Questionnaire

To increase the take up of OA and the range of information available, Local Areas (probably better at the Integrated Care System level), should be provide an application that will allow every Activity Provider (and community group) in their area to load their session data on to an OA feed collector. This then needs to be widely promoted to large, but arguably more importantly to smaller, hyper-local providers that normally deliver a more appropriate “offer”

Activity finders that simply search for named activities (Create activity-type groups) are great if you know what you are looking for. Frontline workers and patients, however, will benefit from wider search criteria to be able to find activities that are appropriate for the individual’s needs and interests. Activity finders could be encouraged to use Target Audience, Social physical activity / Activity by stealth, Accessibility as filters. This strategy introduces the concept that SPLW will be familiar with in the NHS - pathway. A pathway might be the identification of a particular need or health condition that has a set of appropriate activity types connected to it. Pathways could have several steps each with appropriate Create activity-type groups and Intensity levels.

The SPLW wants to know the quality of the activity that they are signing their client up to. It seems reasonable to assume that if the provider was of sufficient quality then it follows that the activity should be too. SPLW are familiar with kitemarks for CQC and Ofsted which are at an organisations level. This is covered in Provider quality assurance strategy. If a quality review was required at the activity level then it is suggested to use the peer review strategy Frontline worker review / rating approach.

ODI have been very successful at “governing” Open Active, with growing adoption of the standard within the physical exercise / sport arena. Broadening this success so that OA underpins exercise-referrals by SPLW, will benefit from cross-sector governance; without this, the alignment of OA with other emerging and developing open standards and related taxonomies will not not happen and will cause confusion and duplication. Open Referral UK is currently going through an exercise to define its future governance, sponsored by DCMS and MHCLG. At the same time, a project led by the South West Academic Health Network is looking to define what standards the NHS will be recommending must be adopted by Social Prescribing systems. It is easy for this strategy to just say, “create a cross-sector governance with teeth and budget” but without this then the obvious benefits of open data will always be a struggle.

Many SPLW have said that physical activity is not top of the agenda for their clients. Often this is because they see exercise as a burden and something they won’t enjoy. However Service Users have explained that they do enjoy socialising. This is a simple strategy for activity providers who wish to be attractive to Social Prescribers to consider offering social elements into their activities. Activity providers should complete the Attending-type to show the group work but then use the Client activity confident and Activity further info to promote the social side of their activity. Social prescribing link workers tend to be currently supporting clients who have complex needs. It is not surprising that physical activity is not top of their ‘to-do’ list. They prefer more social and interesting activities than doing physical exercise. The link workers generally work on a shared decision making process and so physical activity has a referral rate of around 10%. (Note this is a lot higher if the client is referred into frontline workers working in the ‘active’ sector). This may be a result of the motivation generated by the frontline worker. See Training frontline workers strategy. UKActive have said that getting people moving is a step in the right direction and there are a lot of more interesting and social activities that involve physical activity. This strategy is about promoting activity through a more interesting and social angle. Use of the Pathways strategy is one way to achieve this. Encouraging leisure centres and local activity providers to consider Social physical activity / Activity by stealth would be another idea.

Procurement is a very powerful tool to drive adherence to open data standards. If the public and third sector insisted (desirable or essential) on compliance to the standard as part of a procurement exercise then progress will be made. For example, the project that is led by SWAHN -https://www.england.nhs.uk/hssf/ expect compliance with OR APIs to be included in their procurement framework HSSF Essential & Desirable Proposed Criteria Final.pdf. This strategy recommends the OA Governance strategy should work with all sectors to encourage them to specify that OA and OR (and other) data standards are written into their relevant procurement strategies. Any procurement not asking for open data standards should be justifying why not.

Many frontline workers interviewed were frustrated that they don’t always have adequate resources, technology and tools. Encouraging people to take up exercise / attend any local group when they face many other challenges will rely on exploring the options together to build consensus. SPLW need access to the right mobile tools and devices to be successful in this respect. This is not really a strategy but a statement to understand that implementing a digitally enabled data-ecosystem will need all stakeholders to have access to the right hardware,

Deriving real value from OA is dependent on an end to end process across 4 stakeholders (see User Journeys). The ODI provides existing guidance on implementing elements of OpenActive as discreet projects. This strategy recommends a “blue-print” programme plan that will set out a headline plan and supporting tools and guidance on how to implement OA and realise benefits across an ICS. Ideally this would be a programme at an Integrated Care System level so that it had the cross-sector governance required to make it successful. The guidance should explain things from a cultural, process and technical point of view and be aimed at project managers who have the skillsets to make this happen. It is this place-based adoption that drives the greatest benefits to all partners.

The research found that most frontline workers and activity providers have sufficient skills to be able to use the necessary tools / software packages. What is missing is the recognition that data / information about what activities are available should be captured and maintained through a federated model, such as adoption of OpenActive. People are too willing to capture and hold their own information and accept the overhead to maintain this (or more frequently, they don’t maintain it and are happy to then use inaccurate information). At a local, probably at an ICS level, there must be stronger policies for adoption of open data and better adherence to this policy. This will free up frontline worker time, improve experiences for patients and deliver a step-change in the ability to help people engage in valuable and appropriate exercise and engaging in their communities. Citizens, frontline workers and society don’t want to use websites - and local leaders must push hard for a more data-integrated way of working. During 2019, Active Lancashire, on behalf of the Lancashire and South Cumbria ICS undertook research into the digital maturity of social prescribing across the VCFSE. This shows, for example, a continued focus on websites by the sector, rather than recognising the opportunity to shift to a more data-enabled model Digital Maturity. Managers involved in SP will be key influencers to get on board here - see Managers understanding of open data benefits

Most SPLW commented that physical activity is not top of their clients’ lists - who tend to be pre-occupied by issues that might relate to debt, losing their tenancy, their job or suffering significant Mental health stress. The @pathways strategy, could be enriched to and so it will be discussed perhaps later when they are through the crises. However, research is suggesting that physical exercise will help with well-being, mental health and creativity so it migh t be wise to consider a more holistic approach. This strategy is suggesting that rather than a SPLW queueing up the physical exercise chat for down the line, that they chat about the issues that are bothering the client but they also talk about getting them to be more active as it will make the client will feel better. The SPLW can use strategies like Activity by stealth and Social physical activity / Activity by stealth but the point here is to include physical activity as part of a holistic quality of life discussion. London sport have a course for SP to be more confident at referring into physical activity but care is needed to stick with the holistic and personal approach and not be tempted to push people into activities.

The accessibility aids available to an activity can be described in two parts, The first are those that are part of the venue where the activity is taking place and the second are those associated with the activity itself. It is generally agreed that a taxonomy would best describe the accessibility of a venue and activity. As venues are common to all sectors then it is recommended that OA (ODI) should work with a cross sector governance group and a leading disability group to agree an accessibility taxonomy. This research has engaged https://www.accessable.co.uk/ but this is currently a private sector business model. If an accessibility taxonomy can be agreed then OA should adopt an appropriate subset to establish their Activity accessibility taxonomy.

OA has the ability to recognise when the data was last updated through the last modified data in the feed. This will be made more prominent as a last-updated field to give confidence to the social-prescriber. However, it is possible to set up the session series without a scheduled session. This could mean that an activity provider who rarely changes their regular session does not appear to be keeping it up to date. ApP should help their activity providers by encouraging them to refresh (re-save) their content to change this date.

Any frontline organisation, e.g. council, charity, Police, NHS, Housing etc, may make referrals to sessions delivered by local activity providers’. Each sector will have their own definitions of audiences categories and related taxonomies. It would be unfair to expect the Activity Providers to align their activities against every sectors different set of audience categories. As with the Accessibility strategy, it is recommended that the OA (ODI) work with a cross-sector governance body to agree a Target Audience taxonomy. This should be relatively short and focus on key need groups e.g. partially sighted. This will allow each of the sectors to map their own taxonomy e.g. Snomed to the cross-sector target audience which will then allow applications to filter out appropriate activities based on e.g. a Snomed term. Part of the Social-Prescribing-Ready Profile

There is concern from Social Prescribers that their client may not be ready for an activity. Generally the OA data set is being reviewed to give a richer set of data to provide enough information for the SPLW to make the best decision concerning their client needs. The Intensity levels strategy is probably a good one to consider. Also the Activity further info will help. This strategy is for the activity provider to develop a readiness check that the SPLW can carry out with their client and decide whether the client would be ‘ready’ for the activity. This would probably be carried out normally when the client first joined the session but to avoid making it more difficult for the client this allows the check to be performed by the SPLW. The readiness check could be based on a national standard check e.g. Par-q or their own but it should advise whether the activity is appropriate to the SPLW client. The readiness check should be on the activity providers website such that a link can be added to the OA data for the SPLW to access. This will mean that both the activity provider and the SPLW can focus on providing the best match to client needs. Part of the Social-Prescribing-Ready Profile

Clients often need motivating and will lack confidence to attend a session that they have not been to before. The SPLW can consider the Activity buddy strategy or even the Training frontline workers strategy but a really popular suggested strategy is to provide information about the activity through photos. This is not dissimilar to how people might choose to buy their house, a holiday, a car etc. A gallery link could show photos of inside the venue and include describing accessibility as per AirBnB case study. It could include photos of the activity in session, meet the team, what the entrance and reception looks like and whatever else the activity provider wishes to show.

OA has a comprehensive list of activity types but this is only really useful to the SPLW when they know specifically what the client is looking for. The SPLW needs to have a way to find the best activity. The Pathways strategy offers one route. The activity-type list is difficult to navigate / search as it is not very broad at the top and so more broader layers could be added e.g. indoor physical sports, indoor physical team sports, indoor non-contact sports, indoor team non-contact sports etc. This would allow the SPLW to consider a smaller number of potential activity groupings to identify potentially well-matched actual activities. SPLW are also familiar with the Open Referral UK standards which includes a Service-type. This is a broader set of services which includes some physical activity types. See OR and OA roadmaps

It is important to SPLWs that the activity ‘looks after’ their client. Understanding what facilitation is available is a key requirement. It is a helpful to a client to know if there is a reception, someone who will welcome or meet & greet, whether there is an activity lead to seek help from and what additional support is available e.g. activity helper, befriender, carer. This information can be included in the OA data set. An activity provider looking to accept SPLW clients should be encouraged to complete this information. See Completeness checker. Part of the Social-Prescribing-Ready Profile

SPLW have indicated that they would like to know if the session is for self, 1to1 or in a group as usually they favour the 1to1 and groups. Open referral has a field called attending-type which gives an indication of the type of attendance - is it a home visit, an online session, an app, a telephone call or a physical venue? It is suggested to include this field in OA with the extended definitions for physical venue i.e. venue self, venue 1to1, venue group. This might also help with the current Covid restrictions and potential new normal to offer online services e.g. Zoom trainer. Part of the Social-Prescribing-Ready Profile

There are issues of trust with activity quality especially with smaller community groups. The risks should be a case by case risk management decision and the richer data will provide evidence to help that decision. The quality of the activity could be trusted through the quality of the provider. Sport England have an existing quality standard called Quest. Quest Quality standard MCRActive are doing their own quality check e.g. whether a safeguarding policy is in place. It would make sense if this was a cross-sector initiative but should at least be a cross geographical boundary standard. There are two considerations. Firstly that a common standard is adopted - such as Quest. The second is considering how compliance to that standard is assessed. This strategy suggests that consideration is given to the ‘Active’ areas trusting each other’s quality kitemark. This may use the same standard as other areas, but in terms of trusting the assessment undertaken this should start across the 33 Active Partnerships borders. The issue with having a wider shared inspection / assessment Geography is not about the trust in the assessment process, but that actually most of the risks / issues tend to relate to provider management. Hence if Provider A is OK in location A, this is no guarantee that the same provider will be OK, 100 miles away, as the management control will be very different. Technically this would mean an assurance system outside of OA data but adding a reference and a link to verify the accreditation. Care should be taken as to not burden the small activity providers too much and also not to under promote those without this quality standard as the client may trust their local church even without a quality kitemark. Note Open Referral allows many quality reviews which could be a local CVS (Council for Voluntary Sector) kitemark, NHS social prescribing kitemark, Active kitemark, CQC or Ofsted etc.

OA has an open booking standard which if implemented would allow the SPLW, having found an activity in the opportunity data, to then immediately make a booking without having to go through a booking process. At this moment in time, having the ability to easily make a booking for a specific session is not deemed a priority for a SPLW. This is because the SPLW is quite prepared to do whatever it takes to get their client to an activity. They are happy to make a phone-call, send an email or even visit a venue to make the booking. They do accept that having a field that tells them how to make the booking would be useful i.e. which phone number, email or even a weblink. However, it has to be recognised that Social Prescribing is an emerging practice and there are some concerns about SPLWs spending too much time with clients. As Social Prescribing picks up pace then it does seem likely that being able to quickly book a session will become important. It is expected that Open Referral will also start to want to be able to book services as the momentum builds for using that open data set. This strategy recommends adding a field to indicate the means to make a booking but not to give up on the open booking as demand for this is likely to come sooner rather than later. However it is not yet known whether Social Prescribing will become business as usual and so investment to promote open booking might be a bit early.

SPLW were not too concerned about attendance as they usually followed up with the client anyway but some SPApP did allow AcP to indicate attendance. Fitting in with the idea of Social-Prescribing-Ready Profile then another field would indicate that the AcP would be prepared to complete an attendance record. This would mean that the AcP is committed to complete a link for a particular booking.

Almost all SPLW interviewed expressed nervousness about recommending anything that they have not visited. There is a recognition that additional information that can be included within OA may partially address this. There is a potential solution where feedback from visits from “peer frontline professionals” will normally provide adequate confidence for a referral to be made. Currently this often happens informally within individual teams but the strategy here is to widen this peer network of trust such that if a fellow frontline worker (perhaps at ICP level) has given the ok, then they won’t need to check it out themselves. The recommendation is to explore this a bit further to identify a professional rating system that ApP could use to provide confidence to SPLW. A small set of national pilots could define and trial the model to capture the impact in terms of improved productivity and increased numbers of referrals.

It was very clear that the majority of the current SPLW clients would require some form of ‘hand holding’ initially. This was mostly undertaken by the SPLW themselves. However it was noted that this may not be the best use of their time. One SPLW teams interviewed had their own list of volunteers/befrienders that they used to help their clients (most of whom were also former clients themselves). Indeed taking on these volunteering roles is known to be beneficial and short form part of SPLWS strategies locally. There are a number of volunteer management systems out there and it is thought that these could be beneficially aligned as Social Prescribing progresses. There are a number of initiatives looking at making better use of volunteers. There isn’t an easy way to couple a volunteer management system and so this strategy is simply to highlight that it may be useful for SPAcP to consider linking in some way to a volunteer management system.

As take up becomes fairly mature, then the resulting open datasets will provide evidence of sufficiency and demand which would support managers and commissioners in spending budgets to provide local support. This in turn is useful information for the AcP to meet the demand and of course the ApP to provide the software tools. This strategy suggests that some form of management information dashboard might allow a local understanding of what the current situation is and provide evidence to move things forward be you a manager or Activity provider or Application provider.

It is recognised that the quality of the data will be mixed. Various amounts of effort will be put into data entry according to the business case for that organisation. If the strategy of Social-Prescribing-Ready Profile is accepted then the ability to check that an Activity has completed all that data would be useful. This strategy suggests that a richness checker tool be made available so that ApP can surface the AcP that have made the effort to meet the SP ready profile. This tool could be commissioned / commissioned by ODI and made available to ApP at a subsidised rate to incentivise adoption.

If SPLW are recommending that they would like certain fields completed before a referral will be made then as in Social-Prescribing-Ready Profile strategy then the AcP would benefit from being informed of where their current entries fall short. This strategy suggests that an automated completeness tool would encourage and support an AcP entering the data to give them every chance of receiving a referral. This should also increase the quality of the data. This tool could be commissioned / developed by ODI and made available to ApP at a subsidised rate to incentivise adoption.

It is generally accepted that the OA data set is not adequate for a number of data consumer’s usage. This creates a demand for a commercial curation service. Currently there is only one commercial service. This commercial service is generally well received and provides value for money. However, due to the need for this service it does create a dependence risk which may put off some organisations and will put all at risk of price increases they might have to accept. This strategy suggests some consideration of encouraging other commercial offerings to create some competition in the market and provide some fall back if any one organisation should close for whatever reason. Another alternative might be to work with the single commercial offering to provide some form of franchise across the areas of the country. Perhaps in similar way to the telecommunication and utility supply companies. This will help with the risk of scale as if OA takes off and needs curation then this single supplier may struggle to scale.

The technical review has found that it is quite difficult for a developer to consume the whole OA data feed. More than one ApP commented that their only real option was to use the Imin API. It is recognised that this is a commercial organisation and so the same issues arise as per Curation. This strategy suggests similar thinking to the curation issue in that there needs to be some competition. Increasing the take up of OA is likely to be hampered where these choices are limited in this way. It wouldn’t be fair to the commercial investment to provide a publicly funded API but the idea of encouraging core APIs as an alternative to a feed could make the data more accessible to a wider range of frontend applications.

Alongside the range of projects that are looking to position OA as a potentially valuable asset in the SPLW world, there is a similar parallel set of initiatives that are recommending adoption of the Open Referral UK data standard openreferraluk.org. This work is led by Open Community - MCHLG. A comparison of the data fields of the two standards has been carried out OA & OR UK comparison. An attempt has also been made to convert OA data to OR format and technical considerations have been carried out to allow the conversation from OR to OA. This strategy suggests that an alternative to bringing the standards together through OR and OA roadmaps, might be to provide the ability for converting data to and from each standard. This will give an amount of flexibility to the market to make sense of the open data collected and provide aggregated views as appropriate to the frontline.

There are a number additional fields of information that it is recommended will increase the likelihood that patients take-up a referral to take up an identified physical activity. These in essence provide additional information to address potential concerns that may be relevant to SPLW patients (such as having a warm handover process). It is recognised that this will create a data burden for some activity providers and hence populating this set of information should be clearly signposted (within the chosen OA compliant software packages) as only relevant only for activity providers willing to welcome SPLW patients into their sessions. There are also existing OA data fields that will be important but are at risk of low data quality and these should also make up the SP ready profile. These SP ready fields are included here - Social Prescribing Data Requirements. This would then be used by the Richness checker to only view activities that have completed those fields and Completeness checker to inform the data provider that they need to complete further fields if they want to receive a referral from a social prescribing system.

The need to understand as much as possible about the activity before a client is signed up is clear. The rich data set should prove adequate but changing OA data set and the knock on effect it has to application providers is significant. This strategy suggests including activity further information links that can be added for the activity provider to add what they think might be useful e.g. FAQ, FB page link, taster sessions adverts, SP only sessions adverts. There should be a text description field for every link and it would make sense to categorise these (FAQ, Social media link, promotions, directions, special notices etc) as this will also give some help as to the sort of thing that an activity provider could provide. Part of the Social-Prescribing-Ready Profile

It is generally accepted that there are three levels of intensity for physical activity - Low, Moderate and Vigorous. If this was a well defined standard then it would make it easier for SPLW to know for sure that the activity providers were aligning to the same understanding of intensity levels. This strategy suggests that the OA data set includes a controlled list with descriptions for activity providers to describe their intensity level and for the SPLW to understand what might be appropriate for their client. The key is agreeing the definitions which won’t be easy but should be worthwhile and could be added to the cross-sector taxonomy strategies. The science around MET may be able to provide a relatively easy calculation for an individual but needs expert input . (Metabolic equivalent of task - Wikipedia) Part of the Social-Prescribing-Ready Profile

Some SPLW were aware of the Open Referral data standard and many Application providers have all been made aware of it as the NHS HSSF (https://www.england.nhs.uk/hssf/) are currently considering it as one of their standards required for Social Prescribing software. HSSF Essential & Desirable Proposed Criteria Final.pdf. They don’t publish their requirements until the end of 2021. They are looking at recommending that Open Referral UK is adopted as a means to access data from service directories. They are also now considering OpenActive. There are different strengths and weaknesses in both standards. Frontline workers across the public and third sector are likely to want to understand what services and activities are ‘out there’ in the local community. This strategy is suggesting that these two open data standards would benefit from identifying a roadmap which would see them merging over a period of time. It is recognised that existing investment has been made on both sides and hence the ‘over time’ suggestion would give fair warning but going forward would appear to be complementary, favourable to the investors and make better use of public sector investment. The risk to both standards of not merging is that it will create unnecessary competition and costs between them to become The defacto standard, extra cost for the application providers, confusion for the service/activity providers and ultimately the frontline missing out on knowing what is available without needing two different tools. An alternative strategy would be Converting data to and from OA and OR.

To increase the take up of OA and the range of information available, Local Areas (probably better at the Integrated Care System level), should be provide an application that will allow every Activity Provider (and community group) in their area to load their session data on to an OA feed collector. This then needs to be widely promoted to large, but arguably more importantly to smaller, hyper-local providers that normally deliver a more appropriate “offer”

London Sport identified a need for Social Prescribers to be trained to be more confident in advocating sport and physical activity to their clients. This need was also apparent from this user research. London Sport have created a training course which can be reused and so this strategy is simply raising awareness and recommending to provide this training to SPLWs.