Greater Manchester’s whole-system approach to increase physical activity and tackling inequalities

Disabled people and those with long-term health conditions face significant barriers to moving more. Greater Manchester has adopted a whole-system approach towards physical activity led by Greater Manchester Moving with support from partners in health, leisure, local government, transport and others. We work together to deliver the shared GM Moving in Action strategy. For every £1 invested in community sport and physical activity, £4.38 is generated for economy and society. Sport England research found that disabled adults or those with a long-term health condition (LTHC) have a higher wellbeing value (£5,300) for being active than the adult population generally (£2,600).

Physical activity is core to supporting good physical and mental health. It is essential to physical and mental health, wellbeing, preventing and managing chronic conditions/non-communicable diseases, keeping people healthy and in work, and improving population health. Disabled people and those with long-term health conditions face significant barriers to moving more. The Millions Moving More report highlights the need for inclusive, personalised approaches, especially for those with long-term health conditions, and stresses the importance of recognising intersectionality. 

Perception of safety is important here too, as is the perception of risk. Moving more, and exercise, can be seen “risky behaviour” whereas not being active is more of a risk. A consensus statement from health experts, published by Sport England in 2021, explained how activity benefits outweigh risks for people with long-term health conditions and that physical activity is safe – even for people living with symptoms of multiple conditions. 

A whole-system approach is needed to support good health at a population-level, which means delivering alongside partners in health, local and national government, transport, leisure, and the VCSFE sector.

Greater Manchester (GM) has adopted a whole-system approach towards physical activity led by Greater Manchester Moving with support from NHS GM, Greater Manchester Combined Authority (GMCA), GM Public Health Network and partners in health, leisure, local government, transport etc. All parts of the system are working together to deliver the shared GM Moving in Action strategy. 

GM Moving and partners are committed to reducing the inequalities faced by disabled people in becoming more active and have come together to create the GM Commitment to Inclusion Group.

Partners share examples of inclusive practice through partner visits within the region including Beyond Empower, Seashell, and Dance Syndrome. In Tameside, Active Everybody Can is an award-winning inclusion and disability service, providing everyone with the opportunity to develop, thrive, and achieve no matter their need or ability. This is done through encouraging aspiration and hope through learning and moving with confidence from childhood to adulthood, ensuring barriers are removed for everybody to belong, enjoy, engage and grow in their community. There are different services and programmes to suit different needs and stages of life.

Elsewhere, Transport for Greater Manchester are holding a second trial throughout November where older and disabled people have free 24-hour bus travel. This follows a successful initial pilot in August.

Such initiatives support the work of the GM Walking and Wheeling Fund and annual investment programme, supported by NHS GM, supporting VCSFE organisations deliver projects that get more people walking and wheeling.

Speakeasy were just one of the recipients who are working with older and/or disabled people. The charity, which supports people living with aphasia, launched a virtual walking challenge for their members.

J was one of the 50 participants. She had suffered a stroke six years previously while in their mid-fifties and working as a catering manager. This caused marked aphasia and right-sided weakness affecting both her arm and leg. Living alone and socially isolated, she walked slowly and with support from a stick. 

J committed to the challenge by walking further each day around her flat, round the perimeter of the whole building, and eventually building up the stamina and the confidence to walk further around her local area. She sent weekly updates, took part in online calls to share her progress and was very proud. J also attended meet-ups in the park which helped to alleviate her social isolation.

In the 10 GM boroughs, local teams across councils, leisure trusts, the VSCFE sector and others are delivering community-led, system enabled work which is support more people to move more and live well.

In Brinnington, Stockport, local listening revealed that many residents found outdoor walking intimidating due to uneven paths, poor lighting, lack of benches and bad weather. This made walking outdoors stressful rather than enjoyable. Many local people were also managing long-term health challenges, further affecting confidence and mobility. The challenge was to design a walking opportunity that felt safe, supported and genuinely shaped by the community — one that reduced anxiety, encouraged social connection, and invited people back into movement at their own pace.

In response, partners co-designed “Confidence Walks” — short, supported indoor walks created with residents to build safety, trust, and participation. The walks offer a social, accessible space for people managing health conditions such as cancer, respiratory illness, heart disease, or musculoskeletal issues. Their success has spread beyond Stockport and led to wider “confidence-based” sessions, including Confidence Gym and Confidence Swim, demonstrating how community-led ideas can grow into a broader, inclusive physical activity offer.

YourTrust recognised that many residents faced barriers to accessing leisure services, including people with physical disabilities, sensory impairments, learning disabilities, autism and long-term health conditions.

Traditional activity formats and registration systems were not always suited to their needs, and many individuals required tailored support to participate safely and confidently. Additionally, staff required the right training and resources to deliver accessible sessions, and carers/support workers needed to be welcomed as part of the activity rather than seen as observers. 

The challenge was to redesign not only activities alongside those with lived experience, but also culture, policies and processes, to create a genuinely inclusive leisure environment for all.

YourTrust has developed a wide range of inclusive physical activity sessions as part of its commitment to providing equal opportunities across the borough of Rochdale. Through targeted programmes such as chair-based yoga, deaf badminton, inclusive cycling and dance, multisports, sensory walks and more, the Trust has created a culture of accessibility and inclusion. Carers, PAs and support workers are encouraged to participate alongside the individuals they support, and new registration processes ensure appropriate staffing and personalised assistance. This whole-organisation approach is driving improved participation, enhanced wellbeing and a more inclusive community leisure offer.

Carers, PAs and support workers are encouraged to participate alongside the individuals they support, and new registration processes ensure appropriate staffing and personalised assistance. This whole-organisation approach is driving improved participation, enhanced wellbeing and a more inclusive community leisure offer.

Bike Buddy gives disabled people, those living with long term health conditions and those leading a sedentary lifestyle the opportunity to be active through cycling. It creates a lasting cycling culture for each of the partner organisation’s involved in the project. Bike Buddy begins with support from Wheels for All, and then through regular engagement passes to an individual’s support network, giving people the appropriate training to guide and mentor an individual in their care to cycle and be active. It focuses on giving people the skills, knowledge and therefore the confidence to cycle from their front door or from the settings of their care and support organisation, and to make cycling a regular part of their life.

For example, 18-year-old MA has learning disabilities and was hesitant about cycling. Wheels for All started with adapted cycles to build his confidence, and over time, he became eager to try a standard mountain/hybrid bike. Through ten focused sessions, he learned how to ride independently, eventually completing practice rides in the local park. MA was thrilled with his progress and got himself a second-hand bike, which he now uses regularly to stay active.

Sport England’s Active Lives data for Greater Manchester has shown a narrowing gap between the inactivity levels (those completing less than 30 minutes a week) of those with a disability or long-term condition and those without from 22.7 percentage point difference in November 15-16 data to 16.9 percentage points in November 23- 24 data. Inactivity levels for those with a disability or long-term health condition in GM has fallen from 46.1 per cent to 39.9 per cent. This is the lowest they’ve been recorded by Sport England though there is clearly more to do.

Sport England also estimate that community sport and physical activity generated approximately £122.9 billion in ‘social value’ across England in 2023. For every £1 invested in community sport and physical activity, £4.38 is generated for economy and society – up from £4.20 in 2022/23.

The research also found that disabled adults or those with a long-term health condition (LTHC) have a higher wellbeing value (£5,300) for being active than the adult population generally (£2,600).

In Greater Manchester, a King’s Fund report described Greater Manchester as a ‘leading light’ in improving population health at scale. Devolution in Greater Manchester impacted the whole health system and led to improved population health relative to a control group with health improvements partially driven by improvements in the social determinants of health.

Over the past decade, Greater Manchester has reshaped how we work together to transform people, places, and systems. 

Since 2015, when Sport England established its first Memorandum of Understanding (MOU) with the city-region, we have worked together to test, learn, and create lasting change - from the original Blueprint for Change to being chosen in 2018 as one of Sport England’s Local Delivery Pilots.

In 2021 more than 2,000 people helped shape the GM Moving in Action Strategy. This is our shared ten-year plan to bring Sport England’s Uniting the Movement strategy to life across every community, unlocking participation, contribution, and opportunity for all.

What makes Greater Manchester’s progress powerful is our whole-system, place based approach to enable active lives for all. From local authorities and health partners to community organisations and national agencies, everyone plays their part in creating the conditions for long-term change.

Evidence locally and nationally shows that transformational change on this agenda requires a continual focusing on maturing the conditions to tackle inequalities and enable active lives. Referred to locally as our five enablers for change, we are proud to see positive change across all five of these over the last four years.

We have learned so much and continue to develop our learning as we grow our movement for movement across the city region. We know that to deliver Uniting the Movement and GM Moving in Action requires collective leadership, everyone has a role to play. 

We have worked to design a more networked, integrated approach to tackling inequalities, including for disabled people and those with long-term health conditions, with a culture of collaboration and trust at its centre. We believe working better together will help us create better conditions to address inactivity and health inequalities. 

Part of this has been shifting culture from one of measurement that focuses solely on numbers, percentages, key performance indicators, and numerical targets, towards one that values a layering of data; numbers, stories of change and understanding of the enablers of change.

We work in a complex system so cannot attribute positive or negative overall changes in data or outcomes to one organisation, set of interventions, policy changes or levers we pull. 

We’ve learned to take a mixed methods approaches to evaluation and are learning how to tell the story of the work in ways that are consistent with the whole system approach, what we know about measurement, evaluation and learning within this approach. At the same time it needs to make sense and be meaningful to political leaders, the media, people who want to translate the way of working into their place or agenda.

Andrew Lawton, [email protected]