Issue details

Proposed Decision:

APPROVE the commissioning and implementation of a new service model for physical activity for older people and AGREE to enter into a Memorandum of Understanding with Active Kent to administer the grants through delivery organisations until March 2029.

Background

Since 2015, Kent County Council (KCC) have commissioned aphysical activity service for older people, known as the ‘Postural Stability Service’.

The service is for anyone aged 65 or older and those aged 50-64 years who are judged by a health professional to be at higher risk of falling.

The service aims to:

·         Improve balance strength, mobility and confidence to reduce the risk of falling

·         Increase knowledge and awareness of causes of falls, and potential resultant injury, and the benefits of exercise and good nutrition

·         Reduce hospital emergency admissions due to falls.

The Service is delivered in recent years by two organisations. In East Kent, the service was provided by Kent Community Health Foundation Trust (KCHFT) (ceased in March 2025), and in West Kent by Involve.

In 2024 a decision was taken by KCHFT to cease this arrangement and not continue to offer this service post March 2025. This means that until a decision is made on the future of the Postural Stability Service, and the new model is in place, residents in East Kent are being signposted to other providers of local activities via links on the KCHFT Falls Prevention Service webpage. This includes links to KCC’s ‘Get moving’ webpage, Everyday Active Kent, Age UK, KCHFT “One You Walk and Talk" and Active Kent and Medway, where people can see what is on offer in their district. Residents also have the option to receive a DVD of exercises from KCHFT or view an online (internet) exercise class.

In July 2023, KCC initiated the Public Health Service Transformation Programme (PHSTP). The programme responded to a series of strategic developments, challenges, and opportunities in the commissioning landscape, and is underpinned by an evidence-based review of all internal and external Public Health funded services and grants.

As part of the PHSTP, market, stakeholder and public engagement has been undertaken. All responses and contributions from engagement has been analysed and informed future service delivery.

Reason for Decision:

There is a well-established and evidenced understanding of the need for all adults, including older and frail adults, to maintain physical activity for as long as possible to delay the onset of disability, long-term health conditions, and remain independent as long as possible.

Regular physical activity contributes to the key determinants of healthy ageing:

·         Good physical and mental function

·         Opportunities for social interaction

·         A sense of control over, and the responsibility for one’s own health and well-being

·         Managing or coping with disease symptoms and functional limitations. 

Under the Care Act, KCC is obliged to provide or arrange for services, facilities or resources which would prevent, delay, or reduce individuals’ needs for care and support. Within the Care Act statutory guidance, secondary prevention or early intervention, is defined as more targeted interventions aimed at individuals who have an increased risk of developing needs, where the provision of services, resources or facilities may help slow down or reduce any further deterioration or prevent other needs from developing.

KCC also has a statutory duty to improve the health of the population and reduce health inequalities (Health and Social Care Act 2012). KCC receive a ringfenced Public Health Grant to meet this statutory duty and annually report to Government on how this Grant has been allocated.

Physical activity services for older people supports the Council to achieve priorities set out in ‘Framing Kent’s Future’ and ‘Securing Kents Future’ and plays a vital role in ensuring the effective and timely provision of preventative services which can help meet key priorities:

·         Play a key role in the delivery of early intervention and prevention strategies

·         Reduction in health inequalities

·         Reduction in the number of emergency hospital admissions due to falls in older people

·         Increase in the percentage of adults who are physically active

·         Increase strength, balance and exercise education and activities for older people

·         Enable people to remain independent for longer, enjoy a better quality of life and delay the onset of disability.

As part of the PHSTP, a proposed new commissioning/service model has been developed to better serve Kent’s changing population.

The new approach will include providing more classes in more locations across Kent, particularly in communities that would benefit the most.It is proposed to offer support to those aged 50 and older and include shorter, more intensive courses to increase the course completion rate. This will enable more people to get onto the course and complete it and it is anticipated that this will fit better with peoples’ lifestyles and commitments outside of the course.

Instead of commissioning two organisations to provide the service in the East and West of the county it is proposed services are delivered via a new grant system. This will allow various organisations to apply for grant funding to provide evidenced based, desirable local activities closer to where people live, contingent on meeting service requirements.

It is proposed to enter into a Memorandum of Understanding (MOU) with Active Kent to administer and manage the grant process and ongoing management of the service.

Options (other options considered but discarded)

• Keep current service the same - Keeping the current service model was concluded as a non-viable option, due to the service currently havinga high drop-out rate attributable in part to the length of the programme at 36 weeks, and the age/health/vulnerability of the target population. The current serviceis unable to meet current need and is unable to support enough people to have a significant impact on falls.
• Discontinue all elements of the service - Decommissioning the service was concluded as a non-viable option, due to frailty and falls being a key issue in Kent. Physical activity services for older people supports the Council to achieve priorities set out in Framing Kent’s Future and Securing Kent’s Future and the Kent and Medway Integrated Care System to achieve key outcomes set out in the Integrated Care Strategy. The service plays a key role in supporting KCC to reduce health inequalities and improve the health of the Kent population.

How the proposed decision meets the priorities of New Models of Care and Support as set out in ‘‘Framing Kent’s Future – Our Council Strategy 2022 – 2026’’

Physical Activity Service’s for Older People supports the Council to achieve the following priorities set out in the Council’s Strategy 2022-2026 ‘Framing Kent’s Future’:

• Priority 1: Levelling up Kent
  • To see significant improvements in the economy, connectivity, educational attainment, skills and employment rates and public health outcomes in deprived communities in coastal areas so that they improve faster than the rest of Kent to reduce the gaps
  • To work with our partners to hardwire a preventative approach into improving the health of Kent’s population and narrowing health inequalities
  • Adopt an unrelenting focus on reducing cardiovascular disease in our population by continuing to focus on healthier behaviours, stopping smoking, taking up exercise and healthier eating.

How the proposed decision supports Securing Kent’s Future

Physical Activity Service’s for Older People supports the Council to achieve the priorities set out in Securing Kents Future, by improving balance strength, mobility and confidence leading to reduced risk (reduction) of falling, which will decrease the demand and costs in Health and Social Care.

How the proposed decision supportsthe Kent and Medway Integrated Care Strategy

Physical Activity Service’s for Older People supports the Kent & Medway Integrated Care System to achieve the following outcomes set out in the Integrated Care Strategy:

• Helping the most vulnerable and disadvantaged in society to improve their physical and mental health; with a focus on the social determinants of health and preventing people becoming ill in the first place
• Helping people to manage their own health and wellbeing and be proactive partners in their care so they can live happy, independent and fulfilling lives; adding years to life and life to years.

Financial Implications

The new service length will be:

·         Annual MOU with Active Kent, which will be reviewed and agreed annually. This approach will be in place until 31 March 2029.

The estimated cost to KCC Public Health from 1 April 2026 – 31 March 2029 is £507,800. This will be funded from KCC Public Health’s ringfenced grant.