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The issue

Health levels in Sunderland are significantly below the national average. While life expectancy in Sunderland has increased over the last 10 years, adults in Sunderland still die on average almost two years earlier than elsewhere in England. Nearly one in five households has an adult with a life-limiting condition and more than 10 per cent of residents are permanently sick or disabled compared with six per cent nationally. 

Despite some spatial concentrations these health inequalities are a city-wide issue with 11 of the 25 wards in Sunderland being in the top 10 per cent of the most deprived areas in the country. For example, for babies born in different wards on the same day there can be a nine year gap in life expectancy.

Sunderland City Council and Sunderland Teaching Primary Care Trust (TPCT) identified the role of lifestyle choices in creating these health inequalities among residents with:

• only 18.7 per cent of adults doing enough exercise each week – three or more 30 minute sessions each week
• 27 per cent of adults estimated to binge drink – 18 per cent England
• 32 per cent of adults smoking – 26 per cent England – and 21 per cent of mothers smoking during pregnancy
• about 24 per cent of adults being obese – 22 per cent England – and 13 per cent of four and five year olds and 21 per cent of 10 and 11 year olds being overweight and obese.

Local Area Agreement 2008-2011

In response to these challenges, the focus of the Healthy City priority in the Sunderland Strategy 2008 to 2025 and in the local area agreement (LAA) 2008-2011 is:

"To create a city where everyone can be supported to make healthy life and lifestyle choices – a city that provides excellent health and social care services for all who need them. Everyone in Sunderland will have the opportunity to live long, healthy, happy and independent lives."

Achieving positive changes in the lifestyle of Sunderland's residents runs across all delivery activities in the LAA.

Success is being tracked by improvements against a number of key national indicators (NIs) including: Provide people with the opportunity to live as long as those with the longest life expectancy in England (NI 120); and enable people to enjoy an excellent sense of health and emotional wellbeing (NI 119).

To achieve this ambitious health objective, Sunderland City Council has worked with partners to create a comprehensive city-wide health and wellbeing programme. This is to help to improve lifestyles and behaviours especially in the most deprived areas that make up almost 50 per cent of the city. Delivery has been pioneered through new or existing Wellness Centres – known as 'hubs' – linked to outreach services at community centres and schools – known as 'spokes'. Many services have been co-located or reshaped to meet users' needs.

The Wellness ServiceTop of page

Improving quality of life through regular physical activity is at the heart of Sunderland’s vision. The Wellness Service was developed in Sunderland with the aim of improving an individual’s health and well-being. This is through the provision of physical activity opportunities, lifestyle advice and education. The aim has been to shift the emphasis from treatment to prevention of ill health.

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"Sunderland's Wellness Service is full of innovation not least in its approach to partnership working which is breaking down barriers across the city to make it easier for people to make healthier lifestyle choices. This region can learn much from it. It supports Sport England's targets to increase physical activity and it's reducing health inequalities."

Chair of North East Regional Sport Board

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Wellness CentresTop of page

In order to achieve their Healthy City vision and effectively implement the Wellness Service, Sunderland had to make their sport and leisure facilities more easily accessible to residents. In 2004, following the government Health White Paper 'Choosing Health – Making Healthy Choices Easier', Sunderland City Council made the decision to take a successful outsourced fitness operation back in-house. This allowed Sunderland City Council to re-align the service with their emerging Wellness approach, to work more closely with local partners and to increase the targeting and scale of their services to more deprived communities.

With ongoing in-house management, Sunderland has now developed six Wellness Centres. These Wellness Centres act as ‘hubs’ and link to other Wellness services in the city – for example, at community centres. The aim of the Wellness Centres is to provide the facilities needed to increase the number of people taking part in physical activity. The objectives are to:

• ensure an innovative and integrated service approach is developed in Wellness Centres to meet the health needs of specific communities
• reach more people through the joined up approach and to deliver integrated services
• develop a range of preventative services, targeted interventions and pathways to support lifestyle change within the Wellness Centres
• improve people’s understanding of how to live a healthier lifestyle through education on healthy eating, losing weight, physical activity, smoking and safe alcohol consumption.

All six Wellness Centres across the city incorporate the Wellness System, an interactive programme which helps users view, follow and record progress against their personal goals and exercise programmes. The Wellness Centres have state-of-the-art fitness equipment bought through Sunderland City Council’s strategic alliance with Technogym, an exercise equipment provider. Every user is issued with their own Wellness key so they can access their personalised programme, record their progress and see the results. The system also allows the capture of key health and lifestyle data – for example, blood pressure.

Tracking progress is particularly important given the government’s target that 70 per cent of the population should undertake 30 minutes of moderate activity three times a week by 2020. This target represents an increase in participation in Sunderland of one per cent each year to 2020.

Monthly membership of Wellness centres is priced reasonably between £13 and £19 for concessions, and between £31 and £39 for non-concessions based on a month’s notice.

The network of Wellness Centres is continuing to expand. The £22 million Sunderland Aquatic Centre opened in Southwick, Sunderland’s most deprived ward, in 2008. Two new community pools have been provided and a seventh Wellness Centre is due to open in 2010. As well as developing new centres Sunderland has been expanding take-up by, for example, lowering the age limit for children's involvement to eleven to attract more families into the Wellness Centres.

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Bunny Hill Customer Service Centre

Opening in phases between April and June 2006, the £8 million Bunny Hill Customer Service Centre allows local residents to access a wide range of council and partner agency services at one location as part of Sunderland City Council’s “one-stop shop” concept. The centre serves three wards which experience severe deprivation with more than 25 per cent of residents having a limiting long-term illness, more than 39 per cent having no qualifications and 34 per cent of men and 48 per cent of women being economically inactive.

Services at Bunny Hill include:

• a Wellness Centre which promotes health and well being through the provision of physical activity opportunities.
• general inquiries about council services – for example, housing and council tax benefit, homelessness, environmental services – and access to Gentoo services, the housing association for Sunderland.
• an NHS Primary Care Centre providing a range of health services including a GP practice, a pharmacy, planned care – for example, minor surgery – and an urgent service for minor injuries and illnesses.
• a library and community learning suite, including an ICT room. There is also a Books on Prescription service run in partnership with the GPs and a community officer who works in the library with substance misuse clients and young people.
• Sunderland Children’s Centre offers a varied programme of play and learning activities and includes the Buttercup Nursery – full daycare for 26 children and 11 crèche places.
• a community café and an outreach centre for community development.

A number of the services are run by social enterprises – for example, children’s centre and community café – and more than half of the 104 staff are from the local area. Since its opening, the GP’s practice has attracted 7,000 patients compared to an average of 5,000. Urgent care has engaged with 22,000 patients each year and mor than 3,800 patients have been attended in planned care. One quarter of all under-fives in the area are seen by the Children's Services team.

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Sunderland Exercise Referral programme

Sunderland’s Exercise Referral programme is a city-wide physical activity referral approach which allows health professionals to recommend a 15-week course of exercise for patients with a variety of medical problems. These include individuals:

• who have completed a rehabilitation programme
• have high blood pressure, diabetes, arthritis or joint problems
• are overweight or obese
• have established coronary heart disease or risk factors
• suffer from anxiety, depression or a lack of motivation.

Starting with an initial assessment, the programme is available to Sunderland residents and people who are registered with a Sunderland GP. The first session is free but then a small charge is made for each additional session – £2.70 for non-concessions and £1.80 for concessions such as those in receipt of a state pension. Participants are also able to participate in a number of other activities, specifically programmed for referred clients. For example, Cycling on Referral forms part of the menu of options and involves up to two-hour sessions cycling along outdoor routes with a leader. Participants are provided with a bike and all the necessary equipment.

Upon completion of the programme individuals are invited to attend a re-assessment and are given a continued activity pathway – for example, gym, classes, cycling, walking and aqua activities.

The Exercise on Referral Programme primarily takes place at the six Wellness Centres but also at a number of community facilities. The programme is staffed by a team of 20 Wellness Exercise Referral Consultants and NHS lifestyle officers.

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"Many of the illnesses that GP's and hospitals see every day in Sunderland are ones that could potentially have been avoided, or their seriousness reduced. The Wellness Service ensures that people at risk are identified earlier and referred to the appropriate health, diet and physical activity advice that will make a difference to their long-term wellbeing."

Executive Director for Public Health. South of Tyne and Wear

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ImpactTop of page

A robust monitoring system has proved invaluable in measuring impact. For those individuals accessing the Wellness Centres, the Wellness System provides clear evidence about the impact that the Wellness Service is having on improving their health and wellbeing and reducing health inequalities. Success to date has included:

• more than 1,500 of the clients referred each year have completed the exercise referral programme which is delivered in the six Wellness Centres. All 59 GP practices – including some 125 General Practitioners and Health Professionals – refer patients on to the Exercise Referral Programme. Capacity has recently increased with opportunities now available for over 3,000 individuals each year.
• Currently there are 7,597 Wellness Centre members, of which 1,233 are under 19 years of age – 16 per cent.
• Between April 2007 and March 2008 there were more than 300,000 attendances in Wellness Centres by people over the age of 16. Usage of the Wellness Centres was almost twice the local public service agreement (PSA) 2006/07 target of 154,000.

In 2008 Sunderland City Council was awarded Beacon status for Reducing Health Inequalities.

The lessonsTop of page

Sunderland City Council believes there are a number of lessons that underpin the success of their approach to reducing health inequalities through their Wellness Services and Wellness Centres.

• A joined-up city-wide approach with the wide range of external partners and internal departments that is required to address health inequalities. The scale of the service and the number of delivery locations now allows significantly joined-up delivery on a scale that will make an impact.
• A very successful partnership between Sunderland City Council and Sunderland Teaching Primary Care Trust has meant a clear shared vision, priorities, agendas, joint ways of working and distinct roles in funding and delivery.
• A well-developed local strategic partnership (LSP) which is mature in its approach and skilled at producing community strategies and local area agreements with a focus on reducing health inequalities. The partnership "has stepped up a level" by working together over time and achieving significant results.
• A determination to shape frontline services to improve health levels by changing cultures around lifestyle choices. This was helped by having a director of Community and Cultural Services who championed the benefits of being healthy at an early stage.
• By Sunderland City Council acting as both a ‘provider’ and ‘enabler’ to improve access opportunities for physical activity.
• Understanding the need of the target audience was fundamental. Understanding that Sunderland's customer base required more than just a gym was extremely important to agree the purpose of the Wellness Centres and to increase the reach of services in deprived area communities. To be inclusive and successful, the service has to be as applicable to a 18-year-old man as to a 70-year-old woman.

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"It's great, you can come here and make friends as you exercise. If you've got two false hips like me it's a bonus. You go out feeling a million dollars! I've told all my friends and they think I'm brilliant"

Exercise Referral Client

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• Individual support and personalised exercise and health programmes for each client improved the success of the exercise referral programme.
• By being able to align resources in smart ways to maximise their impact on local communities while achieving efficiency savings – for example, through co-location. The Bunny Hill Customer Service Centre was funded through a land sale, grants from five different sources and capital premium contributions from five different occupants.
• An effective communication strategy to ensure doctors and healthcare professionals who refer patients were aware of the exercise referral programme.
• An extensive training programme for staff to provide skills and knowledge to deliver health services to higher risk individuals. There are different skills required for fit users of gyms compared to a user being referred for health and medical reasons.
• By working closely with the community and voluntary sector and placing provision in the heart of a community – for example, the development of the Bunny Hill Customer Service Centre – and supporting the services through outreach.

Further informationTop of page

Richard Hood, Beacon Coordinator for Reducing Health Inequalities 2008/09, Sunderland City Council.
telephone: 0191 561 4713
email:richard.hood@sunderland.gov.uk