Table 1 Common enablers and barriers to engaging NHS leaders in whole systems approaches to physical activity (Adapted from: Evans et al., 2020) [52]
Enablers | Description |
Recognising and facilitating shared system leadership | An explicit commitment to both a whole systems approach to physical and to facilitating shared systems leadership. |
Key individuals or core teams championing the whole systems approach | Although overall leadership needs to be shared, motivated individuals or small core teams working across local authorities and the NHS (particularly in CCGs) can make a difference in championing a whole systems approach to physical activity. |
Key facilitation role for public health across the system | All actors bring different knowledge and skills to the table, but public health professionals uniquely have the evidence-based knowledge about effective physical activity interventions, the understanding of systems approaches, the partnership skills and the remit to play a key facilitation role in promoting physical activity across sectors including in the NHS. |
Balancing senior buy-in with working with enthusiasts | Gaining ‘buy-in’ from senior managers in the NHS is important (particularly to secure any necessary financial support) but it is recognised that senior managers often or usually have little time to personally engage, and once they have given broad approval for physical activity work, they might have relatively little engagement with or knowledge of the detail. Achieving real change often a result of working opportunistically with enthusiasts, whatever their formal status or level of authority whilst securing in principle support and buy-in from those in more senior leadership positions. |
Taking time to build relationships and develop a shared vision | The importance of relationship building (including the time it takes build trust in relationships) and developing shared vision and shared values. |
Barriers | Description |
Capacity – for the NHS and other sectors | Members of the NHS system – and other sectors – have many competing priorities, and their capacity to engage with the physical activity agenda is often experienced as limited. |
NHS culture | NHS performance management is traditionally focused on clinical treatment and care, quality and finance, and despite the stated commitment to prevention does not currently encourage a focus on the long-term benefits of promoting physical activity |
Engaging the acute sector | Promoting physical activity is still something that is not usually seen as acute sector ‘core’ business. |
Difficulty in demonstrating quantifiable impact in the short to medium term | The main benefits of greater physical activity are likely to accrue over a long-time period – 5 to 10 years or more – whilst the NHS is looking for short term reductions in indicators like bed days. |
Difficulty in seeing opportunities for innovation that do not involve significant new resources | A lack of resources is not necessarily a barrier to innovation around physical activity, but there is a perception that stakeholders in the NHS and other parts of the system perceive this as an important barrier. |