear. Figure 2.7 Percentage of people in England participating in at least 30 minutes of sport per week Age 16+ Age Age Age 26+ Disabled Not disabled Male Female BME White British Higher socio-economic groups Lower socio-economic groups Wellbeing participants at T1 Wellbeing participants at T2 Wellbeing participants at T3 17% 36% 32% 39% 41% 31% 38% 35% 39% 26% 51% 55% 57% 65% 73% 0% 10% 20% 30% 40% 50% 60% 70% 80% Source: Active People Survey (April 2014-March 2015), Wellbeing programme surveys. Results by disability, gender, ethnicity and socio-economic group are for people aged 16+ only The evaluation of the first Wellbeing programme found that there had been an overall increase in physical activity amongst adults and secondary school pupils between entry (T1) and exit (T2). There was also a significant decrease in sedentary activity and an increase in the proportion reporting enjoyment of physical activity. The evaluation also showed that some of the increases in physical activity were 15 At least moderate physical activity includes all moderate and high intensity physical activities. This includes a wide range of sports such as running, golf, swimming, team sports, racket sports, gymnastics, boxing, climbing and mountaineering, winter sports, archery, gym, and fitness activities or classes. It also includes moderate intensity participation in bowls and croquet and all recreational cycling. It does not include recreational walking but does include more strenuous walking activities, such as hill trekking, cliff walking, gorge walking and power walking. More information is available here: 20

29 sustained three to six months beyond engagement with the programme (T3). The direction of change is consistent with the findings of the Wellbeing 2 survey although direct comparison is not possible due to changes in survey questions and/or lack of access to the underlying survey data from Wellbeing Project types Types of projects that were particularly successful in improving participants physical activity levels included community-led activities that could be incorporated into people s routines and provide opportunities for social interaction. For example, Age UK delivered a large cycling project in West Cumbria, which was very successful in encouraging older people out of doors and reconnecting them with nature. The scheme increased local interest and challenged older people to raise their physical activity levels, by increasing people s fitness levels incrementally through group exercise. Table 2.7 Incorporating physical activity into participants lifestyles Sustrans case study Portfolio total project costs: 5,403, Total funding received from BIG: 3,615, Total number of beneficiaries: 113, Activities Sustrans Active Travel Consortium delivered a portfolio of 19 projects, in partnership with Living Streets, Ramblers, the London Cycling campaign (LCC) and CTC, the national cycling charity. The overall portfolio engaged 113,989 beneficiaries, against a target of 53, The Active Travel Consortium portfolio promoted increased walking and cycling for everyday journeys/ daily routines through 19 projects delivered in a range of settings across England. For example: Travel Champions West Herts and Bedfordshire this Sustrans-led project recruited and supported volunteers to lead walks, cycle rides or events promoting walking or cycling. Activities were designed to reach hard-to-reach groups, such as a school-based walks for mums that started immediately after school drop off time, and a carers walking group to provide a sociable exercise activity for carers during respite time (carers could also bring the person they cared for along as all walks were wheelchair accessible). Inclusive Cycling Champions led by CTC in partnership with other cycling projects. The project created a network of cycling centres and provided capacity building to improve services (where inclusive cycling already existed) or support to introduce a new scheme. Walk to Work led by Living Streets, this project continued a project established through Wellbeing 1 to encourage employees to get walking by targeting workplaces. The Wellbeing 2 project developed and enhanced digital resources, such as increasing the accessibility of the Walk to Work website on different platforms/channels. Participant/ community impacts and sustainability The portfolio reported good outcomes in relation to the physical activity theme. The portfolio reported that 29,901 beneficiaries had become more physically active by the end of the grant, compared to a target of 15,431 beneficiaries 20. The Inclusive Cycling Champions project led by CTC was particularly successful, reaching 17,373 beneficiaries against a target of 4,400. Of these, 15,364 beneficiaries reported that they had participated in led activities outdoors with others through the CTC project. The Walk to Work project also produced very positive outcomes, recruiting 25,021 beneficiates compared to a target of 15,000. Of these, 8,007 participants reported that their physical activity levels had increased through the project, compared to a target of 6,750 participants Based on figures provided in section 3.2 of the Active Travel Consortium s end of grant portfolio monitoring form. 17 Based on figures provided in section 3.2 of the Active Travel Consortium s end of grant portfolio monitoring form. 18 Based on figures identified in Table 1 of the Active Travel Consortium s Portfolio Outcomes update. 19 Based on figures identified in Table 1 of the Active Travel Consortium s Portfolio Outcomes update. 20 Based on figures identified in Table 1 of the Active Travel Consortium s Portfolio Outcomes update. 21 Based on figures identified in Table 1 of the Active Travel Consortium s Portfolio Outcomes update. 21

30 Sustrans case study In terms of the portfolio s change indicators, the portfolio aimed to actively involve 4,070 people in their community, and had recruited 4,170 individual volunteers by the end of the grant. The portfolio also aimed to increase the awareness of at least 1,880,000 people around opportunities to become physically active through active travel. The portfolio over-achieved on this target, reporting that 2,086,804 individuals had increased awareness of the opportunities and benefits of active travel by the end of the grant ,989 people participated in walking, cycling and other activities organised by the portfolio 23. According to project staff, some participants reported improved fitness and weight loss, however it should be noted that this is anecdotal feedback. These impacts were achieved by building physical activity into participants daily routines. Participants often gradually increased the intensity or duration of their exercise. For example, some of the school mums started leaving the car at home and walking their children to school, in addition to participating in an organised walk from the school gates. As well as increased physical activity levels, participants across the Sustrans portfolio commonly reported a reduction in loneliness and depression as a result of becoming more confident to travel outside of the home or as a result of acting as a volunteer. The CTC Inclusive Cycling project enabled participants with a mental or physical disability, a life-limiting conditions or accessibility limitations to experience the outdoors and nature, deriving benefits for their mental wellbeing in addition to their physical health. It also engaged the families and carers of people with a mental or physical disability to participate. The support provided through Wellbeing 2 enhanced participants quality of life by giving them the opportunity to cycle. The CTC Inclusive Cycling project exceeded its participation target by 400% Assessment of the approach and influence of the Wellbeing 2 programme on Physical Activity This section explores how the impacts identified above were brought about by the Wellbeing 2 programme, in relation to several key areas: engaging hard-to reach groups, sustainability, and communicating with commissioners and policy stakeholders Engaging hard-to-reach groups Although Figure 2.7 (above) suggests that the activity levels of participants in the Wellbeing 2 programme were above average at the start of the intervention, T1 (based on a comparison with APS data), it should be borne in mind that those participants willing to complete the three surveys (at the start and end of the intervention and three months post participation) may well have been the most motivated and so may not necessarily be representative of all participants engaged with the programme. The portfolios utilised a broad definition of hard-to-reach groups; targeting people from deprived areas, people with a wide range of health conditions and disabilities, and people with a wide range of risk factors including poor diet, low motivation and low mood. The Wellbeing portfolios demonstrate important lessons about how to engage effectively with groups that are most in need of wellbeing interventions. This includes innovative approaches developed by the portfolios to engage hard-to-reach, inactive groups in physical activity. Several examples are provided below. Whilst the majority of physical activity options developed through the Wellbeing 2 programme were open to all, some activities were tailored and promoted to specific target groups. For example, the Sustrans 22 Based on figures provided in the Active Travel Consortium s end of grant portfolio monitoring form. 23 Based on figures provided in the Active Travel Consortium s end of grant portfolio monitoring form. 24 According to figures provided in the Active Travel Consortium s end of grant portfolio monitoring form. 22

31 Active Travel Consortium targeted some of their walking groups at older people to help reduce social isolation and combat loneliness, and provided additional support to enable people with physical disabilities, learning disabilities and poor mental health to participate in physical activity. Sustrans also targeted some activities at people from different ethnic backgrounds. For example, some of the walking groups from school sites were established in areas with high Asian populations. This approach promoted community cohesion by bringing together mums that may not otherwise mix at the school gates. Intergenerational work was also taken forward through the physical activity theme, such as bike repair sessions which attracted both young people and people of retirement age. Portsmouth City Council s Chances4Change portfolio ran a cycling project for people with disabilities. The project purchased 60 adapted bikes which could be used with wheelchairs. Some of the participants had never cycled before. The project brought together able bodied volunteers and disability groups, helping to bond communities. Participants reported increases in their physical activity and mental wellbeing. The portfolio also delivered cycling sessions for older people that had not cycled for over 40 years. The cycling project was part of a national strategy, and has been identified as a potential Centre of Excellence to showcase good practice which could be replicated by other providers. The Foyer Federation s Healthy Conversations portfolio, which supported young people from chaotic backgrounds, developed some particularly successful approaches to engaging hard-to-reach groups through physical activity, who had previously been sedentary, as the following case study demonstrates. Table 2.8 Community cohesion promoted through physical activity Foyer Federation case study Portfolio total project costs: 3,538, Total funding received from BIG: 3,538, Total number of beneficiaries: 7679 Activities The Healthy Conversations portfolio provided activities for young people at 78 services (mainly foyer accommodation) across England. Residents at Hereford Foyer (who were all young men), initially decided to focus a Health Action project on developing a Hereford ghost tour. However this idea lost steam at the research stage as the group were keen to do something more practical. A delivery partner, Art 360, identified an opportunity to build a raft for the river carnival and discussed this with the group who were keen to participate: They totally embraced that, they decided how it would work. There were two lads particularly who both wanted to take a lead they are both very charismatic, natural leaders and wanted to get people to join in. They all joined in and some can be quite hard to engage. Their visitors came along as well. It engaged people we probably wouldn t have been able to engage they wanted to join in rather than having to they were so proud floating down the river, that was their boat (Delivery staff, Hereford). Participant/community impacts and sustainability The portfolio reported good outcomes in relation to the physical activity theme. In terms of the portfolio s change indicators, a key aim for the portfolio was to enable young people to identify and chose healthy lifestyle goals that incorporate physical activity into their daily lives. The portfolio supported 5,017 participants to set individual physical activity goals, such as increasing their level of walking or cycling Another change indicator set by the portfolio was for young people to overcome challenges and sustain commitment to healthy lifestyles by making progress towards physical activity. 3,033 participants 25 Based on figures provided in section 3.2 of the Healthy Conversation s end of grant portfolio monitoring form. 26 Based on figures provided in section 3.2 of the Healthy Conversation s end of grant portfolio monitoring form. 23

32 Foyer Federation case study progressed their physical activity goals through the portfolio The Hereford Foyer project gave participants the opportunity to develop work-related skills such as team working, product planning and carpentry. (All the participants were young men below the age of 30). Focusing the project on physical activities helped the young men bond and develop a sense of belonging to their local community. This was very important in helping to break down perceived negative barriers between the residents and the public, and helped the participants to re-engage with members of their local community in a positive and informal way: The benefit of a project like this is the way it brings people together, everyone is really polite and respectful when they visit...riding a raft down a river forms a really good bond, so whatever happens they have that common bond that brings them together (Delivery staff, Hereford). Channelling the Hereford Foyer project through a physical activity which was valued by participants also helped them achieve soft outcomes around developing routines and commitment. Participants also helped to promote the Health Action project to the local community and took photos which were featured in the local press and on the river carnival facebook page: They wanted to show it off, they made the main cover photos of the whole day (Delivery staff, Hereford). There were loads of other organisations at the river carnival. They were competitors in their own right.they were very respectful of not using bad language if children were around. Members of the public were stopping them and asking them questions about it and you could see that they were glowing, they felt really important, it was really positive (Delivery staff, Leominster). The Hereford Foyer project fostered a high degree of commitment amongst participants, who are now keen to repeat the exercise through a project to build go-karts. Staff built a six week project on this theme into their next delivery plan Sustainability Wellbeing 2 portfolios created systems to support sustainability on a number of levels. This included developing the skills of local people to drive community development in the future and operational development. A key strength of the programme design which has supported sustainability has been engaging local people as volunteers. This has worked best where volunteers are committed to the activity. Groundwork, for example, established volunteer-led beginners running groups: Those groups took on a life of their own, they were only meant to be for 10 weeks. They become long term groups. (Team leader, Groundwork West Midlands). Stockport MBC also highlighted how activity, such as cookery clubs, can be self-sustained through volunteers. Charging for sessions was also being introduced to help maintain some types of activity going forward. The Wellbeing 2 funding enabled Groundwork to pay staff to deliver training for volunteers. Lead organisations also recognised the need for some continued investment to sustain volunteering commitments. For example, Sustrans has committed to providing on-going support for volunteers in terms of training to lead group activities and in necessary practical skills such as first aid, and Well London will be sustained in some areas by local authority funded project coordinators supporting a network of volunteers to deliver activities in the longer term. 27 Based on figures provided in the Healthy Conversation s end of grant portfolio monitoring form. 28 Individual physical activity goals were designed for each participant. 24

33 Table 2.9 Systems change through developing volunteering skills Sustrans case study Portfolio total project costs: 5,403, Total funding received from BIG: 3,615, Total number of beneficiaries: 113, Activities Sustrans Active Travel Consortium delivered a portfolio of 19 projects, in partnership with Living Streets, Ramblers, the London Cycling campaign (LCC) and CTC, the national cycling charity. The overall portfolio engaged 113,989 beneficiaries, against a target of 53, The Sustrans Active Travel Consortium provided an opportunity for local people to become Travel Champions. The Travel Champions project recruited volunteers via a local cycle forum, who were keen to lead cycle groups. Staff found that recruiting volunteers with a passion for physical activity worked particularly well. Sustrans also joined up with Mind to deliver walking groups for people with mental health issues. This helped sustain activities: You need someone to value the activity to then take it on, and have the passion to continue with it. (Travel Champions project lead). The project was designed to support this process by gradually transferring ownership to volunteers. The project officer worked closely with the groups for the initial six weeks but then stepped back to encourage others to take it on. You give them something and then once they value it they will carry it on. But you need to pull back staffing otherwise they [volunteers] will not step forward. (Travel Champions project lead). Participant/community impacts and sustainability The portfolio reported good outcomes in relation to the physical activity theme. The portfolio reported that 29,901 beneficiaries had become more physically active by the end of the grant, compared to a target of 15,431 beneficiaries 33. In terms of the portfolio s change indicators, the portfolio aimed to actively involve 4,070 people in their community, and had recruited 4,170 individual volunteers by the end of the grant. The portfolio also aimed to increase the awareness of at least 1,880,000 people around opportunities to become physically active through active travel. The portfolio over-achieved on this target, reporting that 2,086,804 individuals had increased awareness of the opportunities and benefits of active travel by the end of the grant ,989 people participated in walking, cycling and other activities organised by the portfolio 35. The project highlighted the impact of volunteering on participants through the example of a volunteer who was generally unfit and trying to reduce his alcohol and tobacco intake following a triple heart bypass. The volunteer was trained as a bike leader and bike ability instructor through the Travel Champions project. The volunteer was subsequently employed by the local authority. His personal health has been transformed; he has lost weight and stopped drinking alcohol. Volunteers are continuing to run local cycling and walking groups; increasing accessibility to local physical activity options. Volunteers have been equipped with the tools and facilities to enable them to sustain activities, such as use of a gazebo for events. To support sustainably, the Sustrans project lead 29 Based on figures provided in section 3.2 of the Active Travel Consortium s end of grant portfolio monitoring form. 30 Based on figures provided in section 3.2 of the Active Travel Consortium s end of grant portfolio monitoring form. 31 Based on figures identified in Table 1 of the Active Travel Consortium s Portfolio Outcomes update. 32 Based on figures identified in Table 1 of the Active Travel Consortium s Portfolio Outcomes update. 33 Based on figures identified in Table 1 of the Active Travel Consortium s Portfolio Outcomes update. 34 Based on figures provided in the Active Travel Consortium s end of grant portfolio monitoring form. 35 Based on figures provided in the Active Travel Consortium s end of grant portfolio monitoring form. 25

34 Sustrans case study will continue to lead on insurance and risk assessments, a system which is already in place for the established walking groups. Influencing public attitudes and organisations A key success factor of the Wellbeing 2 programme in achieving sustainability was influencing public attitudes and workplace practices. The Mind, Soil Association and Sustrans portfolios ran national awareness raising campaigns to reach wider audiences. On the physical activity theme, the Sustrans Walk to Work project delivered nationwide communication campaigns targeted at large public and private sector employers and corporations with strong CSR (corporate social responsibility) policies. A key success factor was identifying a gatekeeper within each organisation who could help drive the campaign forward. Social media, including digital and marketing, was also central to the success of some of these campaigns. Continuation funding The portfolios consistently reported securing sustainability funding at the individual project level, rather than for their whole portfolio. Commissioners tended to show interest in specific, targeted interventions, closely aligned to their own targets and priorities. Most of the portfolios were therefore working to secure sustainability funding from a wide range of sources. For example, Sustrans was combining local authority funding from health commissioners and income from paid activities, such as a cycle hire scheme. The Walk to Work project (and the related Walk to School project) are being sustained and extended through merging these projects into one. The new Walk to project will be led by Living Streets and funded by the Department for Transport s Local Sustainable Transport Fund 36. Through the new project, Living Streets will extend its outreach work, offering more direct support to encourage a wider range of settings to launch walking activities. Some portfolios were also applying for grant funding to continue some of their Wellbeing 2 activities. For example, Groundwork had secured further support from the Big Lottery Fund through the Reaching Communities programme and also from the Spirit of 2012 programmes to fund discrete projects developed by their Wellbeing 2 portfolio around healthy eating and physical activity. Barriers The main barriers to sustainability were a lack of external funding and high expectations from commissioners in terms of the evidence base required to secure follow-on funding. Some portfolios highlighted difficulties in quantifying impacts, as these would vary for each target group. For example, an increase in physical activity levels by 10 minutes per day may be a good outcome for an elderly person, whereas a young fit person might need to increase their activity levels by an extra hour per day to impact on their overall fitness levels Communicating with commissioners and influencing policy stakeholders Some portfolios built on the success of their Wellbeing 1 portfolio to strengthen links with commissioners and influence policy makers, whilst other portfolios developed new links through the Wellbeing 2 programme. 36 Further information on the approach is available at: 26

35 A number of portfolios have successfully secured external funding from national agencies to sustain physical activity projects developed through the Wellbeing 2 programme. For example, Age UK has secured funding from Sport England to develop walking sports, as they were able to evidence the benefits of this approach in raising physical activity levels amongst older people, particularly walking football for older men. Age UK highlighted the importance of establishing a robust evidence base to be taken seriously by commissioning groups, particularly health commissioners. Table 2.10 Influencing national and local policy makers Sustrans case study Portfolio total project costs: 5,403, Total funding received from BIG: 3,615, Total number of beneficiaries: 113, Activities The Sustrans Active Travel Consortium delivered a portfolio of 19 projects, in partnership with Living Streets, Ramblers, the London Cycling campaign (LCC) and CTC, the national cycling charity. The overall portfolio engaged 113,989 beneficiaries, against a target of 53, The Active Travel Consortium has undertaken influencing activity at a national level. National policy makers from the Department of Health and the Department for Transport have shown interest in the portfolio. For example, the Inclusive Cycling project was asked to provide evidence for a scoping document informing a cycle development strategy. The Inclusive Cycling project also held conversations with the Department for Transport and sat on Government led network groups around Integrated Transport and the Moving More, Living More: Olympic and Paralympic Games legacy policy paper (published by the Department of Health, Cabinet Office, Department for Culture, Media and Sport, Department for Education and Department for Transport in February 2014). The portfolio provided information to inform government priorities in this area. The Consortium also developed a case study for the Department of Health. The Consortium has also actively worked with local commissioners. Particularly good links have been established with the Health Promotion Service for Cornwall and the Isles of Scilly. Good working relationships have also been established with local authorities in Birmingham and Newcastle. Participant/community impacts and sustainability The portfolio reported good outcomes in relation to the physical activity theme. The portfolio reported that 29,901 beneficiaries had become more physically active by the end of the grant, compared to a target of 15,431 beneficiaries 41. The Inclusive Cycling Champions project led by CTC was particularly successful, reaching 17,373 beneficiaries against a target of 4,400. Of these, 15,364 beneficiaries reported that they had participated in led activities outdoors with others through the CTC project. The Walk to Work project also produced very positive outcomes, recruiting 25,021 beneficiates compared to a target of 15,000. Of these, 8,007 participants reported that their physical activity levels had increased through the project, compared to a target of 6,750 participants 42. In terms of the portfolio s change indicators, the portfolio aimed to actively involve 4,070 people in their community, and had recruited 4,170 individual volunteers by the end of the grant. The portfolio also aimed to increase the awareness of at least 1,880,000 people around opportunities to become physically active through active travel. The portfolio over-achieved on this target, reporting that 2,086,804 individuals had increased awareness of the opportunities and benefits of active travel by the end of the grant ,989 people participated in walking, cycling and other activities organised by the portfolio Based on figures provided in section 3.2 of the Active Travel Consortium s end of grant portfolio monitoring form. 38 Based on figures provided in section 3.2 of the Active Travel Consortium s end of grant portfolio monitoring form. 39 Based on figures identified in Table 1 of the Active Travel Consortium s Portfolio Outcomes update. 40 Based on figures identified in Table 1 of the Active Travel Consortium s Portfolio Outcomes update. 41 Based on figures identified in Table 1 of the Active Travel Consortium s Portfolio Outcomes update. 42 Based on figures identified in Table 1 of the Active Travel Consortium s Portfolio Outcomes update. 43 Based on figures provided in the Active Travel Consortium s end of grant portfolio monitoring form. 27

36 3.0 Healthy Eating 3.1 Impact of the Wellbeing 2 programme on Healthy Eating This chapter explores the impact of the Wellbeing 2 programme on healthy eating. Key messages are identified below before presentation of the survey findings. This is followed by a detailed examination of how the impacts were brought about, in relation to several key areas: engaging hard-to reach groups, sustainability, and communicating with commissioners and policy stakeholders. Table 3.1 Key messages Key delivery messages from the case studies: what works The voluntary nature of participation helped to increase the sense of ownership and control. Shorter courses for families and longer term courses to support skills development. Peer-led activities ensure relevant content and presentation of information, (such as apps for young people). Making healthy eating activities enjoyable and fun. Demonstrating healthy eating can be achieved on a budget. Providing clear, simple recipes that only use a few ingredients. Facilitating learning through group activities that promote social interaction. Ensuring activities are culturally appropriate Behaviour changes amongst participants The survey findings presented below demonstrate how participant behaviours changed during and after their involvement in the Wellbeing 2 programme. It is important to note that whilst this behaviour change may have been brought about by participating in the programme, the impacts should be viewed with caution as they could also have been brought about by external factors outside the scope of this evaluation. As in Section 2, findings are based on analysis of the matched dataset unless stated otherwise. Survey findings indicate that participants have made positive changes to their eating habits (both adults and young people). The key findings in this area are highlighted in the following box. 44 Based on figures provided in the Active Travel Consortium s end of grant portfolio monitoring form. 28

37 Impacts on healthy eating Adults The survey data shows some increase in the number of portions of fruit and vegetables eaten each day by adult participants. The average number of fruit and vegetable portions consumed at T1 was 3.2 increasing to 3.4 at T2 and 3.6 at T3. The average number of days on which adults report eating a meal that has been cooked and prepared from basic ingredients either by themselves or someone else increased from 4 days at T1 to 4.2 days at T2 and 4.6 days at T3. Between T1 and T3 there was an increase in the proportion of participating adults agreeing with the statement that eating is important for their health, and they were doing something about it. This increased by 8 percentage points between T1 and T3. At T2 over one-third of adult participants (38%) reported that they had made changes to their eating habits as a result of being involved in the project. At T3 the proportion reporting that they had made positive changes had increased by 5 percentage points (to 43%). Young People Between T1 and T2 the average number of portions of fruit and vegetables eaten per day increased from 3.7 to 4.3 before dropping back to 4 at T3. The survey data indicates that young people helped grown ups to cook a meal more regularly following participation. On average young people reported that they did this 2.4 times a week at T1 increasing to 3 times a week at T2 before falling back to 2.8 at T3. The data for young people indicates a 3.2 percentage point change between T1 and T2 amongst those agreeing that they always like eating fruit and vegetables (from 33.9% to 37.1%). This proportion then remained static between T2 and T3. Fruit and vegetable intake Fruit and vegetable intake amongst adults can be seen to have increased across the survey period. The average number of fruit and vegetable portions consumed at T1 was 3.2, increasing slightly to 3.4 at T2 and again to 3.6 at T3. Reviewing the survey data in detail, the results indicate that there was a larger proportion of adult participants eating 4, 5, or more than 5 portions of fruit and vegetables a day at T2 stage compared to T1. The proportion of participants eating 4 or 5 portions a day then increased again between T2 and T3, whilst the proportion eating more than 5 decreased between T2 and T3. 29

38 Percentage of adults Figure 3.1 On average how many portions of fruit and vegetables do you eat a day? (Adults) 35% 30% 30% 25% 25% 25% 20% 15% 10% 18% 16% 16% 15% 12% 12% 21% 18% 19% 16% 12% 10% 13% 12% 10% T1 T2 T3 5% 0% 2% 1% 0% More than 5 Portions of fruit/veg Base: 164(T1), 166 (T2), 165 (T3). Matched data. The matched survey data indicates that young people participating in the project were more likely to eat 5 or more fruit and vegetable portions a day at T2 than when their participation began at T1. This level of consumption had fallen back by T3 although remained above T1 levels. The average number of portions consumed increased from 3.7 to 4.3 across the T1 to T2 period and then decreased to 4 by T3. 30

39 Percentage of young people Figure 3.2 On average how many portions of fruit and vegetables do you eat a day? (Young people) 35% 32.2% 30% 28.8% 29% 25% 24% 24.20% 25.80% 24.20% 23% 20% T1 15% 15.3% 14.50% 13% T2 T3 10% 10% 8.5% 8.10% 10.2% 5% 0% 5.1% 3.20% 2% More than 5 Portions of fruit/veg Base: 59(T1), 62(T2), 62 (T3). Matched data. Over one-third (36%) of young people were seen to consume 5 or more portions of fruit or vegetables a day by T3 stage compared to 26% at the beginning (T1). There was a corresponding decrease in the proportion of young people eating between 1 and 3 portions of fruit and vegetables a day between T1 and T3. Whilst some areas of change showed a continued improvement beyond the project lifetime, the consumption of fruit and vegetables has not increased in this way, suggesting that the sustainability of impacts linked to this area are more limited. Cooking meals using basic ingredients The matched data indicates that the proportion of participating adults eating meals cooked from basic ingredients for 5 or more days a week increased from 39.2% at T1 to 41.6% at T2 to 55.7% at T3 (a 16.5 percentage point increase between T1 and T3). The average number of days on which adults report eating a meal that has been cooked and prepared from basic ingredients either by themselves or someone else increased from 4 days at T1, to 4.2 days at T2 and 4.6 days at T The mean score at T3 was statistically different to that at T1 (p<0.05). 31

40 Table 3.2 In an average week, how often do you eat a meal that has been prepared and cooked from basic ingredients, either by yourself or someone else? (Adults) In an average week, how often do you eat a meal that has been prepared and cooked from basic ingredients, either by yourself or someone else? Adults T1 Adults T2 Adults T3 Never 6.0% 3.6% 4.2% 1 day 11.4% 10.8% 9.7% 2 days 13.9% 10.2% 7.3% 3 days 16.9% 19.3% 13.3% 4 days 9.6% 12.7% 7.9% 5 days 12.7% 13.3% 20% 6 days 10.2% 10.2% 13.9% 7 days 16.3% 18.1% 21.8% Don't know 3.0% 1.8% 1.8% Base: T1 (166), T2 (166) T3 (165). Matched data. The matched data also indicates some impact in the degree to which young people helped grown ups to cook a meal following their participation in the project. On average, young people reported that they did this 2.4 times a week at T1, 3 times a week at T2 and 2.8 times at T3. Whilst project participation generated an initial modest positive impact, this tailed off slightly between T2 and T3, beyond the end of the project. The following table highlights the matched survey results for this question, indicating some particular areas of impact. For example, those helping grown ups to cook a meal 5, 6 or 7 times a week increased between T1 and T2 by 11 percentage points, then decreased by 6 percentage points by T3. 32

41 Percetnage of adults Table 3.3 In an average week, how often do you help a grown up cook a meal? (Young people) Days Young people T1 Young people T2 Young people T3 0 21% 19% 8% 1 25% 15% 21% 2 15% 23% 16% 3 8% 8% 13% 4 11% 10% 15% 5 2% 8% 5% 6 0% 5% 3% 7 3% 3% 2% Don t know 15% 10% 18% Base: T1 (61), T2 (62), T3 (62). Matched data. Views on healthy eating It is worth noting that at T1 the vast majority of respondents acknowledged that healthy eating was important (97%). However, the programme does still seem to have had a positive impact in helping participants to improve their eating habits and behaviours. Between T1 and T3 there was an increase in the proportion of participating adults with the attitude that healthy eating is important for their health, and that they were doing something about it. This increased by 8 percentage points between T1 and T3. There was a decrease of 9 percentage points in the proportion of participating adults who felt that healthy eating is important for their health but they were not doing anything about it. Figure 3.3 Eating and health; Which statement do you agree with most (Adults) 80% 70% 67% 72% 75% 60% 50% I don't think healthy eating is important for my health 40% 30% 20% 10% 0% 30% 23% 21% 4% 5% 4% T1 T2 T3 Survey stage I think healthy eating is important for my health, but I am not doing anything about it at the moment I think healthy eating is important for my health, and I am doing something about it at the moment Base: T1 (159), T2 (165), T3 (164). Matched data. 33

42 The survey suggests that some young people developed more favourable views toward the inclusion of fruit and vegetables in their diet since their involvement in project activity. The data for young people indicates a 3.2 percentage point change between T1 and T2 amongst those agreeing that they always like eating fruit and vegetables (from 33.9% to 37.1%). This proportion then remained static between T2 and T3. Table 3.4 Eating fruit and vegetables; Which statement do you agree with most? (Young people) Which statement do you agree with most? Young people T1 Young people T2 Young people T3 I never like eating fruit and vegetables 1.6% 0% 1.6% I sometimes like eating fruit and vegetables 64.5% 62.9% 61.3% I always like eating fruit and vegetables 33.9% 37.1% 37.1% Base: T1 (62), T2 (62), T3 (62). Matched data. The survey results suggest that both adults and young people have made changes to their eating habits since being involved in a Wellbeing project, although when comparing the two, the impact amongst the young people is greater. At T2, over one-third of adult participants (38%) reported that they had made changes to their eating habits as a result of being involved in the project, compared to 53% of the view that they had not made any changes to their eating habits as a result of their participation. At T3 the proportion reporting that a change had not been made remained at a similar level (52%) to T2, while the proportion outlining that they had made positive changes had increased by 5 percentage points to 43%. 34

43 Percentage of adults Figure 3.4 Have you made changes to your eating habits as a result of being involved in this project? (Adults) 60% 50% 43% 53% 52% 40% 38% 30% 20% T2 T3 10% 10% 5% 0% Yes No Don't know Made changes? Base: 160 (T2), 164 (T3). Matched data. Just over half of the young people at T2 stage felt that they had made changes to what they eat as a result of the project. However, at T3 the number of responses to this question was very limited and so is not reported. Summary Overall, survey findings indicate that some participants have achieved a positive change in healthy eating habits, although the average level of change varies between the different aspects of healthy eating and between young people and adults. The unmatched data also showed a positive change in eating habits, although the extent of change was generally lower than in the matched dataset. Findings from the unmatched data set Adults Fruit and vegetable consumption The unmatched data on the consumption of fruit and vegetables amongst adults is closely comparable to the matched data findings. Eating meals cooked from basic ingredients The unmatched data shows a slightly less positive impact than the matched data in terms of the proportion of adults eating meals cooked from basic ingredients, in that participants report doing this on an average of 4.4 days (T1), 4.1 days (T2) and 4.6 days (T3) in an average week. The increase between T1 and T3 of 0.2 days compares to 0.6 days in the matched data. Attitudes on eating The unmatched data shows a lesser degree of change in terms of the increase in the proportion of adults with the attitude that eating is important for their health and that were doing something about it. There was an increase of 4 percentage points between T1 (67%) and T3 (71%), compared to 8 percentage 35

44 Findings from the unmatched data set points from the matched data. The unmatched data highlights a decrease of 4 percentage points (from 29% to 25% between T1 and T2, and maintained at T3) in the proportion of participating adults who felt that healthy eating is important for their health, but identified that they were not doing anything about it. This is a lower level of impact than seen with the matched data (which showed a decrease of 9 percentage points). A proportion (43%) of participants felt that they had made changes to their eating habits as a result of participation, although this figure was similar at both T2 and T3 (and slightly higher than shown by the matched data). Young People Fruit and vegetable consumption Consumption of fruit and vegetables amongst young people increased from an average of 3.8 portions a week at T1 to 4 portions a week at T2 (and remained static between T2 and T3). This changes between T1 and T2 was less positive impact than that indicated by the matched results, which showed an increase of 0.6 portions between T1 and T2. Helping grown ups cook meals The unmatched data indicates a positive impact in terms of the proportion of young people helping grown ups cook a meal, albeit at a lower level than that indicated by the matched data. Overall, young people reported that they helped grown ups cook a meal on an average of 2.9 days a week at T1, 3.3 days at T2 and 3.1 days at T3. Whilst the proportion of young people outlining that they never helped grown ups to cook a meal reduced from 20.1% to 11%. Attitudes on eating The unmatched data shows a slightly higher level of change than the matched in terms of young people s views on the inclusion of fruit and vegetables in their diet. For instance, the proportion of young people saying that they always like eating fruit and vegetables increased between T1 and T3 by 4 percentage points (compared to 3 percentage points with the matched data) such that by the follow up stage, 43% of young people were of this opinion. At the same time, those young people agreeing that they never like to eat fruit and vegetables decreased from 2.1% to 1% (between T1 and T3). Approaching half of young people at T2 stage outlined that they had made changes to what they eat as a result of participation, whilst the T3 response rate was too small to provide meaningful findings Comparative analysis The National Diet and Nutrition Survey (NDNS) combines data for the four years 2008/09 to 2011/12 and collected data from a sample of people from age 18 months and over across the UK. The participants were requested to keep a four-day food diary, including types of food consumed and estimated portion sizes, and this data was used to calculate average dietary intake for different demographic groups. The resulting data shows that there was no significant change over the period suggesting that fruit and vegetable intake has remained static at least in the short term. The following chart shows that, on average, adults aged consumed 4.1 portions 46 of fruit and vegetables per day. 46 A portion is defined as 80g with the following exceptions: Fruit juice consumption limited to 150g/day; Baked beans and other pulses consumption limited to 80g/day; Tomato puree multiplied by 5; Dried fruit multiplied by 3. Total fruit (excluding fruit juice) and vegetables and beans/pulses (maximum 80g/day) consumption per day is divided by 80 to get portions/day and added to portion of fruit juice (which is obtained by dividing mean consumption (maximum of 150g/day) by 150) to get total portions per day of fruit, vegetables and fruit juice. Children under 11 have not been included as the 80g portion is only appropriate for older children and adults. 36

45 Portions per day Conversely, our survey data shows that consumption increased over time for participants in Wellbeing projects, although still remained below national averages for adults. Figure 3.5 Average (mean) consumption of "five-a-day" portions T1 T2 T3 National (19-64) Source: National Diet and Nutrition Survey (2008/ /12), Wellbeing programme surveys Surveys undertaken as part of the evaluation of the first Wellbeing programme asked participants to report consumption of fruit and vegetables separately. For adults, the average level of consumption of fruit increased from 2.3 portions a day at entry (T1) to 2.5 at exit (T2) while for vegetables, consumption increased from 2.2 to 2.5 over the same period. However, only some of this increase was maintained beyond the lifetime of the programme, with the average number of portions of fruit and vegetables increasing by 0.2 portions three to six months after engagement had ceased (T3) compared to that at T1. Comparison with the findings of the survey of Wellbeing 2 participants suggests that respondents who took part in the later programme had lower baseline levels of fruit and vegetable consumption but reported a greater increase between T1 and T3 (0.4 portions) Project types Types of projects that were particularly successful in improving participants diets included community-led interventions that built on the interests and lifestyles of different target groups. Consideration of the length of the intervention appeared to be an important factor for project success. Intervention length Portfolios highlighted the value of delivering both short and long term interventions, of different intensity. Longer term interventions enable participants to develop and reinforce healthy eating interventions. For example, the Children s Food Trust found longer term interventions were needed to build children s knowledge and interest in healthy eating, and for staff to reinforce healthy eating messages over the course of an academic year, which increased the likelihood of behaviour changes being sustained. In contrast, short-term interventions (of four weeks duration) worked well in engaging families and young people with unstable and chaotic lifestyles. Westbank commented that although an intervention may only last for several weeks, contact should be maintained for at least a year to support participants to make lasting behaviour change. 37

46 Tailored interventions Age UK s Kitchen Kings project in Hillingdon, supported older men to socialise through cooking healthy balanced meals. Most of the participants had very limited cooking experience, as some had wives who tended to cook most of their meals, and others were widowed or separated. The project was designed to support independent living and provided opportunities for social interaction. Table 3.5 Peer-led healthy eating activities Foyer Federation case study Portfolio total project costs: 3,538, Total funding received from BIG: 3,538, Total number of beneficiaries: 7679 Activities The Healthy Conversations portfolio provided activities for young people at 78 services (mainly foyer accommodation) across England. Residents at Bristol Foyer created a healthy eating cookbook and film. The focus of the Health Action project emerged from the young people s weekly steering group: Every Friday we would have a HAP meeting with the core group of six or eight young people. We did a scrapbook with them, we arranged weekly meetings, it was all their ideas of what they wanted to do different ways to promote it we ended up filming a lot of it they were dedicated to thinking about what they wanted to do. They were very respectful, they all came across really well on camera on the short film (Delivery staff). A small research team of three residents led the design of this Health Action project, researching the content for a recipe book on healthy eating. A wider group of residents were involved in delivering the Health Action project. Activities included making and testing the recipes to feature in the cookbook and making a film of their experiences and introducing the cookbook. The reason why a lot of people eat unhealthily is because they don t know how to eat healthily and a lot of healthy food is expensive the film was to show people that you can eat healthily on a budget (Participant). The research team explored healthy eating recipes that were affordable on the internet. The participants made their own menus and made a short documentary film which included interviews with participants: We experimented with some of the recipes It introduced us to new spices and flavours that we hadn t used before. I definitely eat and enjoy fruit and vegetables more now, it s made me realise that is easier and cheaper to eat healthily (Participant). It was all very equal with [the staff] We got to give our opinions and views and chose what meals we were going to do we were working together rather than being told how to do it. We were organising it all together, it was a group effort (Participant). Participant/community impacts and sustainability The portfolio did not report specific outcomes in relation to the healthy eating theme 49. The participants felt their knowledge of healthy eating increased considerably. They also did a healthy eating quiz to see what participants had learnt about the sugar content and nutritional value of different foods. The recipe book will be marketed to other Foyers and housing providers to support other young 47 Based on figures provided in section 3.2 of the Healthy Conversation s end of grant portfolio monitoring form. 48 Based on figures provided in section 3.2 of the Healthy Conversation s end of grant portfolio monitoring form. 49 Based on a review of the Healthy Conversation s end of grant portfolio monitoring form and change indicators set by the Foyer Federation for the portfolio evaluation. 38

47 Foyer Federation case study people living on a budget to eat healthily: We talked about budgeting In the recipe book that we re bringing out that s one of the main points we want to bring out to people, that these meals are also financially very good and it s not as expensive as you think it is (Participant). One participant commented that her involvement in the project has helped her adjust well to independent living: It has helped me be more independent with cooking my own meals as I live on my own now. So I have to prepare my own food now and I don t have other people to help me or encourage me to make meals, so it s really helped me. It inspired me to try more recipes outside [the Foyer] at home, like nut roast, roast dinners, things like that (Participant). The managers were also really impressed. There is a DVD and also a cookbook, but if people couldn t read they could follow the film, so it s accessible to everyone. (Delivery staff). 3.2 Assessment of the approach and influence of the Wellbeing 2 programme on Healthy Eating This section explores how the impacts identified above were brought about by the Wellbeing 2 programme, focusing on a number of key aspects: engaging hard-to reach groups, sustainability, and communicating with commissioners and policy stakeholders Engaging hard-to-reach groups The Wellbeing portfolios demonstrate important lessons about how to engage effectively with the groups that are likely to be most in need of wellbeing interventions. This includes innovative approaches developed by the portfolios for engaging hard-to-reach groups with the importance of eating a healthy diet. For example, Groundwork delivered healthy eating tester sessions at foodbanks, to engage people picking up food parcels. Activities included demonstrations around healthy eating on a budget and signposting people to health eating courses. Portsmouth City Council s Chances4Change portfolio ran a Beyond the Foodbank project in Eastbourne which encouraged service users to participate in Cooking your own Lunch activities. Participants were trained in the foodbank kitchen, helping to produce a big meal for up to 40 people. This group exercise therefore also helped to break down barriers and stigma in the local community. The project workers described the project as a life changing activity for people living in poverty. Portsmouth City Council s Chances4Change portfolio ran cookery sessions for over 1,500 people, which provided advice on buying healthy food on a budget and portion sizes. Around 300 people from local communities were trained as cookery leaders, to deliver cookery sessions and allotment growing sessions. Chances4Change also increased the capacity of community food initiatives through its Community Chefs projects established through the Wellbeing 1 programme and continued through Wellbeing 2. One County Council has confirmed funding to continue the programme. The Children s Food Trust portfolio highlighted the social wellbeing improvements generated through healthy eating activities, as the cooking clubs and session created a social/group setting in which children and families could mix. This was particularly apparent in the Prince s Trust sessions, which supported young people who are often isolated and lack wider support networks, and those in Pupil Referral Units, where staff commented that the sessions had improved pupil behaviour. The project managers 39

48 highlighted the importance of these activities being voluntary, in supporting making positive choices and increasing participants sense of control over their diet and interest in healthy eating. Portsmouth City Council s Chances4Change portfolio ran a healthy eating and cookery project in Southampton with the Medaille Trust, which supports women who have been trafficked and also refugee women from Southern Africa and the Middle East. The programme helped participants integrate into the UK and they continue to cook and eat as a group. The support workers are sustaining the approach. Table 3.6 Promoting behaviour change through healthy eating Stockport MBC case study Portfolio total project costs: 2,236, Total funding received from BIG: 1,806, Total number of beneficiaries: 33,500 Activities Stockport MBC delivered 19 projects through its Wellbeing 2 portfolio, working across the three programme themes, in some of the most deprived areas in the North West. The project lead highlighted successful activities around the healthy eating theme delivered by the Wellbeing in the North West project led by Stockport MBC. The project delivered two courses: The Cook Your... course focused on weight loss and general health, and the Cook and Taste course provided practical healthy cooking advice. The project also provided an accredited course on healthy eating for people with medical conditions and special dietary requirements. Close links were made with the local authority, which referred people to the courses and also provided the venues. The six week course was long enough to produce behavioural change, but too short for participants to achieve significant weight loss, so an additional weight drop-in session was delivered to maintain contact and support longer-term change. Participant/community impacts and sustainability Stockport MBC s portfolio aimed to impact on 5,500 children, adults and the wider community around the healthy eating theme by improving their diet, food skills and eating habits. The portfolio also aimed to reduce participants BMI through their engagement in community food programmes and increased involvement in local food production. By the end of the grant the portfolio had engaged 12,782 children, parents and members of the wider community in community food projects and increased their knowledge around diet and nutrition, compared to a target of 4,500 people. Furthermore, by the end of the grant 5,356 people reported improvements in their food skills and eating habits, compared to a target of 2,800 people 52. In the final year of the portfolio, 1,116 people who were at risk of obesity/ already obese had reduced their BMI by participating in community food interventions, and 2,012 people reported improved access to healthy foods by their community being supported to grow food locally or establish local food co-operatives 53. In total, the portfolio reported that 12,600 people improved their awareness and behaviour regarding healthy eating through portfolio activities Based on figures provided by North West Networks for Healthy Living Partnerships in their financial status tables. 51 Based on figures provided in the North West Networks for Healthy Living Partnerships end of grant portfolio monitoring form. 52 Based on figures provided in the North West Networks for Healthy Living Partnerships end of grant portfolio monitoring form. 40

49 Stockport MBC case study The project lead reported that participants on the Cook Your... course and the Cook and Taste course reduced their fat consumption, ate more fruit and vegetables and cooked more meals from scratch. The healthy eating courses also reduced social isolation and loneliness by building social networks. Young parents undertaking the cooking classes reported developing strong friendships and support networks which continued beyond the delivery period. In terms of sustaining behaviour change and building social wellbeing assets, the portfolio evaluation found that the optimal length of engagement in healthy eating activities should be between 4 and 6 months. This length of time was shown to enable participants to form new habits and also encouraged a transition to mainstream services or attending weekly classes 55. The Wellbeing 2 programme formally encouraged promotors to include local food growing in their portfolio activities. Findings related to this theme are provided in Chapter 5. Supporting government targets for primary care Several portfolios developed successful programmes that supported government priorities on improving early intervention in key areas. Some of this work has helped to inform national policy developments around early diabetes detection and protection. For example, Groundwork delivered a healthy eating project which focused on educating and promoting behaviour change amongst vulnerable groups. This included people with low level numeracy and literacy levels and limited knowledge of health eating. The project also supported people with long term illnesses and type 2 diabetes arising from obesity. Westbank s Kitchen on Prescription project was a 10 week cookery/food programme, which provided hands-on and practical support for people with a long-term health condition, such as diabetes or heart disease. Participants were drawn from one of the most deprived wards in the country. The project worked hard to establish referral routes from GP Practices and gain GP buy-in to a social model of health. A key worker model was introduced to engage participants and develop community networks. Westbank was subsequently contacted by Voscur, a large umbrella voluntary organisation in Bristol, who had been approached by the NHS to develop innovative health improvement approaches. Westbank was also asked to work with Bristol Commissioning Unit to deliver a similar project to Kitchen on Prescription to people with type 2 diabetes from Somalian and Asian communities (which have a high prevalence of diabetes). Westbank also worked with Bristol Inner City and East Health Improvement team, part of the local authority s Public Health team, informing their health trainers approach to making health eating advice culturally appropriate. 53 Based on figures provided in the North West Networks for Healthy Living Partnerships end of grant portfolio monitoring form. 54 Based on figures from the North West Networks for Healthy Living Partnerships End of Project report. 55 Building Wellbeing Assets: Summary Report: Strengthening the evidence base for community wellbeing projects, produced by the North West Wellbeing Portfolio,

50 3.2.2 Sustainability Wellbeing 2 portfolios created systems to support sustainability on a number of levels. This included developing the skills of local people to drive community development in the future as well as operational development. Table 3.7 Training staff and individuals to sustain activity Children s Food Trust case study Portfolio total project costs: 3,338, Total funding received from BIG: 3,338, Total number of beneficiaries: 504,300 Activities The Children s Food Trust portfolio delivered a wide range of projects around three core healthy eating themes: Supporting children and families to develop and improved their skills and knowledge of cooking and eating healthily. This included developing their understanding of nutrition and portion size and providing tailored cooking activities for children with special educational needs. Helping families experiencing food poverty to cook and eat healthily on a low income. Activities included menu planning, budgeting, shopping and cooking healthy meals from basic ingredients. Supporting vulnerable young people to develop the skills and knowledge to eat healthily on a low income. Activities included menu planning, budgeting, shopping and cooking healthy meals from basic ingredients 58. The portfolio lead highlighted how the Let s Get Cooking portfolio provided training in a number of areas to support sustainability: Supporting existing Let s Get Cooking clubs (established through the Wellbeing 1 programme) to expand their reach and become sustainable, by extending training and developing resources to club coordinators. The coordinators delivered school-based cooking sessions/courses. The resources were designed for school-aged children, with simple recipes using healthy foods that are attractive to children. The Let s Get Cooking team trained staff and volunteers from community organisations and food banks through the Cook and Eat on a Budget project. The staff and volunteers then provide healthy eating activities for local families living on low incomes and/ or experiencing food poverty. Working with the Prince s Trust to deliver training around food and nutrition for vulnerable young people at 11 Fairbridge accommodation centres. These young people were living in deprived areas and less likely to be knowledgeable about healthy food choices and healthy cooking on a budget. Participant/community impacts and sustainability The project exceeded its target for 100,000 families to maintain and develop their food knowledge and skills by signing up to the Let s Get Home website. By the end of the grant, 247,744 visits had been made to the website, with 190,193 unique users joining the site Cook and Eat demonstration sessions were held, and attended by 3,144 family members (compared to a target of 2,000). 716 family members, (compared to a target of 320), attended four week Cook and Eat on a budget courses, held at 28 partner organisations across the North East and Yorkshire and the Humber 60. Project staff explained how sessions brought about behavioural change impacts for participants, and improved their knowledge about healthy eating/better diets. Participants in the Family 56 Based on figures provided by Let s Get Cooking in their financial status tables. 57 Based on figures provided by Let s Get Cooking in their financial status tables. 58 Let s Get Cooking Evaluation report on Outcome 1: The Let s Get Cooking programme and sustaining the current network, produced by the Children s Food Trust, July Let s Get Cooking End of Grant report, Let s Get Cooking End of Grant report,

51 Children s Food Trust case study Cooking project increased their intake of fruit and vegetables, with all parents using the skills they had learnt to cook at home and the majority involving their children in cooking meals from basic ingredients. The Prince s Trust participants also increased their knowledge of healthy eating in an enjoyable setting: The key impact is a group of participants with real and sustainable skills. (Project manager). The lasting legacy is a group of young people with a passion for food. (Club leader). A total of 99 training events were held across the nine English regions. A total of 1,218 Let s Get Cooking club staff (from more than 800 schools) attended the training 61. These included train the trainer sessions which produced community and organisational impacts. For example, one of the trainees was a Hull County Council employee seconded to a voluntary/community sector development organisation to oversee the Fare Share scheme (which involved redistribution of surplus food). This trainee subsequently developed a network of organisations and delivered training to them in healthy eating and community cookery skills. The network included Children s Centres, refugee organisations, and women s organisations. The trainer also raised awareness of the importance of healthy eating amongst local authority colleagues. As a result of these developments, which were brought about through the Wellbeing 2 programme, the local authority s Healthy Living Team is providing continued support for community cooking sessions. This support has involved commissioning a small team from the Children s Food Trust for three years and providing 20,000 for equipment to continue the staff training and community cooking courses. The Let s Get Cooking programme will be sustained through external funding secured to support the cookery club network from a variety of sources including local authorities, waste and recycling authorities, charitable trusts and commercial partners. For example, Tesco are funding the school based activities for two years via their Eat Happy initiative 62. Barriers The main barriers to sustainability were a lack of external funding and demanding expectations from commissioners in terms of the evidence base required to secure follow-on funding Communicating with commissioners and influencing policy stakeholders Some portfolios built on the success of their Wellbeing 1 portfolio to strengthen links with commissioners and influence policy makers, whilst other portfolios developed new links through the Wellbeing 2 programme. Figure 3.6 Sustainability through commercial partnerships Children s Food Trust case study Portfolio total project costs: 3,338, Total funding received from BIG: 3,338, Total number of beneficiaries: 504,300 Activities The Children s Food Trust portfolio delivered a wide range of projects around three core health eating themes: Supporting children and families to develop and improved their skills and knowledge of cooking and eating healthily. This included developing their understanding of nutrition and portion size 61 Let s Get Cooking Evaluation report on Outcome 1: The Let s Get Cooking programme and sustaining the current network, produced by the Children s Food Trust, July Let s Get Cooking End of Grant report, Based on figures provided by Let s Get Cooking in their financial status tables. 64 Based on figures provided by Let s Get Cooking in their financial status tables. 43

52 and providing tailored cooking activities for children with special educational needs. Helping families experiencing food poverty to cook and eat healthily on a low income. Activities included menu planning, budgeting, shopping and cooking healthy meals from basic ingredients. Supporting vulnerable young people to develop the skills and knowledge to eat healthily on a low income. Activities included menu planning, budgeting, shopping and cooking healthy meals from basic ingredients 65. The Let s Get Cooking with the Tesco Eat Happy Project commenced in March The Children s Food Trust connected with Tesco at a conference and this led to further discussions. The project delivered Farm to Fork sessions explaining where food comes from, and Let s Cook, which equips children with cooking skills. Participant/community impacts and sustainability To secure Tesco support for Wellbeing 2 activities, the Children s Food Trust held a trial pop-up course during Summer The Let s Get Cooking course appealed to Tesco as it is a skilled-based programme and seeks to achieve behavioural change. This is in keeping with the aims of Tesco s Eat Happy Project. As part of the commissioning process, Tesco visited local school activities and were impressed with Children s Food Trust staff as: The staff are very knowledgeable and passionate (Tesco representative). The school-based healthy eating and cooking activities (delivered in primary schools, Pupil Referral Units and special schools) are being sustained for the next two years through the Tesco partnership. The Let s Get Cooking with the Tesco Eat Happy Project extension will provide training and support to 3,000 school clubs in primary school, special schools and Pupil Referral Units. The partnership will also help to set up an additional 1,000 clubs across the UK during 2016, which could reach up to 72,000 children and teach them how to cook. Tesco view the project setting in schools as a key factor in achieving behavioural change, and are keen to expand the project into Scotland and Wales in the longer term. Barriers Some portfolios commented that public sector restructuring had reduced opportunities for influencing work through Wellbeing 2. For example, the Children s Food Trust was situated in the Government Office in round one, and so was in close proximity to the Healthy School Teams. They have found it challenging to reinstate these links since the relevant teams have moved to the local authority. Influencing stakeholders Some of the portfolios included activities designed to influence stakeholders in their target sectors. For example, the Soil Association designed materials and procedures to raise healthy eating standards in public settings, including schools and hospitals, as demonstrated in their video, which can be viewed online: The project provided staff training for school cooks and hospital catering staff, and developed a food production framework for schools and hospitals. The Soil Association s work is currently being rolled out to other settings including care homes and workplaces. Further information is provided in the case study below. 65 Let s Get Cooking Evaluation report on Outcome 1: The Let s Get Cooking programme and sustaining the current network, produced by the Children s Food Trust, July

53 Table 3.8 Raising food production and consumption standards in public settings Soil Association case study Portfolio total project costs: 3,615, Total funding received from BIG: 3,615, Total number of beneficiaries: 189, Activities Through the Wellbeing 2 programme, the Food for Life Partnership (FFLP) scaled up and diversified the work funded through the first round of the Wellbeing programme ( ), which focused on school food 69. The second FFLP portfolio continued to support schools to gain the Food for Life Schools Award, which was designed to demonstrate that individual schools provide healthy school meals and provide food education that has a positive impact on both pupils and the wider community 70. The Award is available at three levels: Bronze, Silver and Gold. Through the Wellbeing 2 portfolio 244 schools gained awards: of these, 181 schools achieved the Bronze Award, 53 schools gained the Silver Award and 10 schools secured the Gold Award. A further 152 schools were working towards awards 71. The FFLP also established a Catering Mark, providing an independent endorsement that food providers are taking steps to improve the food they serve, using fresh ingredients which are free from trans fats, harmful additives and GM, and better for animal welfare 72. Through the FFLP s Wellbeing 2 portfolio, 268 organisations were awarded a Catering Mark and a further 76 organisations were working towards accreditation. By the end of the programme, caterers across the country served 1,408,036 meals every week day that met Catering Mark standards, across 9,054 sites. The majority of sites were schools. Other settings gaining the Catering Mark were Early Years settings (299), care homes (185), universities (138), workplaces (31), and hospitals (22) 73. Through the Wellbeing 2 programme, the FFLP delivered 218 training events, attended by around 1,744 teachers, cooks and other stakeholders, to support this work 74. FFLP also used social media to engage with practitioners effectively, with 252 school blogs generated in one academic year, and 7,200 people following the portfolio on Twitter 75. A new area of activity for the FFLP portfolio through the Wellbeing 2 programme was piloting the model in hospital settings. The portfolio gained Board-level buy-in from three leading NHS Trusts, embedding the multi-disciplinary approach through FFLP steering groups and action plans. The FFLP helped progress the hospital food agenda, informing key national developments such as establishing a CQUIN framework 66 Based on figures provided in section 3.2 of the Food for Life Partnership s end of grant portfolio monitoring form. 67 Based on figures provided in section 3.2 of the Food for Life Partnership s end of grant portfolio monitoring form. 68 Based upon: 188,500 school children. Based upon 754 schools targeted or enrolled with Food for Life between 2013 and 2015, multiplied by an average primary school roll number of 250 (Source: Department for Education, quoted in 1,000 pupils and rising primary schools go supersize. The Guardian, 17 May Available here: 1,308 staff training attendees. Based upon a total 1,744 attendances and each attendee attending 1.5 sessions (75% of total sessions) on average. The estimated 189,808 beneficiaries does not include parents, school staff, people and organisations within the food supply chain, and caterers, who may have benefited from the project, so may underestimate the number of beneficiaries. In addition, Soil Association have worked with two care home organisations, three early years organisations, three NHS Trusts and one university, so there will be additional beneficiaries over the longer term. 69 Evaluation of the Food for Life Partnership Summary and Synthesis DRAFT Report, produced by the University of the West of England, June Food for Life Schools Programme, Soil Association website 71 Based on figures provided in the Food for Life Partnership s end of grant portfolio monitoring form. 72 The Food for Life Catering Mark, Soil Association website, 73 Based on figures provided in the Food for Life Partnership s end of grant portfolio monitoring form. 74 Based on figures provided in the Food for Life Partnership s end of grant portfolio monitoring form. 75 Big Lottery Target Update, produced by the Soil Association, May

54 Soil Association case study for patient food Participant/community impacts and sustainability At a policy level, the Department for Education (DfE) identified the FFLP as a significant player in its School Food Plan, highlighting the whole school approach pioneered by the FFLP as the key to transforming food culture in schools. The FFLP sits on the DfE s School Food Plan Expert Panel. The portfolio also demonstrated a strong fit with other policy drivers, including: 2004 DfES guidance Healthy Living Blueprint for Schools, and the government White Paper Choosing Health: Making Healthy Choices Easier; the Children s Food Bill; Education (Nutritional Standards for School Lunches (England) Regulations 2006; Food Policy in Schools A strategic policy framework for Governing Bodies 2007; Nutrient Based Standards for School Food 2009; Every Child Matters; the DfE s School food in England (Departmental advice for governing bodies revised July 2014) and the Healthy Schools Programme 78. The FFLP has also been endorsed by the Department of Health and Department for Environment, Food and Rural Affairs (Defra). The FFLP is a member of the Department of Health s Hospital Food Standards Panel and through this has pushed the national requirement for hospital food and drink strategies 79. The FFLP s Catering Mark has been recognised by Defra's Plan for Public Procurement as a tool to help procurers identify best practice. The scheme is also cited by NHS England and the Department for Education as a framework to improve the food served in hospitals and schools 80. The FFLP is also linked into discussions around Defra s Balanced Scorecard for food and catering procurement. The FFLP has also participated in policy forums hosted by Public Health England, Westminster Policy Forum, Association of Directors of Public Health and the Local Government Association. These links helped the FFLP establish a successful Pathfinder Group, providing a forum for local public health commissioners to share learning and good practice 81. The portfolio achieved a good level of sustainability at an operational level. The FFLP s Food for Life Hospital Leaders Circle programme is well placed to support NHS Trusts to develop a food and drink strategy with local funding from NHS Trusts, CCGs and Public Health. The FFLP also delivered pilots with two large care home providers, leading to a new Food for Life Better Care whole setting approach framework which can form the basis of training and consultancy programmes funded by Public Health and CCGs 82. The FFLP has been commissioned by 21 local authorities through 26 separate contracts. Twelve local authorities re-commissioned FFLP programmes and extended contracts and 10 of these also commissioned the programme to explore new settings. This included a four year contract for integrated 76 Evaluation of the Food for Life Partnership Summary and Synthesis DRAFT Report, produced by the University of the West of England, June CQUIN stands for Commissioning for Quality and Innovation and was introduced by the Department of Health in 2009 to help healthcare commissioners encourage and reward improvements in service quality. Opportunity to adopt local CQUIN goal to improve hospital food, Soil Association 78 The National Healthy Schools Programme (NHSP) is a joint Department of Health and Department for Children, Schools and Families project intended to improve health, raise pupil achievement, improve social inclusion and encourage closer working between health and education providers in the United Kingdom. 79 Evaluation of the Food for Life Partnership Summary and Synthesis DRAFT Report, produced by the University of the West of England, June The Food for Life Catering Mark, Soil Association website, 81 Based on information provided in the Food for Life Partnership s end of grant portfolio monitoring form. 82 Based on information provided in the Food for Life Partnership s end of grant portfolio monitoring form. 46

55 Soil Association case study schools and early years in Warwickshire. The FFLP also secured two further contracts, expanding the model into major English cities 83. The evaluation of FFLP s activities funded through the Wellbeing 2 programme reported that commissioners were highly satisfaction with FFLP and its impact in their areas 84. In terms of participant outcomes, self-reported school meal take up was higher by 3.2% in FFLP engaged schools compared to schools not actively engaged in FFLP in Locally Commissioned programmes 85. The portfolio evaluation reported that pupils in FFLP schools reported consuming one third more portions of fruit and vegetables than those in comparison schools. Furthermore, after adjusting for free school meal eligibility, gender and local authority variation, pupils in schools engaged with the FFLP programme were twice as likely to eat five or more portions of fruit and vegetables per day. They were about 50% more likely to eat more than the national average of 2.55 portions per day 86. Further details on the FFLP s work in schools and hospitals is showcased in a video produced by Ecorys, available online: Case studies produced by the FFLP exploring the work and achievements of school cooks can be found in Annex Two. The Children s Food Trust accredited some of the materials produced through their Wellbeing 2 portfolio, to add credibility by demonstrating their materials meet professional standards. 83 Based on information provided in the Food for Life Partnership s end of grant portfolio monitoring form. 84 Evaluation of the Food for Life Partnership Summary and Synthesis DRAFT Report, produced by the University of the West of England, June Based on information provided in the Food for Life Partnership s end of grant portfolio monitoring form. 86 Evaluation of the Food for Life Partnership Summary and Synthesis DRAFT Report, produced by the University of the West of England, June

56 4.0 Mental Wellbeing 4.1 Impact of the Wellbeing 2 programme on Mental Wellbeing This chapter explores the impact of the Wellbeing 2 programme on the theme of mental wellbeing. Key messages are identified below. This is followed by analysis of survey findings and then detailed examination of how the impacts were brought about in relation to several key areas: engaging hard-to reach groups, sustainability, and communicating with commissioners and policy stakeholders. Table 4.1 Key messages Key delivery messages from the case studies: what works Transferring ownership and a sense of responsibility to the client group. Training and supporting peer educators. Identifying leaders to continue the work in their schools and workplaces. Engaging people with lived experience of mental health problems in conveying key messages and helping to reduce stigma Behaviour changes amongst participants The survey findings presented below demonstrate how participant behaviours have changed during and after their involvement in the Wellbeing 2 programme. It is important to note that whilst this behaviour change may have been brought about by participating in the programme, the impacts should be viewed with caution as they could also have been brought about by external factors outside the scope of this evaluation. This section presents the results of survey questions focused on mental wellbeing. The surveys included the four questions developed by ONS to measure personal wellbeing (covering life satisfaction, feeling worthwhile, happiness and anxiety levels), for which respondents rated themselves on a scale from 0 (not at all) to 10 (completely). These results have then been expressed as an average rating across the sample. In addition, the adult survey also included the short (seven item) Warwick-Edinburgh Mental Wellbeing Scale 87. As in Section 2, findings are based on analysis of the matched dataset unless stated otherwise. Key findings with respect to the mental wellbeing theme are outlined in the following box. Impacts on mental wellbeing Adults Reported levels of life satisfaction increased over the period from 6.2 at T1 to 6.5 at T2 to 7.0 at T3. There was also a positive change in feelings of being worthwhile, happiness and anxiety levels. Those reporting that they were feeling optimistic about the future, either often or all of the time increased from 41% (T1) to 45.2% (T2) to 51.2% (T3), overall a 10.2 percentage point change. 87 Warwick Edinburgh Mental Well-Being Scale (WEMWBS) NHS Health Scotland, University of Warwick and University of Edinburgh, 2006, all rights reserved. 48

57 The proportion of adults outlining that they had been feeling useful often or always during the past two weeks increased from 39.8% (T1), 46.4% (T2) and 53% (T3), an overall by 13.2 percentage points. The proportion of adults feeling that they were dealing with problems well often or all of the time increased from 47% to 54.8% (T1 to T2), then decreasing to 53% (overall a 6 percentage point change). Over half (53% at T2 and 54% at T3) reported that they had experienced changes in their mental wellbeing during the time spent participating in the project. Young People There was a relatively high baseline level of life satisfaction (8.4) which declined slightly to 8.3 at both T2 and T3. Increases in measures related to feeling worthwhile and happiness between T1 and T2 were not sustained at T3. The average rating of feeling worthwhile increased from 8.0 at T1 to 8.5 at T2 while at T3 the figure was 8.1. Similarly, levels of happiness changed from 8.3 at T1 to 8.9 at T2 then 8.4 at T3. At T2, 54% of young people felt that their thoughts and feelings had changed either a bit or a lot, as a result of being involved in the project. The following tables summarise the results for adults and young people, with respect to reported levels of satisfaction, happiness, anxiety and the degree to which participants feel that things in their life are worthwhile. Table 4.2 Average ratings for personal wellbeing questions (scored on a scale of 0 to 10) (Adults). Green shading denotes positive change. Mental wellbeing question Adults T1 Adults T2 Adults T3 Change T1- T2 Change T1-T3 Life satisfaction * Feeling worthwhile * Happiness Anxiety Base: T1 (166), T2 (166), T3 (166). Matched data. * The mean score at this stage was statistically different to that at T1 (p<0.05) Table 4.3 Average ratings for personal wellbeing questions (scored on a scale from 0 to 10) (young people). Green shading denotes positive change. Red denotes negative change. Mental wellbeing question Young people T1 Young people T2 Young people T3 Change T1- T2 Change T1-T3 Life satisfaction Feeling worthwhile Happiness Base: T2 (62), T3 (62). Matched data. Life satisfaction Adults responding to the survey recorded a statistically significant increase in their levels of life satisfaction between T1 and T3 stages. The average rating for life satisfaction amongst adults was 6.2 at T1, 6.5 at T2 and 7.0 at T3. 49

58 For young people, life satisfaction ratings decreased slightly from an average of 8.4 at T1, to 8.3 at T2 and T3, but remained higher than the average rating provided by adults. Feeling that life activities are worthwhile The average rating for feeling worthwhile amongst adult participants was 6.3 at T1, 6.8 at T2 and 7.1 at T3. For young people, these average ratings changed from 8.0 at T1, to 8.5 at T2 then 8.1 at T3. Feeling happy The average rating for feelings of happiness amongst adults was 6.6 at T1, 6.7 at T2 and 7.1 at T3, indicating a statistically significant increase in levels of happiness between T1 and T3. Amongst young people, the average rating for happiness was 8.3 at T1, 8.9 at T2 then 8.4 at T3, indicating an overall increase although highlighting that the increase in happiness levels achieved between T1 and T2 was not wholly sustained. Feelings of anxiety Participating adults reported a reduction in their levels of anxiety, with an average rating of 4.9 at T1, 4.8 at T2 and 4.3 at T3. Young people were not asked about anxiety levels. Feelings of usefulness A positive change was reported by adults in terms of their feelings of usefulness. The proportion of adults outlining that they had been feeling useful often or always during the past two weeks increased from 39.8% (T1), 46.4% (T2) and 53% (T3), an increase of 13.2 percentage points between T1 and T3. There was a more limited impact on the degree to which adults felt that they were dealing with problems. The proportion of adults feeling that they were dealing with problems well often or all of the time increased from 47% to 54.8% (T1 to T2), then decreasing to 53% (overall a 6 percentage point change). The degree to which adults reported feeling able to make up their own mind was the same at T1 and T3, despite increasing at T2. Those reporting that they were able to do this often or all of the time rose from 70.5% (T1) to 71.7% (T2) and then fell back to 70.5% at T3. Relaxation The proportion of participating adults reporting that they had felt relaxed some or all of the time in the previous two weeks showed no change between T1 and T2 (41.6%) but increased by 3.6 percentage points between T2 and T3 (to 45.2%). Between T1 and T3 the proportion of adults reporting that they had been feeling close to other people often or all of the time increased by 4.9 percentage points, from 59% (T1) to 63.9% (T3), despite dropping to 51.8% at T2,. Changes in mental wellbeing The data indicates that at T2, just over half (53%) of adults reported that they had experienced changes in their mental wellbeing during the time they spent participating in the project. This had increased to 54% by T3, suggesting that the main impacts in the area of mental wellbeing had begun to be realised within a relatively short time period (between T1 and T2). 50

59 Percentage of adults Figure 4.1 Have you experienced changes in your mental wellbeing during your time participating in this project? (Adults) 60% 50% 53% 54% 40% 35% 30% 31% T2 T3 20% 12% 14% 10% 0% Yes No Don't know Experienced changes? Base: T2 158, T Matched data. The survey results also suggest that young people s thoughts and feelings have been positively impacted by participation. At T2, 54% of participants felt that their thoughts and feelings had changed either a bit or a lot as a result of being involved in the project. However, at T3 the number of responses to this question was very limited and so is not reported. 51

60 Percentage responses Figure 4.2 Have your thoughts and feelings changed as a result of being involved in this project? (Young people) 35% 30% 25% 24% 30% 26% 20% 20% 15% T2 10% 5% 0% Yes a lot Yes a bit No Don t know Response Base: 46 (T2). Unmatched (matched not available). Summary Overall, the survey results indicate that there has been an increase in mental wellbeing amongst participants. Average ratings for levels of life satisfaction, feeling worthwhile, happiness and anxiety levels all showed a positive change over the survey period for adults. Amongst young people, average levels of happiness and feeling worthwhile were both shown to increase. The ability to think clearly and feeling close to other people are also indicators of mental wellbeing that were seen to increase between the start of the intervention and the T3 stage amongst adult participants. Findings from the unmatched dataset also revealed a positive impact on mental wellbeing which is summarised in the box below. Findings from the unmatched data set Adults Life satisfaction Participating adults reported an overall increase in their levels of satisfaction between T1 and T3 stages. However, the unmatched data indicates a slightly lower level of impact on satisfaction levels than that indicated by the matched data. Feeling worthwhile and useful Between T1 and T3, the unmatched data shows an increase in the proportion of adults expressing that the things they do in life are worthwhile. However, there was no change in feelings of usefulness. Feeling happy The proportion of adults expressing that they were happy was seen to increase between T1 and T3, 52

61 Findings from the unmatched data set although again the level of change was lower than that seen in the matched data. Anxiety Levels of anxiety were seen to reduce amongst adults. Over the comparable period, this level of impact is slightly higher than for the matched dataset. Changes in mental wellbeing At T2, over half (52.1%) of adults outlined that they had experienced changes in their mental wellbeing over the course of having participated in the project, compared to just under one third (32.7%) expressing that no changes had been experienced.. The findings are broadly comparable to those shown by the matched dataset. Young People Life satisfaction and feeling worthwhile The survey data suggests some degree of impact in terms of life satisfaction and feelings that life activities are worthwhile, the level of change was similar to that seen in the matched dataset. Feeling happy The impact on levels of happiness appears less significant than in the matched dataset with a marginal decrease between T1 and T3. Thoughts and feelings The unmatched survey results do suggest that young people s thoughts and feelings have been positively impacted by participation (matched data was not available). At T1, 48.1% of participants felt that their thoughts and feelings had changed either a bit or a lot, compared to 60% at T3. However the low response rate to this question at T3 should be noted. Amongst participating young people, the unmatched survey data suggests a slightly lower degree of impact than for participating adults. However, it should be highlighted that T1 found higher baseline levels for young people compared to adults (for example, 78.5% of adults were satisfied with their life compared to 92.4% of young people). This suggests that young people have a more positive outlook overall or perhaps that they are more inclined than adults to respond positively in surveys of this kind Comparative analysis To provide a benchmark for mental wellbeing, we reviewed the personal wellbeing statistics from the Annual Population Survey. Respondents to this survey were asked the same set of questions as in Section C of the evaluation questionnaire: 1. Overall, how satisfied are you with your life nowadays? 2. Overall, to what extent do you feel the things you do in your life are worthwhile? 3. Overall, how happy did you feel yesterday? 4. Overall, how anxious did you feel yesterday? (the average scores for this question are inverted for comparison purposes against the other indicators). For each question, respondents provided a rating between 0 and 10. Figure 4.3 shows the overall results for England for the period April 2014-March 2015 (age 16+ only). This source currently provides data for a four year period (2011/12 to 2014/15) which shows some improvement over time on all four measures. For example, life satisfaction has increased steadily, on average, from 7.40 to 7.60 over this period while anxiety ratings have reduced from 3.15 to A geographical breakdown shows that, in 2014/15, average life satisfaction ranged from 7.50 in London to 7.72 in the South East of England. 53

62 Average score Average score Figures show the England results against the Wellbeing programme survey results at T1, T2 and T3. This suggests that Wellbeing programme participants have relatively lower levels of life satisfaction, feelings of being worthwhile and feelings of happiness compared to the national average, and higher levels of anxiety. However, the participant survey shows an improvement over time for Wellbeing programme participants (adults) in all four domains. Figure 4.3 Personal wellbeing in England , measured on a scale of Life satisfaction Worthwhile Happiness Anxiety Source: Annual Population Survey. Figure 4.4 Life satisfaction (England and Wellbeing programme participants) T1 T2 T3 National Source: Annual Population Survey, Wellbeing programme survey. 54

63 Average score Average score Figure 4.5 Feeling worthwhile (England and Wellbeing programme participants) T1 T2 T3 National Source: Annual Population Survey, Wellbeing programme survey. Figure 4.6 Happiness (England and Wellbeing programme participants) T1 T2 T3 National Source: Annual Population Survey, Wellbeing programme survey. 55

64 Average score Figure 4.7 Anxiety (England and Wellbeing programme participants) T1 T2 T3 National Source: Annual Population Survey, Wellbeing programme survey. Further analysis of the national data suggests that women are more likely than men to find the things they do in their lives are worthwhile, but are also more likely to report higher anxiety. People who report being disabled have lower personal wellbeing scores than people without a disability. Some ethnic minority and religious minority groups reported lower personal wellbeing scores than others, possibly due to differences in social and economic characteristics. However, it was not possible to disaggregate the Wellbeing participant survey data by demographic characteristics. Evaluation of the first Wellbeing programme found that the programme significantly improved participants personal wellbeing as mean life satisfaction rose from 6.5 at the beginning of engagement with the programme (T1) to 7.1 by the end of the engagement (T2). These improvements were largely sustained three to six months beyond engagement with the programme (T3). As noted previously, the Wellbeing 2 survey findings also showed a significant change in life satisfaction amongst adult survey respondents, starting from a lower average of 6.2 at the beginning of engagement (T1) and increasing to 7.0 at the follow-up stage (T3) Project types Types of projects that were particularly successful in improving the mental wellbeing of participants included community-led approaches that encouraged discussion and reflection. In keeping with the physical activity and healthy eating themes, peer-led approaches proved very successful in the design of activities to promote mental wellbeing. Mind s Time to Change portfolio based their interventions on peer-led approaches, as the following two case studies demonstrate. 56

65 Table 4.4 Peer-led approaches: young people Mind case study Children and Young people s project Portfolio total project costs: 3,163, Total funding received from BIG: 3,163, Total number of beneficiaries: 31, Activities Mind delivered a wide range of awareness raising activities and campaigns through its Time to Change portfolio. This included work with schools in five regions, such as train the trainer sessions for teachers and campaign training for young people, as well as organising pop-up Village events in four of the regions schools ran social marketing activity, with adverts published in the Times Education Supplement and Guardian Teacher s Network 92. The campaign reached 2.37 million young people 93. The schools project worked with 25 secondary schools across five regions, (London, North West, South West, North East and East of England) utilising a train the trainers package and a leadership package developed through the preceding regional pilots and Wellbeing 1 programme. The project explored mental health stigma and helped schools run anti-stigma campaigns. It was delivered over a school term. Local authority school improvement teams, healthy schools teams, and public health teams helped identify schools to participate and to promote the project to schools. The primary target group was year olds. Young leaders from Years 10 and 12 were recruited by Student Councils, including some sixth-form psychology students. Mind delivered leader training on mental health awareness and anti-stigma discrimination, and ways to use the resources. A lead teacher was appointed in each school to help students run a campaign. Most of the school staff involved were pastoral staff, Heads of Year, and PSHE leads. Activities included hosting a Time to Change Day and series of school assemblies. Schools were also encouraged to roll the project out to the wider community through stalls at community events, newsletter articles and parents evenings. Participant/community impacts and sustainability The portfolio worked towards a key change indicator of young people s likelihood of discussing mental health. The portfolio aimed to reach 24,425 children and young people (aged 11-18) through 25 schools, with 50% of these stating they would be more likely to discuss their own/someone else s mental health following participation. By the end of the grant, the portfolio had reached 28,754 children and young people in 25 schools. 19% of young people surveyed in three schools reported speaking about mental health in the previous month (McPin Foundation) and 41% talked about mental health to family and/ or friends; 36% in school/college (SPA Future Thinking) 94. The project lead highlighted the important role played by local authorities in engaging local schools: What worked really well was having a really frank conversation with the local authorities and they identified the schools they felt best placed to take part the schools trust them. (Children & Young People project lead, Mind). The project was designed to empower schools to continue running activities independently in the longer term, although Mind will carry on providing light touch support via . Mind is currently piloting school senior leader networks to raise awareness of mental health stigma. Time to Change has successfully 88 Based on figures provided in section 3.2 of the Time to Change end of grant portfolio monitoring form. 89 Based on figures provided in section 3.2 of the Time to Change end of grant portfolio monitoring form. 90 Does not include those reached by campaigns or social contacts. 91 Based on supplementary information provided for the Time to Change End of Portfolio Report: What progress have you made? 92 Based on information provided in the Time to Change end of grant portfolio monitoring form 93 Based on supplementary information provided for the Time to Change End of Portfolio Report: What progress have you made? 94 Based on information provided in the Time to Change end of grant portfolio monitoring form 57

66 Mind case study Children and Young people s project secured funding ( 4.6 million) for a programme of work in 2015/16 from the Big Lottery Fund ( 1.1 million), Department of Health ( 2.5 million) and Comic Relief ( 1 million) 95. The five regions are also developing work locally, for example Liverpool Mind is working with Merseyside Youth Association and CAMHS to support the network. Cultural Solutions, a delivery partner in the Enable East portfolio, also supported young people by delivering Healthy Happy Minds roadshows, which toured 20 schools across Lincolnshire promoting mental wellbeing awareness 96. Table 4.5 Peer-led approaches: general public Mind case study Community engagement Portfolio total project costs: 3,163, Total funding received from BIG: 3,163, Total number of beneficiaries: 31, Activities Mind delivered a wide range of awareness raising activities and campaigns through its Time to Change portfolio. This included 20 community events, which provided an opportunity for 431 volunteers to take part in 8,456 social contact conversations with members of the public. Large events took place at Brighton Pride (organised jointly with MindOut) and Blackpool Pride. Stereo-Hype events were held in Birmingham and Brixton to engage African and Caribbean audiences, and several smaller community events also held in Lambeth and Birmingham. The Leeds Village involved sports activities to engage with a male audience, and events were held in rural areas in Suffolk and Stowmarket. In London, events were held at the Olympic Park and Bloomsbury Festival, as well as Barclays Bank headquarters on Time to Talk Day Partner-led events also took place in Nottingham and Sunderland 100. The project lead explained the underpinning approach to community engagement. Mind recruited volunteers to facilitate discussions at tackling stigma events using a social contact model (challenging attitudes by bringing people into contact with people they are prejudiced against). The volunteers were people with lived experience of mental health issues. The discussions were held in public venues (such as shopping centres and town centres) and designed to challenge people s perceptions of people with mental health issues. All volunteers attended training sessions and received on-going support. Participant/community impacts and sustainability The portfolio targeted change in a number of areas: increased social contact between people with and without mental health problems, improved public attitudes towards people with mental health problems and empowerment of volunteers The portfolio over-achieved against a number of targets for community engagement activities, including: The Community Engagement team supported external partners to deliver large-scale Time to Change events, including training partner organisations and develop a TTC Village toolkit. 6,119 social contacts were made across nine events, compared to a target of 2,800 at four events 101. MindOut worked with universities and local Mind associations to deliver additional events/social contacts. Further social contacts were made through ongoing outreach work in bars and 95 Based on figures provided in the Time to Change end of grant portfolio monitoring form 96 Based on information provided in the Well-being in the East s end of grant portfolio monitoring form. 97 Based on figures provided in section 3.2 of the Time to Change end of grant portfolio monitoring form. 98 Based on figures provided in section 3.2 of the Time to Change end of grant portfolio monitoring form. 99 Does not include those reached by campaigns or social contacts. 100 Based on supplementary information provided for the Time to Change End of Portfolio Report: What progress have you made? 101 Based on information provided in the Time to Change end of grant portfolio monitoring form 58

67 Mind case study Community engagement restaurants in Brighton and Hove, led by volunteers. (The project recruited 92 volunteers, against a target of 40). The project achieved 3,568 social contacts against a target of 1, Work on building relations with African and Caribbean communities was on-going, as this proved more effective than running large one-off events. The Community Engagement team ran a series of small community events in Lambeth and Birmingham, reaching 1,403 people 103. The project lead explained the success of the community engagement approach: The primary focus was on changing people s attitudes and having those conversations We wanted to make sure the conversations remained between the volunteer and the individual. Conversations did tend to have a big impact. Having one-to-one conversations has the biggest impact of anything we did across the programme because it is so intense and can be tailored to the needs of the individual We also became more and more aware that the amazing by-product of this was that people are becoming more and more confident and willing to speak out and identify and challenge discrimination and become more confident in their everyday lives as a result of this. We definitely saw a lot of friendships forming, people supporting each other. We heard volunteers saying I feel part of a family, this is amazing and a really unusual feeling a lot of people are used to feeling alone (Community Engagement manager). A number of panel discussions and arts performances were also delivered, using African and Caribbean culture and history and food as a way of engaging people. These were co-designed with people from the community: Massively important in the success was working with a steering group of people from those communities (Community Engagement manger). The project lead explained how Mind connected with local community members who provided a link to local African and Caribbean community organisations. Involving the community organisations in communications, and recruitment of volunteers was also a key success factor for the project, and will aid sustainability. Time to Change has successfully secured funding ( 4.6 million) for a programme of work in 2015/16 from the Big Lottery Fund ( 1.1 million), Department of Health ( 2.5 million) and Comic Relief ( 1 million) 104. Portsmouth City Council s Chances4Change portfolio also developed successful peer-led approaches to challenge mental health stigma. The portfolio delivered mental health first aid training, to challenge the stigma surrounding mental health, and to raise awareness of conditions such as depression and anxiety. The project also worked with communities to break down the stigma of seeking help, such as attending a wellbeing centre. The project has also developed smartphone apps on childhood asthma and mental health. Further information on approaches developed by the Chances4Change portfolio to promote mental wellbeing are explored in the case study below. 102 Based on information provided in the Time to Change end of grant portfolio monitoring form 103 Based on information provided in the Time to Change end of grant portfolio monitoring form 104 Based on figures provided in the Time to Change end of grant portfolio monitoring form 59

68 Table 4.6 Community approaches to support mental wellbeing Portsmouth City Council case study Portfolio total project costs: 1,800, Total funding received from BIG: 1,500, Total number of beneficiaries: 11, The Chances4Change portfolio delivered a range of projects supporting mental wellbeing. This included projects designed to empower local people to become community champions. The portfolio reported particular success around the change indicator concerned with training champions or peer mentors to recognise the causes of mental distress and take action to minimise their own distress or that of others. The portfolio aimed to train 380 champions/ peer mentors by the end of the grant. This target was exceeded significantly, with 688 Champions having accessed Mental Health First Aid (MHFA) and Youth Mental Health First Aid (YMHFA) courses by the end of the grant. These courses trained champions to recognise causes of mental distress, take actions to minimise their distress and that of others and tackle stigma around mental health. The courses enabled participants to feel more confident when supporting others with issues and when discussing their own problems. (The portfolio achieved this target by 181%) 108. The portfolio delivered 10 projects across its five hubs which included sessions designed to reduce stigma and improve mental health awareness and outcomes. Champions signposted individuals to local provision and provided information to community groups. This approach supported the personal development of Champions, who reported becoming more confident to handle issues and support others, as well as being able to notice signs of mental health problems in others and themselves (such as depression, anxiety, and suicidal thoughts) 109. Some portfolio activities were also designed to increase awareness around issues that can affect the broader mental wellbeing of local communities such as hate crime, honour-based violence, domestic violence, self-harm, suicides and scams. This was achieved through a variety of awareness sessions and emotional first aid. For example, the Mental Health & Domestic Abuse Awareness Training project in Slough trained professionals and local people in Mental Health Awareness (Mental Health First Aid Lite) and recruited and trained Mental Health Champions to reduce the stigma of mental illness. The project trained residents and workers to recognise the symptoms of mental health problems and domestic abuse and signpost local people to relevant services. The Slough project trained 35 Domestic Abuse Champions with 146 people participating in domestic abuse courses, and trained 157 MHFA Champions, with 318 people attending a MHFA lite course 110. The Champions were drawn from a wide range of local organisations including YMCA, Turning Point, Royal Berkshire Fire Service, Slough Volunteer Centre and Healthwatch. Many of these Champion Workers are using their knowledge gained through the courses within their everyday working life. The project also worked in partnership with Thames Valley Housing and Slough Youth Services, providing training for their clients 111. In Southampton, the portfolio promoted mental wellbeing through a number of music and arts based projects, including Folk Dancing sessions. Participants in an Art Therapy project produced a quilt which was displayed in Southampton Central library. The project included an oral history element, encouraging participants to share their journeys to Southampton from their home nations. Feedback forms collected by the Southampton project reported a range of beneficiary outcomes around increased physical activity levels and mental wellbeing, including increased confidence, improved language skills, drama and dancing skills. Some participants also reported a reduction in isolation and raised self-esteem and confidence 112. The Southampton project established links with the local Steps2Wellbeing service, to promote community based one-to-one and group counselling sessions. (The Steps2Wellbeing Service is a free, confidential 105 Based on figures provided in section 3.2 of the Chances4Change end of grant portfolio monitoring form. 106 Based on figures provided in section 3.2 of the Chances4Change end of grant portfolio monitoring form. 107 Based on figures identified in section 2.2 of the Chances4Change end of grant portfolio monitoring form. 108 Based on figures provided in section 3.1 of the Chances4Change end of grant portfolio monitoring form 109 Chances4Change end of grant portfolio monitoring form. 110 The Salus Project: Mental Health First Aid and Domestic Abuse Awareness Training Final report, June The Salus Project: Mental Health First Aid and Domestic Abuse Awareness Training Final report, June Chances4Change Southampton End of project report,

69 Portsmouth City Council case study NHS service for to people aged 18+ provided by Dorset HealthCare University NHS Foundation Trust. across the county of Dorset and in Southampton) 113. The Steps2Welling service provided training for the local community in dealing with stress and anxiety. This increased local people s knowledge of mental health issues and helped reduce stigma within the community around mental illness. The partnership was also viewed as enhancing service providers understanding of local people s mental health concerns. The project successfully raised awareness and broke down barriers within the community around accessing mental health support services. The project noted a gradual increase in the take-up of counselling and advice by local people 114. The partnership with Steps2Wellbeing will continue post Chances4Change. The portfolio s end of grant monitoring form highlighted clear impacts on beneficiary outcomes through mental health activities. This was particularly clear in relation to the change indicator around enhancing people s skills and confidence to prevent mental ill health and increase people s resilience to cope with mental health issues by engaging people with mental health interventions. By the end of the portfolio, 6,306 beneficiaries (220% of the target) accessed activities designed to support their own mental wellbeing and reported feeling happier, more satisfied with their life, and part of the community 115. Participants reported feeling more confident and had a greater understanding/ knowledge of mental health and the stigma surrounding it. Participants also reported improvements in life satisfaction, happiness and engagement, and reductions in depression and loneliness. Participants reported feeling more capable to prevent/ cope with mental ill health as a result of engaging in portfolio interventions Assessment of the approach and influence of the Wellbeing 2 programme on Mental Wellbeing This section explores how the impacts identified above were brought about by the Wellbeing 2 programme, in relation to several key areas: engaging hard-to reach groups, sustainability and communicating with commissioners and policy stakeholders Engaging hard-to-reach groups The Wellbeing portfolios have provided important lessons about how to engage effectively with groups that are most in need of wellbeing interventions. This includes innovative approaches developed by the portfolios to engage hard-to-reach groups, to reduce social isolation and improve mental wellbeing. For example, Westbank designed an innovative mental health project, based in an area of very high multiple deprivation, with participants residing in the top 1% most deprived areas of the country. Participants reported high levels of health inequalities and co-morbidity. The target group were financially, socially, emotionally and intellectually under-resourced. The project worked closely with local people to identify the activities they wanted and participants helped to establish these. The Wellbeing 2 funding gave Westbank the capacity to experiment, based on participant feedback. Westbank s mental health project used solution focused therapy which was innovative, as the Improving Access to Psychological Therapies programme (IAPT) 117 tends to use CBT (cognitive behaviour therapy) to address low level mental health issues. The project received very positive feedback from participants. The project has since been commissioned by a CCG as part of the local IAPT service for a period of two years initially, as a result of evidence from Westbank s evaluation report. Westbank s Board funded the project for an additional three months to ensure it could demonstrate sufficient evidence for commissioners to sustain it. 113 Steps2Wellbeing website, available at: Chances4Change Southampton End of project report, Based on figures provided in section 3.1 of the Chances4Change end of grant portfolio monitoring form. 116 Chances4Change end of grant portfolio monitoring form. 117 The Improving Access to Psychological Therapies (IAPT) programme supports the frontline NHS in implementing National Institute for Health and Clinical Excellence (NICE) guidelines for people suffering from depression and anxiety disorders. 61

70 Westbank also delivered mental health projects targeted at specific target groups. This included a Polish Women s Group with one-to-one support for Polish women with poor mental health and/ or experiencing isolation, and who may be survivors, or victims of domestic violence and abuse. A similar project was delivered for Somali Women These projects are being sustained by Bristol City Council and the Polish project has been taken on by Bristol Mental Health Services. Enable East s portfolio included four projects run by local branches of Mind. For example Colchester Mind delivered support for parents/guardians and children from armed forces families with direct or indirect experience of poor mental health. The 12 week project raised awareness of approaches to tackling mental health problems. Mid-Essex Mind worked with participants to develop activities to improve and promote better mental, physical and emotional wellbeing and healthy life choices, by building the skills of local people and encouraging community cohesion. Several portfolios highlighted the contribution of arts-based approaches in promoting mental wellbeing. As highlighted in the case study above, Portsmouth City Council s Chances4Change portfolio worked with two arts organisations providing therapeutic activities. Enable East s portfolio also developed arts approaches to tackle mental health problems. Cultural Solutions, a delivery partner ran roadshows in a Lincolnshire school. These were delivered by a performing arts group. The Marvellous Me explored subjects ranging from eating disorders and depression to stress and bullying with primary school-aged children. Cultural Solutions also led a project in consultation with mental health/mindfulness support groups and created artistic and cultural activities with artists to promote mental wellbeing. Enable East s craft-based work in Lincolnshire helped to reduce people s dependence on medication for mental health conditions, and the Foyer Federation s use of a wide range of arts-based activities (including graffiti art, pottery, and screen painting) to help young people raise their self esteem and mental wellbeing. Some of Enable East s mental wellbeing activities were linked to physical activity, such as photo-walks, and Go See; a series of cultural visits, involving resident artists and writers to help participants tell their stories via poems, or short stories. A book was subsequently published, which the participants were very proud of. Participants reported therapeutic benefits and raised self-esteem and mental wellbeing from this exercise. These projects have largely been sustained. All of the support groups continue to deliver the arts activities: They have used the journey of delivering under Wellbeing 2 to now submit their own funding applications or fundraising to continue or expand the activity. (Enable East delivery partner, Cultural Solutions lead). A number of portfolios highlighted the value of arts-based activities in supporting mental wellbeing for mothers with pre-school children with poor mental health. Approaches included Westbank s Dreamtime project, which employed key workers and worked closely with family support workers to deliver activities in Children s Centres, some of which are being sustained and taken on by other Children s Centres. The project was awarded a further two years funding from The Henry Smith Charity to continue this work. Westbank s portfolio evaluation (conducted by the University of the West of England) reported evidence of significant benefits for some Dreamtime Arts participants, including reduced symptoms of anxiety and depression, improved social and mental wellbeing, increased levels of low level physical activity, and suicide reduction. Westbank also demonstrated the value of the intervention through a Social Return On Investment (SROI) study: SROI analysis identified a significant social return for the investment made; for every 1 spent on Dreamtime Arts project there is 2.54 of social value created. (Westbank SROI data 118 ) 118 Stated by a delivery partner from Wellspring Healthy Living. 62

71 Table 4.7 wellbeing Beneficiary testimony: the impact of volunteering and physical activity on mental Sustrans beneficiary case study: Angela s story 119 Angela s mental health problems had left her feeling depressed and she shunned social situations. However, volunteering at Wyre Wheels has given Angela her life back; her confidence is up and she enjoys socialising again. It was Angela s family that suggested she should do something to get her out of the house and raise her spirits; Angela had not left the house for a year! She was severely depressed, shied away from social situations and was unwilling to get involved in things. Angela heard about Wyre Wheels two years ago while she was looking for a job. She spotted an opportunity to volunteer on the cycling project and decided to give it a try. At first she doubted she could do it, but with the support of the centre coordinator, she got through the DBS process and other paperwork. She realised early on that she really enjoyed the administrative tasks, and has undertaken this role from the start. I love it, I absolutely love it. I don t know where I would be without this. Volunteering at Wyre Wheels has led to many opportunities for Angela. She has attended leadership, first aid and disability awareness training courses, which have boosted her self-confidence and career ambitions as she would love to work with people with disabilities. She has even had a couple of job interviews. Signing up to volunteer here was to get me out of the house and give me confidence. Angela believes that being a part of Wyre Wheels has greatly improved her confidence in social settings. She said: They are constantly happy so how can you be miserable when they are around? She is keen to be involved with the community stakeholder group and to help keep the project going. She is now involved in other activities at the centre and takes part in the multi-sport sessions as well. Angela feels that she is much less depressed since she started to volunteer. CTC Inclusive Cycling Officer, Jayne Roders says, Getting out of the house and meeting people, each with their own things to overcome, provides a support network for Angela. She sees the smiles on the riders faces showing how much they enjoy using the bikes and riding round with everyone else. Angela now helps out with the cycling activities at the new Wednesday outdoor sessions and feels that it would be great to get more people to come along: I love being part and parcel of the joy and seeing happy people taking part in the cycling everyone gets to know everybody, it s like a social group. Otherwise they sit at home alone. Getting involved with the inclusive cycling project has also had a positive impact on Angela s family life. Her daughters now also volunteer at the sports centre, and the family have started to do more things together as a result of her involvement and her improved mental health and self-confidence. I am happier and come out and go for walks with [my family] and do things, whereas before I wouldn t. Wyre Wheels at Fleetwood, Fylde is one of over 40 CTC accredited clubs in the UK that are part of the National Inclusive Cycling Network. 119 Beneficiary case study produced by Sustrans Active Travel Consortium portfolio,

72 Table 4.8 Beneficiary testimony: the impact of participation on mental wellbeing and reducing social isolation Enable East beneficiary case study: Anna s story 120 A CULTURE OF TRUST CAN MAKE ALL THE DIFFERENCE By Mid Essex Mind At the heart of any wellbeing project are the beneficiaries, the people who through their involvement with the project can now look at life with a new perspective and replace negative, often self-deprecating thoughts with hopeful, positive and motivating fresh ideas. The Wellbeing in the East portfolio has engaged with over 30,000 individuals across almost 30 projects aimed at improving the health, well-being and happiness of local people and families. Our projects often meet marginalised, or vulnerable adults and believe in building relationships based on trust and supporting people to make small changes to improve their quality of life. Anna saw a poster at her GP surgery for Mid Essex Mind s Building Balance and Resilience project. She is 22 and has a social phobia. She came along to one of our sessions with her mother but was too worried to enter the building. One of the project staff introduced herself and reassured Anna that the session was very informal and friendly. We sat Anna and her mother near the door so Anna could leave if things got too much. During this first session, Anna made no eye contact and didn t engage in any conversation. She left the room on a number of occasions but did complete the kite making project we were doing that day. We encouraged her to go outside and fly the kite, and although initially reluctant, she did join the others. Anna attended many of our workshops, and over the next 18 months learnt cooking, crafts and exercise. She was soon able to hold short conversations, look people in the eye and even joined in some sessions without needing her mother there. Anna s mother says her daughter s wellbeing and confidence has drastically improved and she s gradually overcoming her anxieties and phobias. She now has cognitive behaviour therapy, which is helping her develop coping strategies. It s been so satisfying to watch this young lady progress so well. There are many stories like Anna s coming to light through our wellbeing projects, stories of hope, courage and self-discovery. These wouldn t happen without the time and commitment of the wonderful project teams up and down the country, and of course the beneficiaries who take themselves out of their comfort zone and put their trust in a complete stranger Sustainability Wellbeing 2 portfolios created systems to support sustainability on a number of levels. This included developing the skills within local people to drive community development in the future, and operational development. Peer-educator models are supporting sustainability as detailed above. A key mechanism for sustaining activities developed through the Wellbeing 2 programme was influencing commissioners and stakeholders. Impacts in this area are demonstrated in section Beneficiary case study produced by Enable East s Well-being in the East portfolio, Available online: Why a culture of trust makes all the difference, Susannah Howard, Director of Enable East, Big Lottery Fund blog, 15 th July

73 Barriers The main barriers to sustainability were a lack of external funding and demanding expectations from commissioners in terms of the evidence base required to secure follow-on funding. Portsmouth City Council s portfolio highlighted the development time required to co-produce activities, with people with lived experience of mental health problems and felt two years was too short a timeframe to fully accomplish this: Activities which worked best are designed and co-produced with people in the community letting people choose what they want to do about their own health. We are working with people with a wide range of conditions including obesity, anxiety and depression. We have tried to work with the NHS on coproductions, speaking to the communities and finding out what is important to them. (Portsmouth City Council, portfolio lead) Communicating with commissioners and influencing policy stakeholders Some portfolios built on the success of their Wellbeing 1 portfolio to strengthen links with commissioners and influence policy makers, whilst other portfolios developed new links through the Wellbeing 2 programme. Influencing stakeholders Some of the portfolios included activities designed to influence stakeholders in their target sectors. This included the work of the Soil Association and Mind, as demonstrated in the case study below. Table 4.9 Peer education: training for professionals Mind case study Portfolio total project costs: 3,163, Total funding received from BIG: 3,163, Total number of beneficiaries: 31, Activities Mind delivered a wide range of awareness raising activities and campaigns through its Time to Change portfolio. This included seven media engagement events and seminars aimed at people working in different parts of the media reporting on mental health. Separate events were run for: journalists working in broadcast news (TV and radio news, in partnership with BBC Diversity Unit), sports journalists (in partnership with BBC Sport), people working in entertainment and reality TV programmes (Channel 4), youth media, regional news (editors of regional newspapers), black and minority ethnic portrayals in the media and picture editors. The project lead explained: The strategy behind the events was a business to business strategy, peer to peer educating programme about mental health. (Media engagement lead, Mind). Each event included a panel session featuring a journalist who had received a positive response to their coverage of mental health issues. For example the broadcast news event focused on the reporting of mental health issues in the news and featured Victoria MacDonald, the Health and Social Care Correspondent from Channel 4 News, Sian Williams a journalist from BBC News, and Toby Castle from ITV. The panel shared experiences and learning around reporting on mental health issues and securing a positive response. The peer education approach was very successful in engaging journalists. Each panel also included several people with lived experience of mental health issues, who reflected on their 121 Based on figures provided in section 3.2 of the Time to Change end of grant portfolio monitoring form. 122 Based on figures provided in section 3.2 of the Time to Change end of grant portfolio monitoring form. 123 Does not include those reached by campaigns or social contacts. 65

74 Mind case study experience of these types of media. The delivery setting was also important: We worked in partnership with media organisations. For example with the news event we worked with the diversity team at the BBC. We held the event in Broadcasting House, so we were actually in the building. So it made it really easy for journalists to come along, we were holding it at the end of their working day in their environment. We also had the backing of the BBC who promoted it internally to staff, particularly staff from the news room who the event was really targeted for. (Media engagement lead, Mind). Two seminars explored specific issues: how media consumed by young people shapes their understanding of mental health; and media stories about people from black and minority ethnic communities who have mental health problems. A Get the Picture campaign was also delivered to improve images used to illustrate media stories about mental health 124, and research was commissioned into how mental health issues are covered in print media (Mind Over Matter) 125. The news event was attended by over 80 attendees. Key themes included: the language used in reporting on mental health, ethics, making contributors feel comfortable, reporting on self harm and suicide, and signposting for advice and support. The overall goal of the events was for journalists to feel more confident in reporting on mental health issues. Participant/community impacts and sustainability The portfolio worked towards a key change indicator around delivering seven Meet the Media events to 420 media professionals. Of these, targets were set for 65% to improve their understanding of mental health issues, and 50% to use this knowledge in media reports/programmes. The portfolio engaged a lower number of media professionals than originally anticipated, but the proportion of participants reporting a change was higher than the original target. By the end of the grant, 309 media professionals had attended seven events, with 72% reporting improved understanding of mental health issues, and 77% stating they had used this knowledge in media reports/programmes. A lower number of media professionals were reached overall as the portfolio found that smaller roundtable discussions were more appropriate for the events focusing on young people and black and minority ethnic communities 126. Media professionals recommended the sessions to their colleagues, and Mind was invited to run events for their colleagues. For example, BBC Sport asked Mind to run the same event for their colleagues at Sky Sports in-house, and after the BBC News event, Channel 4 News asked Mind to run the event for their staff in-house: One of the really important things to come out of it was how we made connections that then led to further opportunities, so the event itself was not an end-point, it then led to a further event. (Media engagement lead, Mind). Mind had also been invited to run a workshop for staff at Manchester Evening News. Further information about the media events can be found online at: A number of films made at the events are available to view online: Sports Journalism event Entertainment and Reality TV event Youth Media event Black and Minority Ethnic issues in the media Further information is available online: Based on supplementary information provided for the Time to Change End of Portfolio Report: What progress have you made? 126 Based on informaiton provided in the Time to Change end of grant portfolio monitoring form 66

75 Mind case study Time to Change has successfully secured funding ( 4.6 million) for a programme of work in 2015/16 from the Big Lottery Fund ( 1.1 million), Department of Health ( 2.5 million) and Comic Relief ( 1 million) 127. This chapter has focused on the mental wellbeing strand as a discrete activity, but it is important to note that the programme generated impacts on this theme across the programme: The activities whether they are physical activities, healthy eating or mental health have all got mental health outcomes which are positive. (Westbank portfolio lead). The inter-linkages between the three themes are explored in more detail in chapter Based on figures provided in the Time to Change end of grant portfolio monitoring form 67

76 5.0 Cross-cutting approaches and their value for money This chapter provides examples of cross cutting approaches, in order to demonstrate how the three themes impact on each other and link together, and also explores the impact of new elements of the Wellbeing 2 programme. This chapter also explores the value for money demonstrated by the programme through a cost benefit analysis. 5.1 Holistic approaches Approaches bringing together the thematic strands of the programme Some of the portfolios were primarily focused on one strand of the programme, (for example the Soil Association portfolio focused on healthy eating and Sustrans focused on physical activity). Other portfolios offered activities which cut across the three themes of physical activity, healthy eating and mental wellbeing, such as the Groundwork, Enable East, Westbank and Well London portfolios. However, the portfolio leads consistently commented on informal linkages between the three themes. For example, whilst the Children s Food Trust focused on healthy eating interventions, these also supported the mental wellbeing of participants, particularly families living in poverty and young people with chaotic lifestyles. Impacts on mental wellbeing derived from helping people to establish regular eating patterns and reduce their vulnerability to poor mental health by improving their diet. An interesting example of interconnecting the healthy eating and mental wellbeing themes comes from Stockport MBC s portfolio. The Digging for Health project was launched by Oldham Council in conjunction with the NHS. The project encouraged people to improve their general wellbeing with a focus on eating habits and mental health. Bespoke training was provided in food growing and healthy eating: The portfolio has shown the impact of physical activity and healthy eating on mental wellbeing. A more holistic approach shows the three strands are equally important in contributing to overall wellbeing. This has been achieved through the delivery of joint activity. (Stockport MBC portfolio lead). Portsmouth City Council s Chances4Change portfolio also highlighted the mental wellbeing benefits brought about through participation in healthy eating activities: People with mental health issues have been very responsive to the work in the kitchen or the bakery - its not just practical and active, it s therapeutic. I ve seen fantastic results with people with depression, people that have been signed off from work with mental health issues, seeing them take over their lives and one of the catalysts of this is being involved in community food activities. (Portsmouth City Council, Project lead for healthy eating and cookery). The positive impact of increasing physical activity or encouraging an improved diet on participants mental health was also noted by Westbank. Similarly, although the Sustrans Active Travel Consortium focused on the physical activity theme, its portfolio evaluation reported around half of participants on its Walk to Work project also experienced improved mental wellbeing. Participants across the Sustrans portfolio commonly reported a reduction in loneliness and depression as a result of becoming more confident to travel outside of the home or as a result of acting as a volunteer. Sustrans also worked in partnership with Mind to organise walking groups for people with mental health issues. 68

77 Enable East s Bounce project encouraged people to take ownership of their health, by engaging them in fun and refreshing wellbeing activities. Sessions ranged from 'mini bounce' sessions that could be integrated into other events, or a whole day of activities. The Bounce project worked with a wide range of groups including people over 80 years old, young people being educated in a Pupil Referral Unit, challenging teenagers, and long-term unemployed adults in an area of high deprivation. Enable East s portfolio designed a holistic approach to support young people with disabilities. Delivery partners from Disability for Sport ran a Fit Eaters project at 10 special needs schools. The project was designed to encourage participants to lead healthier lifestyles, by making healthier eating choices and increasing their physical activity. The Sustrans Active Travel Consortium highlights the linkages between physical activity and mental wellbeing. Whilst primarily focused on increasing physical activity through walking and/ or cycling, these activities produced secondary impacts on participants mental wellbeing. Both the Enable East and Sustrans portfolios cited examples were participants mental wellbeing had improved as a result of participating in a group activity: this ranged from arts and crafts classes to walking groups. Both portfolios referred to participants who had either reduced their medication, or avoiding taking medication for depression and anxiety (in consultation with their GP) as a result of improved moods brought about by Wellbeing 2 activities. A key success factor of the Wellbeing 2 programme was therefore its ability to reduce social isolation by providing group activities, which raised participants sense of mental wellbeing. Age UK s portfolio highlighted the value of combining activities such as Tai Chi, coffee mornings, and seated exercises to bring about physical activity and mental wellbeing benefits for older people: The conduit that brought the men together and kept them coming back was that every single group had a social network side to it. People bonded, men supported each other and felt that they were a part of something. It was important to give men that feeling, that they were making a difference and were part of the process So we developed the social network. (Project lead, Older Men s Network, Age UK portfolio). Participants in Enable East s Bounce project engaged in more physical activities such as going for walks and found this me time impacted on their mental wellbeing. The Groundwork case study in section below illustrates how the three themes work together and reinforce each other to improve the overall wellbeing of people with multiple and complex needs. The three strands all link together.while delivering healthy eating we would also encourage mental wellbeing and physical activity [Participants] might think that they were coming for one of those, but they would actually be developing all three. It was easy because they were a natural fit and people naturally reported that they were doing more exercise, or losing weight through healthy eating, or were inspired to do more exercise. They had better mental wellbeing, as they felt better about themselves as they lost weight. (Groundwork Team leader, West Midlands). The basic principles of Wellbeing activities - providing fun, informative, voluntary, community-based activities - were seen as a means to improve general wellbeing and promoting community cohesion through positive interaction with others. 69

78 Table 5.1 Integrating the Wellbeing themes Westbank case study Portfolio total project costs: 2,773, Total funding received from BIG: 2,530, Total number of beneficiaries: 7, Activities Westbank s portfolio delivered nine projects, working with eight delivery partners. This included the Living Well Taking Control project, which supported people recently diagnosed with type 2 diabetes or with pre-diabetic conditions. GP practices across Exeter and North Devon referred patients with a higher than normal blood glucose level to the project. The project supported people to make lifestyle changes and was focused on early intervention as this is when diet, physical activity, and other lifestyle elements can have a positive effect. Participants initially attended the project on a weekly basis, gradually reducing their attendance to monthly and then three monthly intervals. The project addressed an important gap in local health provision, being the only pre-diabetes service in Devon. The diabetes project was managed by an ex- GP Practice manager. This was a key strength of the delivery model as the manager utilised their in-house knowledge of the medical management systems used by GP Surgeries, (System One and Emis web), to develop an effective, secure and traceable referral system into the project. The system linked to additional information which demonstrated a reduction in GP appointments and/ or medication amongst participants. This approach was very successful, resulting in an effective referral pathway into the project, and evidencing positive outcomes for GP Practices referring into the project 131. Participant/community impacts and sustainability The Living Well Taking Control project was designed to improve participants health, by improving their diets and raising their physical activity levels. The project demonstrated good outcomes in relation to a number of key change indicators. For example, by the end of the grant 2,833 people with sedentary lifestyles and poor mobility reported becoming more active, compared to a target of 1,800 people, and 1,033 people with a BMI over 25 engaged with new and additional physical activities, or became more active in their daily lives, compared to a target of 830 people. Positive outcomes were also reported on the healthy eating theme, with 435 people with lifestyle related conditions having attended healthy eating activities, (compared to a target of 450 people) and 1,112 people having attended activities on growing food locally, healthy cooking and healthy lifestyles (compared to a target of 90 people 132 ). According to the project lead, the Living Well Taking Control project generated very positive feedback, 128 Based on figures provided in section 3.2 of the Well-being in the South West s end of grant portfolio monitoring form. 129 Based on figures provided in section 3.2 of the Well-being in the South West s end of grant portfolio monitoring form. 130 Based on figures provided in the Well-being in the South West Infographic, September Based on information provided in the Well-being in the South West s end of grant portfolio monitoring form. 132 Based on figures provided in the Well-being in the South West s end of grant portfolio monitoring form. 70

79 Westbank case study with some participants writing to their MPs, or commissioners to support the case for future funding. Extra sessions were introduced based on participant feedback, such as support whilst shopping. The project was designed to generate robust evidence to support sustainability. The project complied with NICE guidance and a randomised control trial (RCT) was established to help demonstrate impact by exploring whether a community-based diabetes prevention programme delivered by the voluntary sector (the Living Well, Taking Control programme), was more effective than routine care from GP practices in modifying diabetes risk factors (weight, physical activity and blood sugar levels) amongst adults at risk of Type 2 diabetes at six months. The RCT was undertaken by the University of Exeter medical school and the University of Birmingham 133. The portfolio also commissioned a Social Return on Investment report, which assessed nine services delivered through the portfolio, including the diabetes project. All the projects demonstrated a positive return on investment, ranging from a return of 1.36 to for every 1 spent. The Social Return on Investment (SROI) for the Living Well Taking Control project included data from 248 participants and seven focus groups. The SROI found that for every 1 invested in the project, an estimated 5.80 of social return was generated over a three year period 134. An infographic summarising the key findings from the SROI can be found in Annex Two. The results are very encouraging. Westbank has secured support from Public Health England and is informing the development of the roll out of the pre-diabetic programme nationally. Westbank has also secured support from NEW Devon CCG (Northern, Eastern and Western Devon Clinical Commissioning Group) to develop a Social Impact Bond for Devon. This will support the Devon-wide role out of the Living Well Taking Control Diabetes type 2 project New elements of the Wellbeing programme The evaluation was also asked to explore the contribution of new elements of the Wellbeing programme to participants overall wellbeing and their impact on individual elements of wellbeing. The new elements were local food growing, young people, older people, people with multiple and complex needs and early intervention in pregnancy and the early years. These cross-cutting themes have been incorporated across the programme to varying extents. Local food growing The Wellbeing 2 programme formally encouraged promoters to include local food growing in their portfolio activities. This has proved to be a successful mechanism for engaging hard-to-reach groups and cuts across the themes of physical activity (by involving participants in the production process) and healthy eating (by encouraging participants to utilise the food they have grown in their diet). Activities ranged from small-scale initiatives for residents living in Foyer settings (Foyer Federation) and housing estates (Well London), through to potentially larger-scale programmes for schools and hospitals, introduced as part of wider systems-change measures (Soil Association a case study on this approach can be found in subsection below). 133 Further information is available online at: Westbank Community Health and Care Living Well, Taking Control Programme Evaluation and Social Return on Investment Analysis: Summary Report, produced by the University of the West of England, Based on information provided in the Well-being in the South West s end of grant portfolio monitoring form. 71

80 Young people Some of the Wellbeing 2 portfolios developed tailored activities for young people. Several portfolios focused on school-age children, such as the Soil Association s work on improving food standards in primary schools. Activities for all age groups included food education, and access to healthy alternatives in school meals. In contrast, the Foyer Federation worked with young people aged to promote healthy eating on a budget. The Children s Food Trust supported a wide range of young people to engage in healthy eating activities, from school aged children through to Prince s Trust participants aged years. Older people A wide range of older people were engaged in Wellbeing 2 activities. An example of this is retired people coming forward to train as volunteers for the GLA s Well London portfolio. Age UK s portfolio delivered a wide range of activities for older people. This included a Dementia Friendly project focused on making their generic services and wellbeing services more accessible to people with dementia. The portfolio also funded cascade training and developed resources for local community organisations to increase physical activity levels amongst underrepresented groups, particularly people living in care homes, older men, BME groups, and rurally isolated older people. For example, Age UK East Cheshire s Healthy Lifestyle Service provided a range of physical, social and creative opportunities for older people. Participants were referred from GPs, district nurses, community matrons, social workers. Participants tended to have a clinical need, but also needed support to self-manage long term conditions. Age UK highlighted the importance of gender-appropriate activities for older people. For example, Tai Chi, coffee mornings and social events successfully engaged older women, whilst walking football and the men in Sheds projects successfully engaged older men. Physical activities were also found to help engage older people aged Westbank delivered a number of successful activities for older people, including seated exercise and a craft and chats group which tackled social isolation. People with multiple and complex needs The Wellbeing 2 programme demonstrates less impact on people with multiple and complex needs as interventions tended to be open, area-based initiatives, such as community activities and events. Where portfolios were target group driven, activities tended to be based on school populations or housing association residents, rather than people with specific multiple and complex needs such as a history of mental health problems, or substance misuse. Several portfolios have impacted on people with multiple and complex needs, but these needs may be undiagnosed, or were not the focus of the intervention. For example, the Foyer Federation s Healthy Conversations portfolio supported young homeless people from chaotic backgrounds who were living at a Foyer for between 6 months- 2 years. Many of these young people may have experienced multiple and complex needs (mental health issues, substance misuse, experienced domestic violence and family breakdown, etc.). Healthy Conversations promoted an asset based approaches to support these young people to tackle a variety of complex needs. For example Batley Foyer empowered residents to create a mobile app for homeless young people looking for emergency accommodation. Portsmouth City Council s Chances4Change portfolio trained local people to provide advice and support for the victims of domestic abuse and domestic violence. The Chances4Change portfolio also ran 72

81 sessions for people in community rehab, who had spent time in prison and had a history of drug and alcohol addiction. Table 5.2 Peer-led health resources Foyer Federation case study Portfolio total project costs: 3,538, Total funding received from BIG: 3,538, Total number of beneficiaries: 7679 Activities The Healthy Conversations portfolio provided activities for young people at 78 services (mainly foyer accommodation) across England. Residents at Ellesmere Port were already well connected to local health providers prior to Healthy Conversations, most being registered with doctors and dentists. Some were also volunteering in the local community, such as on a local farm. However, many of the residents had struggled with self esteem and the use of legal highs, and were keen to help their peers overcome similar challenges. The residents at Ellesmere Port felt that legal highs were becoming a real issue for their peers and so they developed a Health Action project on this theme. The residents formed a research group to investigate the issue locally. Activities included running focus groups with residents at another housing provider to explore issues from the user perspective and ensure that solutions would be user-friendly. The group also arranged for external providers, such as a drugs worker, to run sessions in the Foyer. The residents also worked with a marketing company to produce a booklet on legal highs and the dangers they pose: They wanted to give other young people information, to help them to make an informed choice (Delivery staff). Participants/community impacts and sustainability The portfolio reported good outcomes in relation to development of approaches that brought together the three programme themes. A key change indicator set by the portfolio was to engage 570 young people as volunteers to design Health Action projects to improve access to mental health, physical activity and healthy eating support. Another key change indicator set by the portfolio was for these 570 volunteers to design 95 Health Action projects. The portfolio overachieved both of these targets, recruiting 1166 young people who volunteered to help design and develop 140 Health Action projects 138. The Ellesmere Port residents involved in their Health Action project are now promoting the leaflet to local health and community venues to ensure it is available to their peers. The delivery staff noted that the experience and responsibility of helping to develop the sessions and booklet had helped participants, particularly some of the young men, raise their self-esteem: We have seen them coming out of their shells (Delivery staff). Stockport MBC s North West Networks for Healthy Living Partnerships portfolio delivered a community gardening project known as the Roots project. The project promoted a healthier lifestyle using the Five Ways to Wellbeing model: Connect, Be Active, Take Notice, Keep Learning, Give 139. This project supported challenging target groups including people with substance misuse addictions, and socially isolated people. The project reached a wide age range, from children, through to young people in their 136 Based on figures provided in section 3.2 of the Healthy Conversation s end of grant portfolio monitoring form. 137 Based on figures provided in section 3.2 of the Healthy Conversation s end of grant portfolio monitoring form. 138 Based on figures provided in the Healthy Conversation s end of grant portfolio monitoring form

82 20s and older people over 60. Activities were tailored to the physical activity levels of individuals. Participants reported improvements in their mental wellbeing and social wellbeing, as the group-led activities encouraged participants to interact and develop friendships, reducing their social isolation. This particularly helped a participant with Asperger s feel more stable as part of the community and able to sustain her tenancy, which had previously been a problem. The project also helped reduce some individuals to reduce their alcohol consumption. The project worked with the addiction service which referred participants who felt more positive and productive from participating in an activity they enjoyed. The project created a bank of volunteers and resources that will ensure activities continue in the short to medium term (please also refer to the Age UK example below). Stockport MBC confirmed that the Roots project in Bootle became self-sustaining by the end of the grant and will continue being delivered with the support of volunteers. The volunteers created a strong support network, meet socially outside the project, and are keen to make the project work for themselves 140. Further information is available online 141. Information on portfolio outcomes are available in Stockport MBC s full case study in the Healthy Eating chapter of this report. Table 5.3 Supporting prisoners Groundwork case study Portfolio total project costs: 2,708, Total funding received from BIG: 2,708, Total number of beneficiaries: 24,046 Activities The Target: Wellbeing portfolio supported the delivery of 34 projects working across the three Wellbeing 2 programme themes: physical activity, health eating and mental wellbeing. This included the GOOP (Greener on the Outside of Prison) project, which developed innovative approaches to improve the wellbeing of offenders in prison. The GOOP project is well embedded in all of the publicly funded prisons in the North West. The offender management project is linked to probation and community sites using horticulture and other land-based environmental activities to work with offenders. Activities were designed to enhance mental wellbeing and reduce self harm. The project also promoted physical activity and awareness of healthier eating. This was designed to support the prison agenda around reducing reoffending and strengthening desistance from crime. Participant/community impacts and sustainability The Target: Wellbeing portfolio reported good outcomes in relation to the three core themes of the programme. For example, in relation to mental wellbeing, the portfolio reported that 14,696 people in the North West (compared to a target of 2,360 people) and 2,335 people in the North East (compared to a target of 576 people) felt more confident in managing their everyday lives 144. The GOOP project evaluation reinforced this finding, highlighting the positive impact of the GOOP project on the mental wellbeing of prisoners. The GOOP evaluation report stated that 89% of participants felt more confident to manage their everyday lives, 94% of participants reported increased opportunities for social interaction, and 81% had gained new skills or knowledge 145. The GOOP project evaluation also noted that participating prisons reported the positive impact of GOOP on both the behaviour of prisoners and the prison environment 146. The Target: Wellbeing portfolio reported positive outcomes around healthy eating: 10,821 people in the North West (compared to a target of 564 people) and 10,821 people in the North East (compared to a 140 Based on information provided in the North West Networks for Healthy Living Partnerships End of Project report. 141 Grow your own project nurtures community spirit, posted 4 th March 2013, Based on figures provided by the Big Lottery Fund s Wellbeing 2 programme funding team. 143 Based on figures provided by the Big Lottery Fund s Wellbeing 2 programme funding team. 144 Based on figures provided in Target Wellbeing s end of grant portfolio monitoring form. 145 Based on a total beneficiary cohort of 872 people. Target Wellbeing: Impact Report: Greener on the Outside of Prisons, produced by the University of Central Lancashire, May Target Wellbeing: Impact Report: Greener on the Outside of Prisons, produced by the University of Central Lancashire, May

83 Groundwork case study target of 578 people) increased their knowledge about nutrition and healthy eating. The GOOP project also reported positive outcomes on the healthy eating theme. 74% of participants stated they had increased access to healthy food choices, developed new skills around growing or cooking nutritional food and increased their knowledge around nutrition and healthy eating 147. The Target: Wellbeing portfolio also reported positive outcomes around physical activity levels. 11,114 people in the North West (compared to a target of 3,041) and 1,697 people in the North East (compared to a target of 730 people) increased their physical activity levels in their daily lives by participating in the project 148. Positive outcomes on the physical activity theme were also evident for the GOOP project specifically, with 95% of participants reporting an increased awareness and understanding of the benefits of physical activity and 64% of participants reporting reduced barriers to exercise or having taken up a new activity 149. The project lead explained the participant impacts brought about by the GOOP project: Its been really exciting working in a setting where the idea of empowerment is quite alien The gardening projects have taken an empowerment model to prisoners and we've seen quite a number of people s lives being transformed and turned around We had feedback from our prison governors around reduced self harm and improved behavioural patterns around calmness and mental health. That has been really exciting and the sense of pride we ve seen people have in nurturing and growing things. (GOOP project manager and Professor in Health and Sustainability / Director of Healthy Settings Unit at University of Central Lancashire). The participants also learnt relationship skills such as working together, which will help them gain and retain employment in the future, which is known to be a key underlying determinant of health and wellbeing. Developing these skills in the prison setting helped increase participants resilience to mental ill-health and reduce their tendency to self-harm. The GOOP project also produced positive impacts on prisons at an organisational level. The portfolio engaged with NHS health care delivery staff to demonstrate the benefits of project activities in providing sustainable, cost-effective services that produce a positive impact on participants mental health and reduce self harming amongst participants. Discussions have taken place around continuation funding linked to those outcomes. In terms of sustainability, at the end of the grant, GOOP was being delivered in all the publicly run prisons in the North West and one Approved Premises as well as being championed by the Regional Director for Custodial Sentences (who is the national lead for the Decency agenda) 150. The project lead confirmed that Groundwork was also exploring opportunities to role out the model to prisons in other regions. At the time of the research, the project had secured a further year of funding from the NHS and National Offender Management Service. This will fund the programme coordinator to continue engaging with prisons, and strengthen the links between horticulture activities and promoting mental wellbeing and reducing alcohol and substance misuse. The coordinator will also support the outside network which brings together prison managers from across the North West. Groundwork was also hoping to sustain the network with their own resources and attract additional external resources to further this work. Early intervention in pregnancy and the first years Only a minority of portfolios designed specific interventions for women in pregnancy and the first years, and therefore there is less evidence of direct impact in this area. However, Westbank delivered a Weaning project; a four week cooking/food course for mothers or carers of babies of weaning age. The 147 Based on a total beneficiary cohort of 872 people. Target Wellbeing: Impact Report: Greener on the Outside of Prisons, produced by the University of Central Lancashire, May Based on figures provided in Target Wellbeing s end of grant portfolio monitoring form. 149 Based on a total beneficiary cohort of 872 people. Target Wellbeing: Impact Report: Greener on the Outside of Prisons, produced by the University of Central Lancashire, May Based on information provided in Target Wellbeing s end of grant portfolio monitoring form. 75

84 course was designed to give new mothers the confidence to make healthy and age appropriate foods for their babies. Similarly Westbank s Healthy Eating for Under 5s project was designed to support mothers/ carers of toddlers and pre-school children. The Weaning project is now being funded by The Henry Smith Charity. Some portfolios also supported mums-to-be and new mums through open activities. Examples include the Foyer Federation s portfolio supporting residents during pregnancy and Well London supporting families with young children by circulating flyers on healthy eating activities in the book-bags of children from local primary schools. Portsmouth City Council s Chances4Change portfolio delivered a Walk and Talk project for toddlers and mothers. This was delivered in libraries and included healthy eating sessions and dance sessions. The Chances4 Change portfolio also appointed local people as nutrition and weaning champions, who attended an 8 week volunteering course which included two sessions with a registered dietician to gain knowledge about nutrition, particularly the under 5s. The champions learnt about the physical signs of readiness for weaning, food that should not be given to children less than a year old, which foods are best for children, knowledge about good diet and nutrition, healthy vitamins, vitamin vouchers, vitamin D and iron deficiency and their symptoms. The Champions subsequently used this knowledge by facilitating their own workshops about nutrition and weaning in Sure Start Children s Centres in their local communities. Although the sessions are peer-led, being delivered by community champions, it is recognised that the champions require long term support and further training to ensure they remain effective and confident in the role 151. Table 5.4 Early intervention in pregnancy Stockport MBC case study Portfolio total project costs: 2,236, Total funding received from BIG: 1,806, Total number of beneficiaries: 33,500 Activities Stockport MBC delivered 19 projects through its Wellbeing 2 portfolio, working across the three programme themes, working in some of the most deprived areas in the North West. Stockport MBC s North West Networks for Healthy Living Partnerships portfolio delivered a project for pregnant woman at the May Logan Healthy Living Centre. The Healthy Beginnings project was designed to improve the health and wellbeing of pregnant women, new parents/carers and their children. Activities included aqua natal and antenatal yoga. This service engaged a target group that otherwise would not have access to these services locally, and provided new opportunities for pregnant women to exercise. This provided safe and appropriate physical activity for women who wanted to remain active during pregnancy. Activities were delivered by a community midwife using a holistic approach, including healthy eating in pregnancy discussions. Participant/community impacts and sustainability The Healthy Beginnings project staff highlighted a range of participant impacts. For example, one participant suffered from post-natal depression and reported that the sessions were restorative, providing a break where she could socialise and interact with other adults. Another pregnant participant reported feeling more empowered as the project helped her to loose weight and choose a birth option that previously would not have been possible as her BMI had been too high. Participants also developed social networks, improving their social wellbeing. 151 Chances4Change Southampton End of project report, Based on figures provided by North West Networks for Healthy Living Partnerships in their financial status tables. 153 Based on figures provided in the North West Networks for Healthy Living Partnerships end of grant portfolio monitoring form. 76

85 Stockport MBC case study The project worked with Sefton County Council Public Health team and Community midwives based in, or visiting the Healthy Living Centre helped to raise awareness of the pregnancy classes and refer clients to them. Discussions with the Public Health team led to a midwife becoming involved in delivering the activity and the Public Health Team is now supporting the project. The Healthy Beginnings team benefited from being co-located with a community midwife team, which initially attracted support for the project and subsequently led to delivery by midwives. This was crucial in securing ongoing funding. Sustainability was also secured as there was no other comparable activity in the area, and it demonstrated a close fit to the agenda of the service that funded it. Evidence of good attendance levels and case studies showing the benefits also helped convince commissioners. Aqua natal and antenatal yoga activities provided by another project in the portfolio, based in Bootle, will continue through a contract with the Public Health team. A community midwife helped deliver the activity which raised the profile of the project and its impacts with the Public Health team Systems change approaches Systems changes approaches developed through the programme that support capacity building and organisational development in the voluntary sector were evident at a number of levels. Upskilling local practitioners to enhance delivery and lead organisational development Some portfolios invested in the development of the voluntary and community sector, providing volunteer training to increase capacity and providing staff training for local delivery partners. A key success factor has been the investment in local people through volunteering and peer education approaches: We have seen huge benefits in volunteering and peer to peer mentoring across the whole portfolio. Most of the people that have engaged in the projects, regardless of what the project is about, have come for a social reason. (Groundwork portfolio lead). Stockport MBC highlighted the benefits of community-led activity and volunteering opportunities in bringing about a wider impact on community wellbeing and cohesion, by giving community members a way to give something back. For example, the Roots project enabled many volunteers to develop a community garden. Initiatives of this type gave the community a focal point and sense of ownership over improving their local area. Through Wellbeing 2, Stockport MBC enhanced working methods at the project-level by upskilling individual charities around governance, marketing, finance management and capacity building. The portfolio lead conducted a health check of all delivery partners at the beginning of the programme and offered support to upskill the delivery partner organisations. It is hoped that some of the systems change will be sustained within the delivery partner organisations. Table 5.5 Systems change through organisational development Enable East case study Portfolio total project costs: 2,693, Total funding received from BIG: 2,687, Total number of beneficiaries: 30,000 Activities The Enable East portfolio worked with over 30,000 people through 29 projects in the East of England, 154 Based on information from the North West Networks for Healthy Living Partnerships End of Project report. 155 Based on figures provided in section 1.4 of the Well-being in the East s end of grant portfolio monitoring form. 156 Based on figures provided by the Well-being in the East portfolio. 77

86 Enable East case study Lincolnshire and the North East of England, providing healthy eating, physical activity and mental wellbeing activities 157. The portfolio supported delivery partner organisations to embrace change management approaches to support the sustainability of their work in the longer term. The portfolio lead recognised the importance of helping smaller charities plan their strategic marketing work with commissioners, as some of the Wellbeing 1 projects encountered common problems around managing risks and therefore providing assurances to commissioners. The lead partner organisation organised four Learning Network events to support capacity building of their smaller voluntary sector delivery partner organisations. The first Learning Network focused on risk, project management and communication strategies, another focused on sustainability and the final one explored monitoring and evaluation. The portfolio engaged a Harvard University Professor who is a world leader in change management, to deliver training for their delivery partners at one of the networking events. The training explored strategic marketing and developing brand awareness to help organisations promote their activities to commissioners by: Engaging with commissioners and working out how they could work together to deliver the outcomes that future commissioners might want. And explore how they can adapt and change and move forward together successfully (Enable East Director). The change management event was also designed to help groups respond to changes in the external environment, such as funding and political priorities. Enable East also developed links between other parts of the health and social care environment and introduced their delivery partners to stakeholders to help sustain activities 158. Participant/community impacts and sustainability The Enable East portfolio exceeded all its targets. These were set around its three core target groups: armed forces families, looked after children and people using foodbanks. In terms of healthy eating outcomes, the portfolio reported that by the end of the grant, 24,882 people had increased awareness and improved attitudes towards healthy eating (compared to a target of 1,548 people in the first six months of delivery and 4,144 people in the second six months). 16,968 participants reported that they and their families were eating more healthily by the end of the grant (compared to a target of 968 people in the first six months and 2,169 people in the second six months) 159. In relation to the physical activity theme, 10,379 participants had developed individual plans for increasing their physical activity levels (compared to a target of 537 people in the first six months and 1,393 people in the second six months) 160. In terms of mental wellbeing, the portfolio produced strong results against a number of change indicators. 1,906 employers reported increased confidence and competence in supporting mental wellbeing, promoting good mental health and tackling stigma around mental health. At the community level, 16,836 people reported increased capacity, skills and confidence in their local community to promote mental wellbeing (compared to a target of 871 people in the first six months and 2,459 people in the second six months) 161. The change management activities were well received by local commissioners: We use a lot of voluntary sector help and I d like to see them up-skilled and that s what I ve seen [at the change management event]. They ve done a really good job in encouraging them, showing them how to 157 Why a culture of trust makes all the difference, Susannah Howard, Director of Enable East, Big Lottery Fund blog, 15 th July Further information on activities can be found on the Enable East website: Based on information provided in the Well-being in the East s end of grant portfolio monitoring form 160 Based on information provided in the Well-being in the East s end of grant portfolio monitoring form 161 Based on information provided in the Well-being in the East s end of grant portfolio monitoring form. 78

87 Enable East case study make themselves proficient, how to make themselves more attractive to commissioners, and I really think they ve done a good job (Local commissioner from Essex County Council). For further details, view the Enable East video produced by Ecorys: In terms of sustainability, eight of the projects were continuing, by either embedding aspects of delivery into other programmes run by their organisation, or through having secured external funding 162. Impacts will also be sustained through enhanced job descriptions for future job roles. For example, as a result of their involvement as a delivery partner in the Children s Food Trust s portfolio, the Prince s Trust has revised its job description for a support worker, to incorporate healthy eating activities as well as delivering outdoor activities, and the Foyer Federation has incorporated more activities based on the three themes into their core offer. Sustrans also highlighted systems change at an organisational level. The Wellbeing 2 programme provided an opportunity for the organisation to act as a management body for a grant, and was the first time the organisation had employed sub-contractors and issued contracts. This impacted at an organisational level: Sustrans has been transformed by acting as the lead in the Consortium to deliver the programme This has forced us to up our game and the quality of our systems. We ve made significant improvements to the way we monitor and evaluate We ve had to support the project delivery partners so have had to learn ourselves before we can teach it. (Portfolio lead). In turn, there have been organisational changes in the delivery partner organisations. Living Streets expanded their activity significantly through Wellbeing 2 and as such have implemented new systems and moved offices. Sustrans has supported the implementation of financial management systems within some of their delivery partner organisations. Influencing local decision makers Another aspect of systems change achieved by some portfolios was around influencing local commissioners. This was achieved by joining local partnerships and steering groups and demonstrating how Wellbeing 2 activities can help commissioners, such as local authority public health teams, to meet the priorities identified in local planning documents such as their Joint Strategic Needs Assessment. Some individual projects have positioned themselves to demonstrate experience from Wellbeing 2 and offer an enhanced service to commissioners. This has enabled organisations to make more strategic links with commissioners, rather than waiting to respond to a direct tender exercise. Partnership approaches have also been used as a way to help smaller organisations to feature in these discussions, as they are typically less likely to pass a formal PQQ processes. There is a GP event locally, where all the GPs in the area meet together for a study afternoon - we have presented at the clinical meetings and presented at CCG cabinet meetings, to Health and Wellbeing Boards. We have engaged with the statutory sector where there is strategy decision making and tried to present at the level which will ensure closer working in the future. Presenting evidence of impact and creating a shared agenda. Our local evaluation has been very important- so we can present an external body s findings and not our own. (Westbank portfolio lead). 162 Based on information provided in the Well-being in the East s end of grant portfolio monitoring form. 79

88 Table 5.6 Creating new models of community centred care Altogether Better case study Portfolio total project costs: 2,689, Total funding received from BIG: 2,689, Total number of beneficiaries: 2,531 Activities Altogether Better built upon their previously successful approach of finding, developing and supporting volunteer champions to work in the community, and invited groups of champions to work closely with the NHS in General Practice, a specialist hospital service and across the system to address city- wide issues. The aims were : To improve the wellbeing, particularly the mental well-being, of champions and all those who participated in the groups and activities they had developed To radically change the way that the NHS provides services by: -extending the range of offers that promote wellbeing and thereby reducing demand for professionally provided services - enabling people and communities to be active partners in their own health and care, codesigning and delivering services in new ways - enabling people to understand how to make more appropriate use of professionally provided services - enabling the NHS to move some way from providing attention to individuals to supporting groups of champions who provide support and attention to groups of local people -ultimately creating the conditions across the system that support positive mental health and wellbeing in the communities involved. With support from Altogether Better and their local partners, people were invited to become Health Champions: By their General Practice By a specialist service for people with chronic fatigue On behalf of the system as a whole to tackle the city wide issues (young people in one site and giving children a good start in the other). Using whole system approaches and drawing on the principles of coproduction over 1131 Altogether Better Champions in seven localities across three regions, in 30 GP practice were nurtured as a group and encouraged to take action to improve local health and wellbeing with their NHS partners. The Champions reached over 17,000 citizens indirectly and reached 1,400 participants through 216 activities, 175 of which have taken place regularly 165. The Young Health Champions worked across a wide geographical area to identify and develop ways for young people to more actively engage with and influence their own and their community s health 166. The asset based model enabled Champions to develop a wide range of innovative and creative activities based on their own interests, life experiences and local community need. Staff greatly valued their more engaged relationship with citizens and recognised that champions were providing a valuable contribution to the wellbeing of patients. 95% of staff involved would recommend the work and wished to continue. The Champions added capacity into the system and enabled professionals to focus on their core functions 167. The work in General Practice is described in the Altogether Better video produced by Ecorys, which can be viewed here: Based on figures provided in section 3.2 of the Altogether Better s end of grant portfolio monitoring form. 164 Based on figures provided in section 3.2 of the Altogether Better s end of grant portfolio monitoring form. 165 Based on figures provided in the Altogether Better s end of grant portfolio monitoring form. 166 Altogether Better Working Together to Create Healthier People and Communities: Bringing citizens and services together in new conversations report, Altogether Better 2015, Executive Summary, p Based on information provided in the Altogether Better s end of grant portfolio monitoring form. 80

89 Altogether Better case study Participant/community impacts and sustainability The introduction of Practice Health Champions brought about health improvements for both the Champions themselves and wider participants. The approach also brought about long term and embedded system change, by involving the Champions in service design and delivery 168. As a result of the work: 87% (488) of Champions and 94% (286) of participants reported having gained new knowledge/awareness related to health and wellbeing. 86% (482) of Champions and 94% (286) of participants reported increased levels of confidence and wellbeing following their involvement in the project. 98% (550) of Champions and 99% (300) of participants reported being more involved in social activities/membership of social groups/social networks following their involvement in the project 169. Becoming a champion proved to be life changing for some people and life improving for many. The changes were due to feeling more confident, having a purpose in life, making good friends, particularly with people they would otherwise never meet, and the capacity of this to lead to increased community cohesion and resilience. It s really helped me get back on track it was about isolated and lonely people and I was one of them, basically left to rot. When you invited me that day, it saved my life. (Practice Health Champion) 170. A range of outcomes supported the system change objectives with statutory organisations showing a greater recognition of the resourcefulness and generosity of citizens who use their services. This in turn raises the possibility of these organisations radically changing the way that they provide services. 95% of staff would recommend the work and wish to continue. New relationships between champions an organisations will be sustainable into the long term, becoming in the words of one GP simply how we do things round here The contribution of the champions to systems change was summarised by a Practice Manager as: The work that we ve done in the practice has far, far exceeded my expectations in terms of the skills that they ve brought, the enthusiasm, the time they ve given, actually how they ve just become part of the practice. (Practice Manager, North East) 172. Altogether Better has secured funding to support the sustainability of the model and its transfer to a further 44 GP practices in other areas including London. Work will be sustained and extended in all 7 localities beyond the BIG funding period. In Bradford, all practices will continue with the PHC work and the CCG has commissioned work in a further eighteen practices. In Calderdale, the CCG has committed funding to work in a further five practices. In Sheffield current work will continue and the CCG and local authority funded another year of activity and are keen to mainstream the approach. East Riding will continue and have plans to extend. Shropshire CCG has confirmed a further three years funding for the project to recruit/support another 100 Young Health Champions per year. The approach is well-placed to support the NHS Five Year Forward View, which aims to engage with communities and citizens in new ways, involving them directly in decisions about the future of health and care services Based on information provided in the Altogether Better s end of grant portfolio monitoring form. 169 Based on figures provided in the Altogether Better s end of grant portfolio monitoring form. 170 Cited in Altogether Better Working Together to Create Healthier People and Communities: Bringing citizens and services together in new conversations report, Altogether Better 2015, Executive Summary, p Cited in Altogether Better Working Together to Create Healthier People and Communities: Bringing citizens and services together in new conversations. Altogether Better Executive Summary p Cited in Altogether Better Working Together to Create Healthier People and Communities: Bringing citizens and services together in new conversations, Altogether Better 2015, Executive Summary, p Based on information provided in the Altogether Better s end of grant portfolio monitoring form 81

90 Table 5.7 Demonstrating effective practice to meet local priorities Foyer Federation case study Portfolio total project costs: 3,538, Total funding received from BIG: 3,538, Total number of beneficiaries: 7679 Activities The Healthy Conversations portfolio provided activities for young people at 78 services (mainly foyer accommodation) across England. Crewe Foyer secured 40,000 funding from the local authority s Public Health Transformation Fund to sustain their Healthy Conversations activities for a year. The Foyer is well known to the local Clinical Commissioning Group (CCG) through their wider housing work. This gave the Foyer confidence to approach the local public health team: We are already linked with the CCGs we have three different contracts with CCGs. We ve also applied for NHS Winter Resilience money, to offer a service for people in A&E who are homeless and clogging up A&E We developed a homeless discharge service. We have also got an integrated mental health worker who has always been funded by the predecessors of the CCGs (Hub lead). Participant/community impacts and sustainability The sustained activity will be known as Health Adventures and available to residents and other young people that the Foyer supports in community settings through its youth work. The funding will be used to employ a new member of staff. Public Health is very target driven so it is has been important that the Foyer is able to evidence outcomes from Healthy Conversations. They engaged commissioners through a formal bidding process to secure the funding, but were invited to submit a bid because they were well known locally: We were ready and agile to do it I go to general health meetings in anything that I think offers an opportunity for us I am part of the Mental Health Task and Fitness group for Housing, previously I was on the Community Health Council a Trustee for the Hospital Trust we ve always gone into the health agenda I also sit on the Homeless Strategy Group and the Young People s Housing Groups We put ourselves about and showed we are part of health. Healthy Conversations has given us something to talk about because it touches critical areas; physical health, mental health, early psychosis, legal highs. It s brokered the ground and given us something to say from an asset-based perspective (Hub lead). Commissioners are looking for asset-based approaches to support the preventative agenda and reduce the need for young people to use NHS services. The Foyer initiated some of the interactions with commissioners, including the Head of Public Health: They want a virtual circle of asset based approaches I initiated the conversation just very persistent. If you know it meets the need you have to go in there with confidence you just go to them as Health whereas before you would have gone to Supporting People its getting into the JSNA, and staying in the JSNA (Hub lead). Through Age UK s portfolio, Age UK East Cheshire was able to position itself to provide services through the integrated care agenda. Age UK employed wellbeing coordinators based within local integrated care teams and tried to extend the service into other Primary Care clusters in Cheshire East. Wellbeing 2 funded a further two wellbeing coordinators, linked into Age UK s healthy lifestyle service. The wellbeing coordinators received referrals from the new integrated neighbourhood team based around GP clusters. The Wellbeing 2 programme helped Age UK embed their services with GPs by basing their staff within 174 Based on figures provided in section 3.2 of the Healthy Conversation s end of grant portfolio monitoring form. 175 Based on figures provided in section 3.2 of the Healthy Conversation s end of grant portfolio monitoring form. 82

91 the integrated care team. This placed them in close contact with GPs, community matrons and district nurses, who were able to see the effectiveness of the wellbeing coordinators. The two CCGs in Cheshire East subsequently agreed that the wellbeing coordinators role was the way forward for dealing with early Intervention and prevention working alongside their staff. The CCGs therefore built the wellbeing coordinators role into their business case for the future of integrated care in Cheshire East. (At the time of the research, the longer-term funding had yet to be secured for these posts). A commissioner from the NHS Eastern Cheshire Clinical Commissioning Group confirmed the value of the wellbeing coordinators, particularly in supporting people with long term multiple and complex needs (older people unable to leave their homes, because of physical limitations and low confidence). The wellbeing coordinators are the only role dedicated to working as part of the integrated health and social care teams, which focus on wellbeing and helping people to maintain independent living. This approach may produce longer term cost savings for the NHS, but was at too early a stage in the intervention cycle to evidence this at the time of the research. Stockport MBC also secured CCG or public health funding for several interventions, such as the Walking away from Diabetes project, and Salford activity on prescription project. Barriers The portfolios encountered a number of barriers in bringing about systems change: The time taken to make the right connections. The time taken to embed activities and get them known in the community many portfolios relied on volunteer inputs for essential capacity building to raise their profile in the local area (Well London for example trained volunteers in door-knocking approaches to engage local residents). The wider context of budgetary cuts leading to commissioners requiring evidence that activities could become largely self-sustaining and community-led. 5.2 Wider impacts on wellbeing and the community Broader improvements brought about to participants lives through participation The evaluation was asked to explore wider impacts for beneficiaries including improving their routines overall and helping them to move on with education, training and work. Personal development Participating in wellbeing activities supported the personal development of participants, building their self-confidence, self-esteem, and work-related skills. This was particularly noted for young people and full-time mums with no/limited work experience. This was commonly highlighted by volunteers. A number of portfolios trained up volunteers who then progressed into employment. For example, a volunteer for Sustrans became a paid project officer and subsequently managed one of the projects. Stockport MBC noted improvements to participants mental health and wellbeing as a result of increased confidence, which in turn enabled some to progress onto volunteering or education. Health outcomes are most successfully achieved through a community development approach by getting participants involved in the design of interventions. Allowing individuals to develop their social 83

92 and personal wellbeing assets (confidence, self-esteem, motivation) leads to changes in health outcomes - you can t just jump in to get the health outcomes you need to do some groundwork. What is clear is that it is the approach and staff that are most important in achieving these outcomes rather than the specific type of project. (Stockport MBC Portfolio lead).portsmouth City Council highlighted how asset-based approaches supported participants personal development as well as promoting health improvements: Employment options, we found that people had improvements in their mental health, taking part in the projects and becoming volunteers, had a big impact on their future employability and financial situation. (Portsmouth City Council portfolio lead). Portsmouth City Council s Chances4Change portfolio also noted increases in participants confidence levels: The activity of cooking changed people s opinion of themselves. Activities like feeding other people can be life changing for people; they engender confidence and a sense of community, and they feel they are helping people. (Portsmouth City Council portfolio s healthy eating and cookery lead). Enable East s portfolio ran three events working with local champions, providing skills development opportunities for young people, foster carers and others working in the care system. The Changing the Outlook project equipped participants with the skills to deliver sessions locally to support young people to improve their wellbeing. The model was designed to provide sustainable skills development for people working in the care system. Activities included growing local produce on an allotment, bicycle reclamation, and residential weekends. The project impacted on both the trainers and participants: I got inspired after delivering Bounce that I should make changes myself to be healthier and to have some more me time. I also gave up smoking after delivering a number of the sessions. (Enable East session trainer). Table 5.8 Investing in residents personal development Foyer Federation case study Portfolio total project costs: 3,538, Total funding received from BIG: 3,538, Total number of beneficiaries: 7679 Activities The Healthy Conversations portfolio provided activities for young people at 78 services (mainly foyer accommodation) across England. Following the success of the Youth at Risk staff training in coaching techniques, Newhaven Foyer decided to also invest in a Youth at Risk five day personal development course for young people which was very beneficial. The delivery staff commented that they observed a big change in participants and their compassion for others. It was hoped that this would support sustainability. Youth at Risk was delivered across East Sussex. In year one, Newhaven raised an additional 40,000 which enabled all frontline staff across their services and youth services to receive the training. In year two, they raised another 80,000 from the Henry Smith charity to deliver the training across East Sussex as an intensive personal development course for young people. They were keen to do this as they had noticed that the young people were starting to use the Youth at Risk terminology. 176 Based on figures provided in section 3.2 of the Healthy Conversation s end of grant portfolio monitoring form. 177 Based on figures provided in section 3.2 of the Healthy Conversation s end of grant portfolio monitoring form. 84

93 Foyer Federation case study It s a self development programme, breaking down the barriers...those key drivers are based in every decision you make, so its getting them to recognise the drivers and possibly overcome them (Project manager). Participant/community impacts and sustainability The portfolio did not report on specific outcome targets in relation to residents personal development 178. Staff and participants at Newhaven Foyer explained how the Youth at Risk personal development course impacted on participants personal development: It has knocked down some barriers for me. I can still be quite quiet and on the back foot, but I do put myself forward more You end up talking to people that you never thought you would talk to, the barrier just disappears when you are in here (Participant). Delivery partners working with participants to develop their employability skills have noticed a real difference in participants: It was about challenging behaviours and I have really noticed a change in some of the young women since they ve been on it. One young woman in particular is much more engaging now, before she wouldn t see me, or if she would she d say I can t talk to you five minutes in Now she has engaged with me since that she has now completed a whole day course in First Aid and I m trying to get her an apprenticeship in Health and Social Care, she s done really well and I think a lot of that was down to the Youth at Risk course they did She definitely improved, before she was really defensive and aggressive in her approach but now she s actually having meaningful conversations, she is definitely getting ready for work, and the other one has an apprenticeship which started last week (Delivery partner). Employability Some portfolios highlighted how increased wellbeing impacts on employability. Stockport MBC enabled participants to volunteer and gain a formal qualification (NVQ Level 2 in Nutrition) alongside activities encouraging weight loss and healthy eating. Table 5.9 Volunteering and apprenticeships leading to employment Well London case study Portfolio total project costs: 1,792, Total funding received from BIG: 1,792, Total number of beneficiaries: 18,746 Activities Through the Wellbeing 2 programme, Well London became a locally commissioned model. Individual programmes were commissioned, led mainly by local authority public health teams. The model was also tested in a primary care setting and by a housing association. Well London programmes took place in 11 neighbourhoods, across nine London boroughs. Each programme included Heart of the Community activities which engaged the local community and built individual and community capacity through training, volunteering and employment opportunities. Each programme also delivered mental wellbeing, physical activity, and healthy eating activities designed to empower and strengthen local communities. The bespoke Well London Volunteers Training Programme was validated through focus groups with Well London Volunteers and accredited by the Royal Society for Public Health. The training programme included modules on: public health messages and the role of the Well London volunteer in local 178 Based on a review of the Healthy Conversation s end of grant portfolio monitoring form and change indicators set by the Foyer Federation for the portfolio evaluation. 179 Based on figures provided in section 3.2 of Well London s end of grant portfolio monitoring form. 180 Based on figures provided in section 3.2 of Well London s end of grant portfolio monitoring form. 85

94 Well London case study communities, communication skills, motivational interviewing, community development and outreach in local communities Participant/community impacts and sustainability Well London exceeded its volunteering targets. The target was for 210 individuals (3% of all programme participants) to report an increase in levels of volunteering. By the end of the programme, 11,248 individuals (60%) had increased their volunteering levels, and 284 volunteers had joined the Well London Delivery Teams 183. Well London also created 27 apprenticeships for young people, and 10 of these were match-funded by local organisations 184. An apprentice at Stratford Village GP Surgery explained the approach and its impact on her personal development: There were lots of training opportunities so we were able to grow as we were learning...without that apprenticeship I wouldn t have the confidence We gave a speech at the end of Well London event The job I have now I have to give credit to Well London, because I was actually kept on at the Surgery to continue working with patients and the community.i know I wouldn t be able to do this role without all the vital tips and techniques I picked up from the work we were doing with Well London. Also on a personal note it gave me confidence and reminded me that I can do lots of things it made me feel a lot better about myself and now I have a permanent post. (Well London apprentice now employed by the Surgery to continue her work). UEL's Institute for Health & Human Development (IHHD) developed a joint bid with Bart's Health NHS Trust to Bart's Charity for primary care work in Newham and Tower Hamlets, in order to build on the learning from Well London at Stratford Village GP Surgery. Well London activities will be sustained in a number of London boroughs, including Tower Hamlets, Brent, Greenwich and Lewisham. The portfolio will be taken forward by delivery partners from the University of East London (UEL), which has secured commitment to formalising a Well Communities partnership between UEL and the Royal Society for Public Health to progress the model outside London. This includes plans for establishing Well Communities on a more business-like footing as a not-for-profit community interest company. It is hoped this will generate new opportunities for securing more sustainable funding in the future 185. More broadly, the Well London portfolio generated interest from stakeholders in a number of regions who were keen to adopt the Well London approach. For example: Public Health Wales is interested in the Well Communities model as part of a systems approach to health improvement; Metropolitan Housing is interested in testing the framework on housing estates in Derby and Nottingham; Newham CCG would like to scale up Well London across primary care in the borough; Coventry and Warwick Mental Health Trust is interested in the Well Communities framework as a basis for their staff and patient engagement and wellbeing programmes; and Northamptonshire County Council is interested in the Well Communities framework as a basis for their new health improvement strategy for public health across Northamptonshire 186. Well London was also short-listed for the Carnegie UK Enabling State awards Overview of Well London Volunteers Training Programme. 182 Further information on Well London Volunteer Delivery Teams can be found online: Youthforce, another delivery partner, led on apprenticeships Based on information provided in Well London s End of Grant report. 184 Based on information provided in Well London s end of grant portfolio monitoring form. 185 Based on information provided in Well London s Appendix to End of Grant report. 186 Based on information provided in Well London s Appendix to End of Grant report 187 Based on information provided in Well London s Appendix to End of Grant report. 86

95 Table 5.10 Beneficiary testimony: the impact of volunteering on mental wellbeing and employability Enable East beneficiary case study: Saumya s story 188 HOW VOLUNTEERING COMPLETELY CHANGED MY LIFE By Saumya Singh I came to the UK in September 2012 from India when my husband chose to do his fellowship in Emergency Medicine here. With a flourishing career back in India I arrived in the UK full of hope that my academic background would open numerous opportunities for me here too. For 18 months I constantly applied for jobs, rarely getting an interview. After numerous rejections I almost lost hope of ever finding a job. I have always been a very confident individual but I became overwhelmed with self-doubt. Then one day I registered to the Evolution project run by CSV Media in Ipswich, a volunteering programme for refugees, asylum seekers and migrant women who have recently moved to the UK. I enrolled on to some exciting courses and realised I could gain certifications that might improve my chances of getting into employment. I felt really motivated and didn t want to miss any opportunity to get out there. I visited CSV regularly and one day poured my heart out to Gauri, the Project Co-ordinator. She understood me so well, and due to my MBA in healthcare management she asked me to volunteer at the CSV Media Roadshows, part of Enable East s Big Lottery funded Wellbeing in the East portfolio. The roadshows gave me a chance to use my potential. Going to different areas, reaching out to people, encouraging them to pursue healthy lives and liaising with other organisations was hugely satisfying. It was great to see people from diverse backgrounds coming together to build a resilient community. Today I work as a Project Officer for the Evolution project. I owe so much to the Wellbeing in the East Roadshows, where my interests could be nurtured, my passion to work with people was observed and my enthusiasm to be part of building healthier, stronger communities became evident. Today I don t feel isolated; I belong to this community as much as this community belongs to me. Portfolios generated wider benefits for young people in particular. For example, the Foyer Federation and the Children s Food Trust supported young people living chaotic lifestyles, in some cases in temporary accommodation. This target group reported increased self-esteem and self-confidence as a result of participation, and some young people extended education and training goals, as the interventions had increased their sense of direction. 188 Beneficiary case study produced by Enable East s Well-being in the East portfolio, Available online: How volunteering changed my life, Saumya Singh, Enable East, Big Lottery Fund blog, 13 th July

96 Table 5.11 Goal setting helping young people to improve their employability Foyer Federation case study Portfolio total project costs: 3,538, Total funding received from BIG: 3,538, Total number of beneficiaries: 7679 Activities The Healthy Conversations portfolio provided activities for young people at 78 services (mainly foyer accommodation) across England. The Foyer Federation s Healthy Conversations portfolio helped young people develop employability skills: A lot of our young people generationally their families have never worked they come here expecting to always be on benefit and have no aspirations. Through Healthy Conversations we have been able to work with the Community Development Association. They have come in and run workshops and work ready people have been offered apprenticeships as part of this programme which has been brilliant (Newhaven project manager). The delivery partner delivered their Opportunities programme onsite at the Foyer. The employability programme was designed for year olds and up to 25 year olds with special educational needs. This includes a job club on a Thursday afternoon in the Foyer lounge. The activity engaged 15 young people. The aim of the workshops was around: Getting them work ready, all their PSHE personal, social, emotional health and wellbeing, all the stuff that helps them re-engage I come in and look at their CVs, help with employability, look at any [college] courses that might be suitable. I provide a drop in (Delivery partner). Participant/community impacts and sustainability The portfolio reported on several change indicators around goal setting, which showed positive results. The portfolio reached 4,486 young people (compared to a target of 4,026), who set 15,281 goals between them (against a target of 9,462 goals). The most popular theme for goal setting amongst young people was mental wellbeing (with 5,922 goals being set around mental wellbeing). Furthermore, 3,689 young people progressed their goals (compared to a target of 3,020). Between them, these young people progressed 9,390 goals against a target of 6,493; 3,665 of these goals related to the mental wellbeing theme 191. The delivery partner at Newhaven Foyer noted how the goal setting approaches utilised through Healthy Conversations has helped participants improve their employability: We have definitely seen an improvement. They have to reach certain goals the ones that do actually reach their goals certainly two people when I first met them weren t even ready for group work and now they ve been through an induction and are going for a traineeship. I know their inductions went well They need some goal setting before they go, because they need to know that they can achieve. So they need to be able to set goals for themselves and then the key worker can support them to reach those goals. It might be something simple like getting the bus, but if they can do that then they can see that there s an improvement. If they can do that you can help them see they ve come such a long way and that you think they are now ready to move on (Delivery partner) Impacts on community wellbeing The ethos behind the Wellbeing 2 programme was to support community development within the context of public funding cuts, engaging and upskilling local people to take ownership and help shape their local community services. 189 Based on figures provided in section 3.2 of the Healthy Conversation s end of grant portfolio monitoring form. 190 Based on figures provided in section 3.2 of the Healthy Conversation s end of grant portfolio monitoring form. 191 Based on figures provided in the Healthy Conversation s end of grant portfolio monitoring form. 88

97 Each project is focused on the need of the local community I think that is what has made the portfolio so successful - we haven t taken away that local bottom up approach. Most of the services have been driven by the local service users need and what they will engage in people are from areas of deprivation where budgets are tight and knowledge of healthy eating is poor. (Westbank portfolio lead). The development of asset-based approaches is a key success factor of the Wellbeing 2 programme. Asset-based approaches recognise the existing skills and knowledge of participants, and build on these by engaging local people in the design and delivery of activities. The portfolios provided a wide range of training and up-skilling opportunities for local people through volunteering and apprenticeships. The upskilling of local people will also support the sustainability of activities in the longer term, as the community have a greater sense of ownership and responsibility for maintaining activities which support the wellbeing of their community. This is achieved through the coproduction of activities by engaging local people on steering groups and in planning sessions to identify need, design interventions and deliver activities using a peer education approach. An example of this approach is provided in the Peabody Trust case study below. Table 5.12 Community Activators Peabody Trust case study Portfolio total project costs: 1,806, Total funding received from BIG: 1,806, Total number of beneficiaries: 16,665 Activities The Activate London portfolio empowered participants and communities to develop the skills and confidence to take control of, and improve, their collective health and wellbeing by taking ownership of local projects. The portfolio supported 16,665 participants to improve their overall wellbeing, compared to a target of 10,989 people. The portfolio engaged people from some of the most disadvantaged and socially excluded communities across London 194. The Community Activator project empowered local people to champion wellbeing in their communities, by supporting them to develop the skills and confidence to lead community activities. The portfolio recruited 54 local people as Community Activators. The Community Activators ran a wide range of activities including: Zumba, bingo, cooking classes, a chicken club, and toddler groups 195. The Community Activators projects were designed to promote healthy eating and exercise, reduce isolation, and improve mental wellbeing. Activities delivered by the Community Activators engaged a total of 2,307 participants 196. Community Activators could initially apply for a budget of up to 800 and also for additional funding to run subsequent activities. For example, Toddlers Inc was set up by several Community Activators in April 2014, after attending a Tenants Association meeting where the need for local activities was identified. The Community Activators received 2,000 to purchase equipment for the toddler group, such as soft play mats, cots, bouncers, chairs and an indoor bouncy castle. The grant also paid for marketing materials to promote the group 197. The aim was to develop activities that could be sustained by local people: We are building up the local capacity and capability in those areas so they can then apply for local grants to run the programmes. (Peabody Director of Community Programmes). This approach secured the longer-term engagement of some Community Activators, enabling them to 192 Based on figures provided in Activate London s financial tables. 193 Based on figures provided in Activate London s financial tables. 194 Based on figures provided in Activate London s end of grant monitoring form. 195 Based on information provided by Activate London in FINAL REPORT 1.1 What progress have you made? paper. 196 Activate: Stories of Participation and Impact report, produced by the Young Foundation, March Activate: Stories of Participation and Impact report, produced by the Young Foundation, March

98 Peabody Trust case study plug local service gaps. The toddler group became self-sustaining by charging mums a small fee to pay for fresh fruit and snacks at the sessions. The portfolio found that activities addressing community needs were the most sustainable 198. Participant/community impacts and sustainability Activate London exceeded all its outcome targets in relation to the three key programme themes. By the end of the grant 8,128 people stated that they had improved their mental wellbeing (compared to a target of 4,978), by participating in arts and social projects. 4,569 people reported an increase in their physical activity levels (compared to a target of 2,957 people) and 3,968 people had healthier diets (compared to a target of 3,054 people) 199. These outcomes were highlighted at the individual level by Community Activators. For example, the Community Activator leading the toddler group noticed an increase in participants physical activity levels and confidence, healthier eating and improved communication between children and their parents/ carers: Having the fruit time and getting them involved in the tidying up, they feel like they re part of it, part of a group. It does them good to prepare them for nursery. (Community Activator) 200. The activities also supported parent and child bonding, and produced wider community benefits: We are trying to get the community involved it s not just a playgroup it is for the community, it s not just for the children a lot of it is for the parents and the carers It can be a meeting place people on the estate, they re coming to the group and speaking to people who they ve never spoken to before and yet are in the same community. (Community Activator) 201. In terms of sustainability, Peabody s Community Development team is working to continue the Community Activators model through work with Peabody residents and management committees 202. Its sustainable because it trains up very local community development workers so they can champion these activities in their own communities For example some Activators would receive initial funding for an exercise class, but it would gradually become a pay-as-you-go class, and that would pay the tutor costs and Peabody would provide the venue for free, that would be our in-kind contribution. It was designed to get local people to take responsibility and champion health and wellbeing in their local communities. (Portfolio lead). Some of the portfolios ran public campaigns. Some campaigns were focused on specific populations (school-based or estate-based). For example Sustrans ran active travel campaigns initially in schools and then widened these out to involve families and the wider community. These campaigns were seen as supporting community cohesion. Groundwork highlighted wider community benefits from their healthy eating courses, as participants engaged with their families more, spending quality time with their children cooking food from scratch. Participants reported real impacts on family life. A number of portfolios commented that Wellbeing 2 activities had increased community cohesion. For example, some of the trainers from the Children s Food Trust portfolio noted greater co-operation and cohesion amongst local residents as the programme became established locally. 198 Based on information provided by Activate London in FINAL REPORT 1.3 What have you learned? paper 199 Based on figures provided in Activate London s end of grant monitoring form. 200 Activate: Stories of Participation and Impact report, produced by the Young Foundation, March Activate: Stories of Participation and Impact report, produced by the Young Foundation, March Based on information provided by Activate London in FINAL REPORT 1.3 What have you learned? paper 90

99 5.2.3 Impacts of project settings The integration of activities into the local community was a key success factor for the Wellbeing 2 programme, and will help to sustain activities in the longer term. Initial investments through the Wellbeing 2 programme, both in local people and resources, re-energised local settings and resulted in activities being more likely to be mainstreamed by participating organisations. This section will highlight impacts achieved by a variety of project settings. Several portfolios also highlighted the influence of local community politics on take-up of project settings, whereby participants may not attend an activity in an unfamiliar part of town or somewhere they do not feel they belong. Successful project settings were identified as follows: Community settings and events A key success factor of the Wellbeing 2 portfolios was establishing a local presence. Sustrans established community hubs for promotion and delivery. Based in shop fronts and leisure centre, this approach was very successful in raising the profile of the project and encouraging people to participate. Some Wellbeing 2 portfolios upgraded local buildings and spaces. For example, the Foyer Federation s portfolio upgraded music rooms, and funded small capital items and equipment to furnish and decorate art rooms, chill out spaces (for wellbeing activities and counselling sessions), gardens, and allotments. Well London invested in a community centre kitchen and allotment for local food growing and to promote healthy eating. These activities fostered a sense of belonging, pride and commitment in local spaces and communities: It s created a greater sense of belonging, and doing things jointly has brought people together. We had a community fair, and a number people from the activity groups were involved in running and setting up the community fair for the whole community. (Chief Executive, the For All Healthy Living Centre, Westbank portfolio). Care homes were also identified as a positive setting for activities. Age UK delivered training to staff in care homes to become older men s champions, to engage male residents at risk of being isolated in residential homes. As a result of the training, the older men s champions are now hosting activities which engage male residents and help them feel more part of the home community. The Soil Association are also in the early stages of rolling out their healthy eating standards to care home settings. Portsmouth City Council s Chances4Change portfolio delivered Singing Box sessions for older people with dementia and Alzheimer s in the care environment. Each care home in the local area was given a Singing Box. The aim is to generate business revenue in the future, to support the sustainability of the project, by selling the karaoke style singing box for 1,200 to 1,300. Westbank highlighted the value of delivering activities in Healthy Living Centres and Children s Centres: Delivering in the Healthy Living Centre where there are GPs, pharmacists, dentists, midwives and health visitors, the whole location model in a very beautiful building which is about wellbeing, we recognised that people like coming to the building, its not the fear of going to see your doctor, it s a place to come and engage in positive activities. In the children centres, that s where the families feel most comfortable and safe and going to them rather then asking them to come to you. (Complementary Health & Wellbeing Manager, and Head of Services, Wellspring Healthy Living, Westbank portfolio). Delivering activities on commissioners sites also provided a very effective means of communicating with commissioners, as the following examples demonstrate. 91

100 Schools A number of portfolios delivered extra-curricular/enrichment activities in school-based settings which proved very effective. For example, the Children s Food Trust delivered school based healthy eating clubs, as described in Chapter 4. Mind and Portsmouth City Council s Chances4Change portfolio trained school teachers in mental health awareness and first aid, to improve support for students showing signs of poor mental health or bullying. The Soil Association and Mind also delivered school-based activities. Table 5.13 Participant-led school based activities Foyer Federation case study Portfolio total project costs: 3,538, Total funding received from BIG: 3,538, Total number of beneficiaries: 7679 Activities The Healthy Conversations portfolio provided activities for young people at 78 services (mainly foyer accommodation) across England. Residents of Market Wells ran a very successful Health Action project working with a primary school in a locally deprived area. Two Foyers linked up with the school through the local Police who knew the school needed some help. The young people from the Foyers held planning meetings with the school and worked with them to paint the playground, including murals and a road layout on the ground to help the school teach road safety to the children. This was a key priority for the school as there is a high level of road deaths in the Wirral. The younger brother of one of the participants attends the school and this engendered a high level of pride in all the family members, especially when the school held a special assembly to say thank you to the young people. Participant/community impacts and sustainability A key change indicator set by the portfolio was to engage 570 young people as volunteers to design Health Action projects to improve access to mental health, physical activity and healthy eating support. Another key change indicator set by the portfolio was for these 570 volunteers to design 95 Health Action projects. The portfolio overachieved both of these targets, recruiting 1,166 young people who volunteered to help design and develop 140 Health Action projects 205. The Market Wells Health Action project benefitted 300 children at the school and will be used as an ongoing tool in teaching road safety. The project saved the school around 20,000 and has led to an ongoing relationship between the Foyers and the school. One participant is now undertaking work experience at the school. The Foyer also engaged other community organisations in their Health Action projects. This included cross-generational work at an older people s community centre focusing on nutrition. This culminated in a big community open day providing food and information on healthy eating. An open/fun day was also held for the local community to celebrate the outcomes of Healthy Conversations, with young people and local health providers hosting stalls. GP Practices A number of portfolios demonstrated the value of partnership working with GP Practices to support the legacy of activities, by embedding services locally and becoming part of the Practice environment. Examples include Well London s work in GP Practices and Altogether Better s creation of Practice Health Champions based in GP Practices. For example, the First4Health Group, a federated group of three GP 203 Based on figures provided in section 3.2 of the Healthy Conversation s end of grant portfolio monitoring form. 204 Based on figures provided in section 3.2 of the Healthy Conversation s end of grant portfolio monitoring form. 205 Based on figures provided in the Healthy Conversation s end of grant portfolio monitoring form. 92

101 Practices in the London Borough of Newham, hosted Well London activities to enhance patient engagement: As a result of Well London within the First4Health Group, we are using a similar sort of approach to engagement with our patients. So we are looking at holding events where patients can effectively come along and talk about what it is they want to see in their GP Surgeries. So its not about what s wrong with the Surgery, its moving away from the moaning culture, to this is your community, these are the local services that are around, you don t necessarily need to see a GP so we become more of a signpost to other services. And its also getting GPs involved in local communities. (Chief Executive of a consortium of GP Practices participating in the GLA Well London portfolio). Basing activities in GP practices provided very successful for the Well London portfolio. As a result, UEL's Institute for Health & Human Development (IHHD) developed a joint bid with Bart's Health NHS Trust to Bart's Charity for primary care work in Newham and Tower Hamlets, to build on the learning from Well London at Stratford Village GP Surgery. (Please refer to the case study on Altogether Better s approach in section above). Hospitals The Soil Association s Food for Life Partnership worked with hospitals to improve healthy eating standards and provision for patients. This approach is explored in the Soil Association case study in chapter 3 on the Healthy Eating theme. Sports facilities The Enable East portfolio highlighted the importance of delivering services in innovative settings to increase take-up. For example, CHAPS Men s health check events were held at local football stadiums to overcome issues men had around accessing health services at GP Surgeries. The health checks were available before and after work hours to fit around participants work commitments Cross cutting work on sustainability In addition to the sustainability actions identified in the thematic chapters, portfolios also worked on the following approaches to sustainability: Social prescribing models Age UK s Fit for the Future project explored social prescribing approaches, engaging with health professionals to encourage them to refer to patients to local Age UK activities designed to get older people more active, improve their diet, and increase social connectivity. Westbank also established a social prescribing model, which has been incorporated into Westbank s wider strategic planning, so the portfolio has demonstrated the impact of linking activity to people health needs and embedded this into their health and social care planning. Local authorities Some portfolios were well integrated into their local authority through their delivery model. Several portfolios were led by local authorities, such as Stockport MBC and Portsmouth City Council. However, Stockport MBC commented that the portfolio managers were based in a stand alone team within the local authority which did not lend itself to broader systems change. Other successful methods for securing local 93

102 authority support to help sustain activity included basing project coordinators within local authority settings (such as Well London), and demonstrating how projects can help local authorities implement their Joint Strategic Needs Assessment (JSNA) (refer to the Foyer Federation case study for example). Stockport MBC s North West Networks for Healthy Living Partnerships portfolio was made up of 19 projects delivering wellbeing activities across the North West. Each project used its local area Joint Strategic Needs Assessment to identify the needs of the local area and developed an appropriate local project, based on a community led model. Some portfolios highlighted the value of being co-located with a local authority, such as the Well London portfolio. Portsmouth City Council s Chances4Change portfolio leads were based in the local authority, working alongside commissioners, and were trying to align themselves more closely with the Clinical Commissioning Groups, by demonstrating how the portfolio supported the Healthy Weight strategy and the Mental Health strategy, and the local authority Public Health teams to reach hard-to-reach groups who may not engage with traditional services. The asset based approaches increase community-based resilience and therefore help promote health and wellbeing and fit well with the wider commissioning landscape around prevention. The approach helps to meet outcomes around self-reported wellbeing and physical activity in the public health framework. Social enterprise Portsmouth City Council s Chances4Change portfolio connected local people that wanted to set up their own projects with social entrepreneurs, to help them generate a small amount of income by delivering community food activities, catering and teaching cooking skills. Eight projects across South East England have been supported to set up community interest companies; these are fledgling social enterprises to support the legacy and sustainability of activities delivered through Wellbeing 2. The community interest companies include community bakeries, two community catering businesses and three community cookery schools. Similarly the Foyer Federation s portfolio encouraged young people to trial small scale social enterprises through making products to sell in local markets and community events, with the profits being reinvested into peer activities. Product development Several portfolios were seeking to commercialise products produced through the Wellbeing 2 programme, to generate business revenue to support sustainability. For example, Enable East s portfolio was adapting some of the Bounce materials and planned to market these to employers as Bounce for Business. Similarly Portsmouth City Council s portfolio was seeking to generate business revenue in the future by selling the karaoke style singing box for 1,200 to 1, Cost benefit analysis The cost benefit analysis has been undertaken with reference to the framework set out in Section Costs This section presents an overview of the costs associated with the Wellbeing 2 programme. 94

103 Portfolio expenditure The table below shows that the portfolios spent a total of 39.2 million of funding provided by the Big Lottery Fund. This averages to 2,802,520 per portfolio. The amount of funding spent ranged from 1,792,274 by Well London to 3,769,925 for Age UK. Table 5.14 Portfolio expenditure (Big Lottery Fund grant) ( ) Portfolio name Management Portfolio revenue Portfolio capital Total Age UK 705,488 3,064, ,769,925 Children s Food Trust 374,986 3,338, ,713,548 Soil Association 690,767 2,924, ,615,000 Sustrans 180,000 3,292, ,308 3,615,000 Foyer 452,797 3,063,790 21,633 3,538,220 Mind 535,724 2,626,725 1,521 3,163,970 Groundwork ,708,388 Altogether Better 609,829 2,079, ,689,105 Enable East 452,083 2,214,126 21,145 2,687,354 Peabody 180,000 1,599,130 26,870 1,806,000 Stockport 198,500 1,593,750 13,750 1,806,000 Portsmouth 297,773 1,502, ,800,000 Well London 381,010 1,411, ,792,274 Westbank 344,998 2,162,267 23,233 2,530,498 TOTAL 5,403,955 30,872, ,460 39,235,282 AVERAGE 415,689 2,374,806 35,780 2,802, Information on expenditure was derived from Section 3.2 of the Grant Monitoring Form for 11 of the portfolios. For Enable East and Mind, the latest Portfolio Monitoring Form was used instead. As expenditure data was only derived from the portfolios own records, any internal costs for grant management and administration incurred by the Big Lottery Fund have not been included which is likely to result in an underestimate of the total direct programme costs to the Big Lottery Fund. Other funding Only three of the 13 portfolios reported other funding (i.e. reported total expenditure exceeded the amount of funding provided by the Big Lottery Fund). Details of these other funding sources were not provided. Given the lack of other funding sources, or lack of reporting on other funding sources, the resulting Benefit Cost Ratio (BCR) or Return on Investment (ROI) has been calculated to show the return on the Big Lottery Fund s investment only. Other costs Some or all of the portfolios may have benefited from non-financial, or in-kind, support: for example, staff time or free use of premises. There may also have been wider costs associated with the programme: this might include costs incurred by participants (for example, paying to attend, travel expenses, taking time off work to attend) or costs incurred by other agencies, where participants were referred to other services. 95

104 However, such inputs (and the costs associated with them) were not systematically recorded by portfolios. Therefore, this analysis does not consider these other costs and, as a result, is likely to underestimate the true costs of the programme, although our desk research suggests that anecdotally such costs are likely to have been minimal Benefits This section discusses the potential benefits arising from the activity undertaken by the projects in terms of changes in healthy eating, physical activity and mental wellbeing. Analysis is based on responses from 166 adults and 62 children who completed all three surveys (T1, T2, T3). The surveys administered to this group of children omitted questions on additionality, so additionality estimates are based solely on responses to the adult surveys. Programme beneficiaries The total estimated benefits can be estimated by multiplying or grossing up the average gain (adjusted for additionality) by the total number of beneficiaries for the whole programme. Please note that this assumes this wider group of beneficiaries achieved the same benefits, on average, reported by the 166 adults responding to our surveys. The table below shows that there were an estimated 993,562 beneficiaries across the whole programme. Please note that the number of beneficiaries has been derived from portfolio estimates and it has not been possible to verify how these figures were calculated. Therefore, it is possible that there are differences in how these estimates were derived between or even within portfolios. It should be noted that there is also some degree of variation in the nature and scale of activities experienced by individual participants. However, these figures do provide the best estimate of the number of beneficiaries across the whole programme. The table also shows that there were 548,032 beneficiaries in total across the four portfolios that contributed to the matched sample (adult surveys 206 ). This can be considered a more conservative estimate by which to gross up the total estimated benefits and has been used as the basis for a range (see below for benefit cost ratios). Table 5.15 Wellbeing Project Beneficiaries Portfolio name Beneficiaries (Surveys) Beneficiaries (Total) Children s Food Trust 504, ,300 Soil Association - 189, The children surveys that were returned are excluded because there was no additionality question reported. 207 Let's Get Cooking beneficiaries via cookery sessions held by the Let's Get Cooking network of clubs and also directly through annual Cookathon events. 208 Based upon: 188,500 school children. Based upon 754 schools targeted or enrolled with Food for Life between 2013 and 2015, multiplied by an average primary school roll number of 250 (Source: Department for Education, quoted in 1,000 pupils and rising primary schools go supersize. The Guardian, 17 May Available here: 1,308 staff training attendees. Based upon a total 1,744 attendances and each attendee attending 1.5 sessions (75% of total sessions) on average. The estimated 189,808 beneficiaries does not include parents, school staff, people and organisations within the food supply chain, and caterers, who may have benefited from the project, so may underestimate the number of beneficiaries. In addition, Soil Association have worked with two care home organisations, three early years organisations, three NHS Trusts and one university, so there will be additional beneficiaries over the longer term. 96

105 Portfolio name Beneficiaries (Surveys) Beneficiaries (Total) Sustrans - 113,989 Stockport - 33,500 Mind 31, ,173 Enable East - 30,000 Groundwork - 24,046 Well London - 18,746 Peabody - 16,665 Portsmouth - 9,156 Foyer 7,679 7,679 Westbank - 7,089 Age UK 4,880 4,880 Altogether Better - 2,531 TOTAL 548, ,562 Physical activity Survey findings regarding the number of additional 30 minute sessions of physical activity (at least moderate intensity) were used in conjunction with information on the extent to which respondents felt that their involvement in the project had resulted in changes to their physical activity levels which would not otherwise have taken place 210 to estimate the average number of additional 30 minute sessions of physical activity that had resulted from the project. On average, the projects have contributed to an average adult increasing their at least moderate physical activity by an estimated 1.20 sessions lasting 30 minutes at T2. In other words, it is estimated that every adult did 36 minutes more physical activity in the past month as a result of the projects. At T3, the impact is greater: at least moderate physical activity was estimated to increase by 2.87 sessions lasting 30 minutes on average as a result of the projects compared with T1 consumption. In other words, it is estimated that every adult did 86 minutes more physical activity in the past month as a result of the projects. 209 Does not include those reached by campaigns or social contacts. 210 At T2 and T3, participants were asked: - Have you made changes to your physical activity as a result of being involved in this project? (Options were: Yes, No, Don t know) - Do you think you would have made the same changes to your physical activity had you not been involved in this project? (Options were: Definitely, Probably, Probably not, Definitely not). Participants answering Yes to the former question were weighted according to their responses to the latter question. Weights given were: Definitely = 0.1 Probably = 0.3 Probably not = 0.7 Definitely not = 0.9. In other words, a higher weighting would be given to participants who attributed more of the impact to the programme. Those attributed most weight to the impact of the programme were weighted as 0.9 (therefore 10% of the impact could still be due to other sources or have dissipated), those attributed the least were weighted as 0.1 (assuming that 90% of impact still may have occurred). 97

106 It is estimated that the benefit of every additional 30 minutes of at least moderate physical activity is This is valued using the number of Quality Adjusted Life Years (QALYs) gained by participants. This valuation is based primarily on a 2010 study 212 that uses a Willingness To Pay methodology to ascertain the social value of QALYs gained from health-related interventions and other types of public projects. This study estimated the average willingness to pay per QALY of between 17,980 and 22,750, or approximately 20,000 on average. In subsequent analysis 213, this result has been used to equate a 30 minute physical exercise session of (at least) moderate intensity to a QALY gain of : multiplying this by the value of a QALY (approximately 20,000) provides us with the value of minutes of physical activity at 4.45 equates to 15p per minute. At T2, the projects have contributed to an average adult increasing their at least moderate physical activity by an estimated 1.20 sessions lasting 30 minutes (or 36 minutes). The value attributed to this is 5.34 (15p per minute x 36 minutes). 214 At T3, the projects have contributed to an average adult increasing their at least moderate physical activity by an estimated 2.87 sessions lasting 30 minutes (or 86 minutes). The value attributed to this is (15p per minute x 86 minutes). 215 The total estimated benefits can be estimated by multiplying or grossing up the average gain (adjusted for additionality) by the 993,562 beneficiaries across the whole programme, or the 548,032 beneficiaries amongst the four projects that returned adult surveys. Roughly speaking there were 1 million beneficiaries across the whole programme; at T2 the average value of at least moderate physical activity brought on by a project was approximately 5.34; therefore the approximate aggregate benefit of physical activity as a result of the projects was 5.3 million at T2. More formally, this equates to 5,305,621 (993,562 x 5.34). At T3, the approximate aggregate benefit of physical activity as a result of the projects was 12.7 million. More formally, this equates to 12,677,851 (993,562 x 12.76). Grossing-up based on the 548,032 beneficiaries amongst the four projects that returned adult surveys, the aggregate benefit of physical activity as a result of the projects was 2,926,491 at T2 (548,032 x 5.34). At T3, the aggregate benefit of physical activity as a result of the projects was 6,992,888 (548,032 x 12.76). Healthy eating Survey findings regarding the number of portions of fruit and vegetables consumed were used in conjunction with information on the extent to which respondents felt that their involvement in the project had resulted in changes to their healthy eating habits which would not otherwise have taken place 216 to estimate the average number of additional portions of fruit and vegetables consumed that had resulted from the project. 211 "...we make the assumption that the same QALY gain...is not specific to when the activity is undertaken," Fordham and Barton (2007). However, the paper takes from a study where a 30 minute session was undertaken each month for the duration of one year. The T1-T3 surveys request that respondents report on their activity in the last month, not the last year; therefore such an assumption is necessary because sustainability cannot be estimated by the Wellbeing programme surveys beyond one month of activity. 212 Weighting and Valuing Quality Adjusted Life Years Using Stated Preference Methods: Preliminary Results from the Social Value of a QALY Project. Baker et al. Health Technology Assessment, Fordham and Barton (2007). 214 Fordham and Barton (2007) refers more specifically to calories burned, which implies that running for less than 30 minutes per session or walking for longer than 30 minutes per session could provide the same benefit. 215 Ibid. 216 Using the same additionality weightings as for physical activity. 98

107 On average, the projects have contributed to an average adult increasing their consumption by an estimated 0.32 portions per day at T2. In other words, it is estimated that every third adult (approximately) ate an additional portion of fruit or vegetables every day as a result of the projects. At T3, the impact is greater: consumption of fruit and vegetables was estimated to increase by 0.36 portions on average as a result of the projects compared with T1 consumption. Although the link between fruit and vegetable consumption and health and wellbeing is long established, there is a paucity of studies that enable of valuation of the link. A World Health Organisation (WHO) paper 217 provides evidence on the link between five-a-day consumption and health and wellbeing benefits, specifically the incidence of heart disease, stroke and different types of cancer. Importantly, the WHO paper converts this benefit into Disability Adjusted Life Years (DALYs), as means of measuring the benefit of five-a-day to individuals wellbeing. DALYs are the sum of years of potential life lost due to premature mortality, and the years of productive life lost due to disability. 218 In other words, DALYs estimate the potential number of years lost due to ill-health, disability or early death. An Australian study 219 values the attributable burden of inadequate fruit and vegetable consumption 220 to people aged 25 and over in Australia in as 68,077 DALYs. The paper defines inadequate fruit and vegetable consumption as eating fewer than five portions of fruit and vegetables per day. Therefore, the benefit applies to people who eat five or more portions of fruit and vegetables per day, compared to those who eat fewer than five portions per day. The DALY burden per person aged 25 and over is DALYs (68,077 DALYs Australia population aged 25 and over in ). It is possible to calculate the value from five-a-day consumption, based on another Australian paper 223 that conservatively values a DALY at AUD$60,000 ( 28,297 at today s exchange rate 224 ). The benefit of adequate fruit and vegetable consumption per year at 1996 prices is ( x 28,297). This equates to at current prices is effectively the benefit of five-a-day consumption per year at current prices. However, our analysis provide an estimate of those eating additional portions of fruit and vegetables, rather than those eating five-a-day at T2 or T3 who were not at T1, after additionality considerations had been taken into account. The latter is likely to yield low impact, since consumption of five-a-day is low. For example, based on the T1 surveys, average consumption was around 3 portions of fruit and vegetables The global burden of disease attributable to low consumption of fruit and vegetables: implications for the global strategy on diet. K. Lock, J. Pomerleau, L. Causer, D. Altmann, M. McKee. Bulletin of the World Health Organization, February 2005, 83 (2) Mathers et al. (1999). 220 In other words: the costs associated with inadequate fruit and vegetable consumption. 221 i.e. per year. 222 Source: Australian 1996 census. 223 The economic costs of obesity: Report by Access Economics Pty Limited to Diabetes Australia, October October Source: Google.co.uk. 225 Source: BankofEngland.co.uk prices (most recent available) portions of fruit and vegetables. 99

108 It could be said, therefore, that, on average, participants would need to consume two extra portions to satisfy the adequate consumption of fruit and vegetables criterion. In other words, it could be assumed 227 that two extra portions provide of benefit in terms of adequate fruit and vegetables consumption (therefore 1 extra portion would equate to of benefit). At T2, the projects have contributed to an average adult increasing their consumption by an estimated 0.32 portions per day. The value attributed to this is ([ extra portions] x ). At T3, the projects have contributed to an average adult increasing their consumption by an estimated 0.36 portions per day. The value attributed to this is ([ extra portions] x ). Please note that caution should be exercised when interpreting these estimations due to the assumptions made. Also note that the source attributing fruit and vegetable consumption to DALYs in an Australian study from , therefore further caution should be exercised due to the age of this study and its use in the context of a different country. The total estimated benefits can be estimated by multiplying or grossing up the average gain (adjusted for additionality) by the 993,562 beneficiaries across the whole programme, or the 548,032 beneficiaries amongst the four projects that returned adult surveys. Roughly speaking there were 1 million beneficiaries across the whole programme; at T2 the average value of fruit and vegetable consumption brought on by a project was approximately 45; therefore the approximate aggregate benefit of fruit and vegetable consumption as a result of the projects was 45 million at T2. More formally, this equates to 44,839,453 (993,562 x 45.13). At T3, the approximate aggregate benefit of fruit and vegetable consumption as a result of the projects was 50 million. More formally, this equates to 50,234,494 (993,562 x 50.56). Grossing-up based on the 548,032 beneficiaries from four projects that returned adult surveys, the aggregate benefit of fruit and vegetable consumption as a result of the projects was 24,732,684 at T2 (548,032 x 45.13). At T3, the aggregate benefit of fruit and vegetable consumption as a result of the projects was 27,708,498 (548,032 x 50.56). Mental wellbeing The survey provides some indication of positive effects on mental wellbeing amongst participants. There are two main schools of thoughts on valuing mental health and wellbeing. The first relies on valuing tangible benefits in terms of health outcomes: for example benefit to the NHS in terms of treatment that would otherwise have been necessary. Benefits could be measured in terms of proxy values (e.g. cost saving associated with NHS time/resources saved) or a QALY approach 229 similar to that presented earlier in the report. 227 The value is a binary variable (adequate consumption, or not) and that the data provided necessarily is numeric (number of portions). 228 This was the most relevant and recent valuation that could found. 229 See for example: Greater Manchester Cost Benefit Analysis: Technical Specification version 2.0. new economy Manchester. March 2013; however, this source presents the benefit as avoiding a loss in health status in QALYs from avoiding a severe (Level 3) mental health problem. 100

109 The second measures more subjective or intangible benefits to a person s wellbeing, perhaps based upon a Subjective Wellbeing approach or Willingness To Pay approach. 230 The study did not find widespread evidence across the projects that benefits to mental wellbeing directly led, or could be said to have led, to significant cost-savings to the NHS. Neither was it found that benefits to mental wellbeing would elicit a willingness to pay for the project from beneficiaries in direct comparison to a mental health-related intervention (for example, a course of therapy or CBT). A subjective wellbeing approach would require information on individuals incomes, which was not available. Also, any mental wellbeing benefits may have arisen from improvements to individuals healthy eating or physical activity, so including further benefits would double-count existing benefits. Therefore, it has not been possible to value the impact on mental wellbeing in monetary terms for this cost benefit analysis. Overall Benefit Cost Ratio The estimated benefits and costs associated with the programme are presented below. At T3 the estimated benefit cost ratio ranges from 1.60 to In the context of this analysis, the benefit cost ratio (BCR) should be interpreted as the Return on Investment (ROI) from the Big Lottery Fund s contribution to costs. Table 5.16 Benefit Cost Ratio (grossed up by all 993,562 beneficiaries) T2 T3 Total benefits 50,147,976 62,898,028 Total costs 39,235,282 39,235,282 Benefit cost ratio Table 5.17 Benefit Cost Ratio (grossed up by all 548,032 beneficiaries) T2 T3 Total benefits 27,666,292 34,693,489 Total costs 14,185,663 14,185,663 Benefit cost ratio It could be said that the BCRs presented above can be seen as conservative figures subject to any sensitivity analysis and normal allowances for error because they exclude any valuation of changes in mental wellbeing arising from the projects. However, in-kind costs and internal costs for grant management and administration are not accounted for in the total costs, therefore total costs may be underestimated. Caveats around the assumed extent to which any changes are sustained should also be noted (for example, the research which was used to inform the valuation of physical activity is based on the assumption that changes are maintained for one year). No attempt has been made to value the extent to which benefits may persist into future years. 230 Valuation Techniques for Social Cost-Benefit Analysis: Stated Preference, Revealed Preference and Subjective Well-Being Approaches. D. Fujiwara, R. Campbell. HMT/DWP, July

110 6.0 Conclusions and recommendations 6.1 Summary of key findings This evaluation has identified a number of key success factors associated with the design and implementation of Wellbeing activities, namely: Coproduction, including peer educator activities. Asset based approaches. Project settings have been shown to be very important. Reducing social isolation through group activities. Providing opportunities for individuals to develop their skills, re-engage with learning and training and progress into volunteering or employment. The embedding of these approaches has enabled a good proportion of activities funded through Wellbeing 2 to become self-sustaining. The survey results illustrate how the three strands of the programme: physical activity, healthy eating and mental wellbeing each contribute to overall wellbeing. Whilst impacts are shown for each strand, the programme generated slightly higher impacts for the healthy eating and mental wellbeing strands than the physical activity strand. The change in consumption of fruit and vegetables was higher for young people compared to adults (between T1 and T2), although the increase recorded by young people at the end of project participation was only partly sustained at the follow up stage. In contrast, the increase in life satisfaction recorded by adults was higher than that for children (which actually registered a small decrease at T2/3). Adults reported an increase in their levels of life satisfaction from 6.2 at T1 (start of the intervention) to 6.5 at T2 (end of the intervention) to 7.0 at T3 (around three months post intervention). Adults also reported positive change in feelings of being worthwhile, happiness and anxiety levels. The increases in moderate physical activity levels were greater for both adults and children compared to the more modest increases recorded for vigorous and gentle activity. The qualitative evidence demonstrates successful approaches in bringing about behaviour change, and their impact on local people and communities. The survey results also suggest that Wellbeing 2 participants have made changes which have been sustained beyond the time of their involvement with the projects. However, the relatively low response rate (which included several portfolios opting out of the national survey entirely) means that it is unclear how far the responses received can are generalizable to the wider population of participants. The report therefore identifies a series of recommendations for future programme design, highlighting the importance of ring-fencing resources to support the generation of robust evidence at a programme level to evidence the value of funding this type of programme. The three programme themes can clearly be seen to impact on each other and link together to promote overall wellbeing. The report has demonstrated how impacts on the three themes are intrinsically linked, with physical activity and healthy eating both potentially bringing about increased mental wellbeing while improvements in mental wellbeing can increase feelings of control over general health as well as interest in adopting healthier lifestyles (including improved diets and increased physical activity levels). The 102

111 connectivity between the three themes should be recognised in the development of future programmes and funding streams. In addition to impacting on the three themes, the Wellbeing 2 programme also generated broader outcomes around reducing social isolation, and raising self confidence and self esteem, enabling people to move forward in their work-related lives. The report also provides strong examples of wider impacts on participants families and local communities. Whilst these wider impacts cannot be quantified, it is worth noting that the programme has therefore impacted on both direct participants and a range of indirect beneficiaries. The programme reported a good level of impact around the development of cost-effective approaches to delivering wellbeing activities. A cost benefit analysis was undertaken to determine, as far as possible, the return on investment for the Big Lottery Fund related to the Wellbeing 2 programme. Utilising available research evidence concerning the value of physical activity and healthy eating suggests a return on investment of between 1.71 and 2.45 for every 1 spent. This is likely to be a conservative estimate of the value of benefits generated by the programme as it does not account for the value of impacts on mental wellbeing. The programme reported a good level of impact around the development of cost-effective approaches to delivering wellbeing activities. The evaluation was also asked to explore the extent to which wellbeing interventions have helped to prevent ill-health or other problems which lead to costs to public services. Whilst longer-term tracking would be required to robustly demonstrate clear impacts in these areas (and any associated cost savings for public services), it is clear that activities were encouraging people with life-limiting health conditions such as diabetes and obesity to improve their health, and were supporting vulnerable groups to lead healthier lives that may help them maintain independent living for longer. The portfolios developed a number of successful sustainability mechanisms, highlighting the importance of a multi-faceted approach to achieving sustainability. Successful approaches highlighted in this report are: Mainstreaming activities (into a core offer). Upskilling local people to drive community development in the future (volunteers, champions, ambassadors, apprenticeships). Training staff in partner organisations (to cascade training and implement practices in their work) Operational developments. Upgrading local community building and spaces (kitchen, gardens, allotments). Social enterprises. Social media (websites, apps, DVDs). Awareness raising and campaigning. The wider context of public sector funding cuts and austerity is a key barrier to securing alternative funding sources to sustain activity. Consequently activities were sustained on a project-by-project basis rather than at a portfolio level. Portfolios consistently highlighted that potential commissioners demanded robust evidence of impact and some felt that two years funding allowed insufficient time for developing and delivering community-led approaches and embedding them within local structures. 103

112 6.2 Recommendations The process of undertaking the evaluation has generated a number of lessons for future evaluation design which are summarised below: Portfolio versus programme-level evaluation grant recipients should be given clear guidance on the Big Lottery Fund s expectations for evaluation, including the degree of involvement and cooperation required with any programme evaluation. Use of surveys for data collection flexibility is required when administering surveys across a programme. It is also essential that grant recipients are required to commit to participation in the survey at an early stage in order to maximise the likelihood that response targets are met. Communication in this case, particular problems seem to have occurred as a result of the portfolio nature of the programme which meant that portfolio teams were essentially managing the survey administration process across a number of projects. Were this approach to be repeated it would be preferable for the evaluation team to have direct contact with those projects distributing the surveys in order to ensure that this is being done in accordance with the instructions and to allow more careful monitoring of returns. Timing of evaluations portfolio/project evaluation outputs need to be produced in time to feed into any programme evaluation. 104

113 Annex One: Big Lottery Fund Wellbeing 2 Portfolio summaries A1

114 North West Networks for Healthy Living Partnerships - Stockport Metropolitan Borough Council North West Networks for Healthy Living Partnerships addresses the themes of young people, complex needs, older people and local food. Let's Get Cooking - Children's Food Trust The Children s Food Trust enables children, adults and the wider community to eat more healthily by promoting healthy eating, increasing people s knowledge and understanding of the links between local food and healthy lifestyles, by developing their food skills and by improving their eating habits. Time to Change MIND Time to Change is England's biggest programme to end the stigma and discrimination faced by people with mental health problems. The programme is run by the charities Mind and Rethink Mental Illness, and funded by the Department of Health, Comic Relief and the Big Lottery Fund. Time to Change aims to work with all sectors and communities to encourage more open conversation about mental health and ensure that people with mental health problems can be equal and active citizens. Time to Change combines a national campaign with community activity. It funds grassroots anti-stigma projects, and supports people with experience of mental health problems to become active social leaders. The programme also works with the media, a wide range of organisations, BME communities and children and young people. Food for Life Partnership - Soil Association The Food for Life Partnership aims to transform food culture along its journey: growing, cooking, origin and quality. It initially worked with 180 flagship schools, promoting the principle of a whole school approach including links into local communities. The partnership now has 14 local directly-commissioned programmes including: direct commissioning by clusters of schools; additional grant funding from the Department of Health; a quasi-franchising model with accredited local providers; and is developing new partnerships. The portfolio is branching out beyond schools into other organisations and sectors to extend its reach into any setting where food is provided to the public. Chances 4 Change - Portsmouth City Council The Wellbeing 2 programme is structured around five geographical hubs led by Public Health teams in local authorities and a sixth hub, consisting of six previous delivery partners, working across the healthy eating, physical activity and mental wellbeing themes. Altogether Better - South Yorkshire Partnership NHS Foundation Trust Altogether Better is working with CCG s, GP practices, acute trusts, mental health trusts and others to build on its community health champion approach, offering a new kind of relationship between local citizens and services. The aim is systems change, to bring a whole systems approach to planning and delivery which sees the citizen or patient as an equal partner in the process. Wellbeing in the East Enable East Enable East builds resilience amongst some of most vulnerable people with multiple and complex needs: armed forces families, looking after children and people using food banks. Activate London - Peabody Trust The Peabody Trust takes a community development approach to improve the wellbeing of residents living on social housing estates across London. A2

115 Active Travel Consortium Sustrans Sustrans reach people in their communities, education or work places. Activities include providing people with high quality opportunities to try out or start cycling or walking and giving people information about why and where they can try out walking and cycling. Well London - Greater London Authority Well London is developing local programmes that can be commissioned by an agency such as a local authority or GP Practice etc. The portfolio gives a greater role to local policy makers to incorporate local priorities into activities. There are 11 projects being run in nine London boroughs, across the physical activity, healthy eating and mental health themes. Healthy Transitions - Foyer Federation Through a series of activities, young people learn how to take responsibility for their physical and mental health goals. They also learn how to develop healthy connections that enable them to build a healthier lifestyle. Target: Wellbeing Federation of Groundwork Trusts Groundwork builds on existing research and relationships with commissioners to help generate more support for voluntary and community sector health and wellbeing projects. Wellbeing in the South West Westbank Westbank focusses on supporting people with more complex and specific needs and covers all three Wellbeing programme strands; healthy eating, mental wellbeing and physical activity. Fit as a Fiddle - Age UK Age UK ensures older people have access to a tailored package of community support that helps improve their wellbeing, keeping them out of the GP surgery and in their own homes and happy. A3

116 Annex Two: Local evaluation evidence A4

117 A5

118 A6

119 A7

120 A8

121 A9