Helping to build a healthier nation

Lucie Culkin reports: When he first left his previous job to join Nuffield Health, Marc Holl found himself defending his new employer to his physio friends who assumed he had sold himself out. It might be best known as an independent healthcare provider or a chain of gyms and fitness centres but Nuffield Health is the UK’s largest healthcare charity committed to keeping the nation healthy.

‘People just presumed I was going to work for Nuffield Health to go and work for this big shiny corporate organisation,’ Holl explains.

‘I would say ‘did you realise it’s a charity’ and people would be ‘oh they surely just do that for tax reasons’. So now I tend to put them straight over a glass of wine  and tell them exactly why it is accountable, what makes us a charity and how we reinvest [income] in the services.’

As an organisation with no shareholders, Nuffield Health operates 31 independent hospitals, 112 fitness and wellbeing clubs and more than 165 workplace wellbeing services across the UK, and it reinvests its income back into these services to achieve its vision to build a healthier nation. Nuffield Health is committed to developing and supporting its staff and investing in the provision of a range of flagship programmes, which support communities by widening access.

It  has 550 physiotherapists, all members of the CSP. Marc Holl is Nuffield Health’s professional head of physiotherapy and clinical development lead. Along with the organisation’s other physiotherapists,he’s a CSP member. 

‘We’re one of the only remaining independent hospital groups who states that all physios must be chartered,’ he says. ‘We promote the CSP a lot to those physios: what  being chartered means, what the CSP is there for and why we are proud to promote it.’

Nuffield Health’s strapline is ‘building a healthier nation’ and this vision drives its activities and flagship programmes. 

Each of these is available for CSP members – regardless of where they work – to refer eligible patients to as an enhancement to their treatment.

Holl says: ‘We want to promote this to MSK physios in private practice and the NHS. So with the Joint Pain Programme, say, once you’ve done your core treatment with people that have got joint pain, either before, or after orthopaedic surgery, or if they’re not appropriate for orthopaedic surgery, Nuffield Health – across our national network of fitness and wellbeing centres –  can offer you this programme.' 

We try to avoid running the flagship programmes in hospitals. Because straightaway that medicalises that treatment

Nuffield Health’s physiotherapy teams have been involved in the design, implementation and delivery of all four programmes, and each has a physiotherapy element. They are the only cohort of staff within Nuffield Health and its medical disciplines (which include doctors, nurses, occupational therapists and psychologists) that have contributed towards the development and help in the delivery of all four. 

One of the key characteristics of the flagship programmes is that they take place outside of a medical environment, in Nuffield Health fitness and wellbeing clubs.

‘Where possible, we try to avoid running the flagship programmes in hospitals. Because straightaway that medicalises that treatment,’ Holl says.  ‘We’re trying to bring it into a health and wellbeing environment so they can be amongst other people who don’t have joint pain, but they can feel inspired to work out like they do. 

He goes on: ‘If somebody’s got joint pain, one of the side effects is that they may feel unhealthy or they feel like they can’t exercise, that they can’t join a gym. And in the meantime, while they’re waiting for treatment, potentially they may become unhealthier because they might be not exercising, not knowing if it’s safe to exercise, or they might not know what exercise to do.’

By taking part in the programme, these people come into the gym environment, where the Nuffield Health team will work with them to help them improve their quality of life with a wider understanding of nutrition, exercise and pain relief.

Taking a holistic approach

The Cystic Fibrosis Exercise Programme takes a similar approach. It takes children out of the medical environment and into the gym, where they’re supported with education and exercise with physiotherapists and personal trainers. It takes an even more holistic approach, supporting family members as well as the child undergoing treatment.

‘It’s an excellent programme,’ Holl says. ‘While the children are with the PTs and the physios in the gyms, the mum, dad, brother, sister can be in the swimming pool or the salon or the jacuzzi, or having a workout in a class. It’s looking after the patient and their family so the patient – the young child or the teenager with cystic fibrosis is having free fitness programmes, and the family can be using the leisure facilities free of charge as well to  help keep them healthy, to support their mental health,  and help make them more resilient.

‘Building a healthy nation is not just about that individual in the middle, it’s about that support network. They’ve got a home and their mums, dads, brothers, sisters, whoever might be affected by the disease as well, and we’ve got to keep them healthy.’

Schools’ programme

The SWAP programme is on course to reach 50,000 children by the end of this year. It’s a six-week education programme, primarily for nine to 12-year-olds, which aims to promote the importance of physical and mental health with fun, interactive activities.

Local teams work with participating schools in their area  and either go into the school and work directly with  the children or provide digital materials for school staff. The programme focusses on four themes, physical activity, eating healthily, sleep, and emotional wellbeing.

Holl admits the programme has been more successful in teaching his son about healthy eating than he was himself, and says, ‘If it’s delivered to 120 girls and boys in a school, even if only 50% of them go back and think ‘I’m going to reduce my sugar intake’ it has made a  difference.’

Research project

The fourth programme is slightly different and more specialist. STAMINA (supported exercise training for men with prostate cancer on androgen deprivation therapy) is  a five-year research project funded by the National Institute for Health Research (NIHR). It is designed to evaluate the effectiveness of a long term supported exercise intervention in men with advanced prostate cancer who have undergone medical castration with androgen deprivation therapy (ADT). Like the other three, it is accessible for CSP members.

Nuffield Health has three main revenue streams and the profit from them is reinvested into the flagship programmes and also into the

organisation’s staff, through its extensive training initiatives, which include an in-house learning academy. 

The highest revenue stream, and most profitable part of the business, are the private hospitals. There are 31 of them. Then there are the 112 fitness and  wellbeing clubs, which are paid for by their consumers, mostly through monthly subscription fees. The third revenue stream is corporate clients: organisations who pay for their staff to have access to health care, either on site or off site. For these customers, Nuffield Health provides workplace gyms (there are almost 300 corporate gyms hidden away within the basements of investment banks and other businesses) and medical centres, where physios and GPs are available to support employees. 

Nuffield Health makes efficient use of its own resources in its charitable activities. Staff across the organisation are invited to participate in the flagship programmes, they learn about them in their academy sessions, and are allowed to take two days out of work each year to, for example, go to a school to talk about SWAP. 

‘You could be a finance manager or you could be a physio and take two days a year out of your diary to go and deliver a programme, or you could be working in the canteen at head office and decide to take two days a year off to go and deliver the SWAP programme,’ Holl says.

‘What we want to do is to give everybody within our workforce the ability to build a healthier nation, for example by going into the schools to educate them about healthy eating, and they all get trained by the academy to go and do that.’

‘The core purpose of the charity,’ Holl concludes, ‘is to try and keep people well, to keep the nation healthier. That’s what we’re trying to achieve.’