Making it happen

Whole-system Working

To integrate physical activity across whole-systems will require commitment from people at all levels able to action change and influence behaviour plus collaboration within and between a wide range of organisations. Given the complexity of the systems concerned, we acknowledge that the work will be both challenging and messy.
For effective changes to take place, it will be important for those implementing the strategy to both move beyond existing comfort zones and to adopt a test and learn mindset – and for them to be supported in doing so.
The strategy involves everyone who can influence behaviour, from individuals themselves and staff on the ground to leaders and policy makers.

Sources of influence include:

The individual themselves
Capability, opportunity, motivation, attitudes, beliefs, knowledge, existing behaviours
Social environment

Family, friends, support groups, social networks, social norms within their relationship groups.

Organisations and institutions

Schools, GPs and health and social care, businesses, charities, faith organisations, clubs.

Physical environments

The built environment, access to the natural environment, transport links.


National and local strategies, budgets, laws, rules, regulations, codes.

Whole-system approach to physical activity (adapted from Sport England);

Partnerships and Collaboration

All Together Active provides guiding principles to support collaboration and help partners align priorities and funding. Drawing on existing policies, initiatives and local engagement, the strategy will enable each Place to implement ideas in a way that works best for their residents and stakeholders.

“Activity-related budgets go much further when we collaborate and pool funding than when we spend separately. For example, at the Liverpool City Region Combined Authority, we have capital money to build walking and cycling routes. We’ll get better value and benefit more people if we can align this with funds for cycle training and behaviour change, with programmes that get people walking or cycling as part of rehabilitation or social care support, and with projects looking to make walking and wheeling the default for home to school travel.”

Huw Jenkins, Lead Officer – Transport Policy, Liverpool City Region Combined Authority

Place-Based Frameworks

A framework in each Place will map audiences of interest and planned activities to determine scale and need. Frameworks will capitalise on the common emerging opportunities, looking at where the greatest impact can be achieved in various environments across the full life course. This work will include recognising where inactive people may fall through gaps and finding ways to identify and prevent this.

“I think it would be useful for it to be explicitly agreed as a priority in each of the nine places, because then organisations are held to account for delivering something against this strategy. I think that’s really important as there are lots of priorities at the moment…Part of that then, for the next step…is a really clear plan in terms of what it actually is that we’re going to deliver against this strategy.”

We will encourage and support each Place to develop a framework that includes what contribution to the overall target of 150,000 inactive people more active that they could look to achieve with investment and resources.

How system elements fit together:

PA physical activity. ICS Integrated Care System. ICB Integrated Care Board. ICP Integrated Care Partnership.

System Leaders

The driving force behind the strategy is our network of System Leaders who will cover roles across advocacy, co-ordination and, in some cases, delivery. System Leaders will be critical in ensuring stakeholder and community engagement is at the heart of everything we do, galvanising enthusiasm, inspiring commitment, and coordinating efforts around shared aspirations.

A System Leader can be anyone passionate about using physical activity to improve health and who is committed All Together Active goals. They may be from an organisation or from the community. Individuals taking on a System Leader role must be able to allocate dedicated time to the task.

The strategy creates three levels of System Leader: Physical Activity Subregional System Champions, Physical Activity Local System Champions and Physical Activity System Ambassadors. A core network of Subregional System Champions is already in place, and has been co-ordinating engagement to inform and develop the strategy.

Physical Activity Local System Champions

Role: Drive development of the system approach within their Place at a strategic level

Example activities:

  • Identify opportunities where physical activity can support local health priorities
  • Take part in Place-based planning
  • Support others to implement initiatives
  • Act as a catalyst for local engagement
  • Support learning within their Place and work with Subregional
  • Champions to build and share knowledge
Physical Activity Subregional System Champions

Role: Coordinate things that can be best done at subregional level

Example activities:

  • Lead on influencing national policy
  • Take part in subregional planning
  • Coordinate shared training
  • Consolidate learning to give overall sense of how the subregion is doing
  • Support Places and facilitate collaboration between them
Physical Activity System Ambassadors (both regional and local)

Role: Advocate for physical activity in the course of their day to day work

Example activities:

  • Identify opportunities to embed physical activity in programmes and processes
  • Support learning and evaluation to embed emerging thinking in their work context
  • Represent their organisation, advocating for physical activity as a tool for better physical and mental health
  • At times, take part in more in-depth activities in support of All Together Active

Behavioural Enablers

Six behavioural enablers came out strongly in local engagement as essential for success.

Making the case for physical activity to partners

Find out more

Investing in the system approach

Find out more

Local ownership

Find out more

Community engagement & co-creation

Find out more

Deprived neighbourhoods

Find out more

Promoting positive experiences of physical activity

Find out more

Strategy governance

The framework of System Leaders will be overseen by a clear governance structure led by Strategy Sponsor, Professor Ian A Ashworth (Director of Public Health for Cheshire West and Chester and Chair of the NHS Cheshire and Merseyside Population Health Board).

Strategy Accountable Body: Physical Activity Sub-Group of Population Health Board

Strategy Project Lead: Active Cheshire & MSP

Local Ownership/Governance to be determined in each of the 9 Places

Commissioning body: Population Health Board, formerly accountable to the Cheshire and Merseyside Health and Care Partnership; since July 2022, accountable to NHS Cheshire and Merseyside as the Integrated Care System for the region.
Since 2020, the Population Health Physical Activity Sub-Group has been commissioned to guide the development of this strategy. The Active Partnerships for the subregion, Active Cheshire and MSP, were appointed project leads for the development of the strategy and co-chairs of the sub-group.

Funding and Resourcing

“Spare funding is hard to come by, so this work will not get done if we wait for a major investment.”

Feedback from the Engagement process

Instead, System Leaders will drive the creation and implementation of plans for building capacity and aligning collective budgets, funding bids and workstreams.

Test, learn and scale up

Building on existing evidence, we will grow the evidence base through pilot projects and a test, learn and scale up process.

Measuring Impact

Impact measurements will provide insights into each of the following:
  • Direct cost savings, such as falls prevention and reductions in serious mental health referrals.
  • Improvements in both individual and community wellbeing.
  • How the strategy is supporting the Marmot Indicators in reducing local health inequalities.
  • The effectiveness of subregional support for Places
This will require both qualitative and quantitative data: facts, figures, individual stories, and information on how processes are performing.

Traditional evaluation methods may not always be effective in this dynamic environment. However, we will aim for measurements to be as consistent as possible between Places, audiences, environments and activities.

To achieve this, we will use best practice evaluation approaches from health and social care as the basis of our approach. By aligning methods with existing local measures and using the core themes from the strategy, we will enable Places to assess whether physical activity is being used to its full potential. Though complete consistency will not always be achievable, we will work together flexibly to generate insight which is fit for purpose and helps answer the big questions.


The Road Map

Get Involved

If your organisation would like to be involved in progressing the work at local level then get involved today!