Westminster and Kensington and Chelsea: Embedding physical activity in Adult Social Care

The public health and adult social care services in the Royal Borough of Kensington and Chelsea and Westminster City Council have launched a bold, system wide shift to embed physical activity into routine adult social care practice. Acknowledging the impact of inactivity on frailty and long-term care demand, the councils incorporated movement conversations into assessments, care planning and reviews. Through co-design, workforce development and system change, physical activity is now embedded in IT systems, strategies and commissioning frameworks. More than 139 staff have been trained, confidence has soared and early data shows residents are engaging more, setting goals and achieving them. This demonstrates a scalable, prevention-focused model with real potential to transform outcomes.

Physical inactivity is a major driver of poor health, functional decline and long-term care need. Locally, nearly 75,000 adults complete less than 30 minutes of movement per week, and around one in four residents are inactive. Only a small proportion of older adults meet World Health Organization guidelines.

Partnering with Imperial College London for research on ‘Opportunities for physical activity in Adult Social Care provision’ to strengthen the evidence base, we found that just 10–14 per cent of care plans for adults aged 65+ referenced physical activity. This highlighted a missed prevention opportunity within ASC, despite its central role in promoting wellbeing and independence under the Care Act.

RBKC and Westminster City Council realised that if prevention wasn’t built into adult social care’s daily systems and ways of working, valuable opportunities to promote physical activity and connect people to the wider local services were being missed.

The project started with investigating the challenges and opportunities encountered by ASC workers in promoting physical activity to service users, moving on to developing a whole-system approach to embedding physical activity into ASC practice.

Co-design and engagement

The programme was co-designed with over 70 staff across commissioning, safeguarding, workforce development and operational services. This extensive engagement ensured solutions were practical and owned by frontline teams. 

Relationship building, collaboration, continuous updates and feedback from all stakeholders have been crucial to identify services and processes used by the different teams and ensure a tailored and relevant approach to the different systems.

System and process integration

Key actions included:

1.Improving staff confidence, awareness and creating a community of practice:

• Ran a front-line staff survey to gather knowledge, level of confidence and local offer available when discussing physical activity with service users.
• Commissioned ASC-specific physical activity training following a strength-based approach.
• Developed internal and external guidance resources.
• Established a Physical Activity Champions network.

2. Embedding physical activity within systems and processes:

• Designed and embedded new physical activity fields within ASC assessment and care planning forms.
• Ran a pilot project with Community Independent Service testing the new physical activity questions within assessments and reviews.
• Embedded physical activity withing recommissioning frameworks, including Older People’s services.
• Embedded physical activity within strategies covering Prevention, Health and Wellbeing, Autism, and Information and Advice.
• A Bi-Borough Prevention Task and Finish Group led by Public Health and ASC was born to strengthen collaborations, implementation and accountability.

The success of the pilot within the Community Independent Service (short-term interventions) allowed the implementation of relevant physical activity sections across all ASC assessment and review forms.

Partnership working and pathways

The programme strengthened collaboration with leisure and community partners, including GLL, Everyone Active, Everyone Health and Sport for Confidence improving referral pathways and addressing barriers to access.

This approach has seen great impact across the workforce, system and outcomes for service users:

Workforce development

• 139 ASC frontline staff trained
• confidence in discussing and assessing physical activity increased from 31 per cent to 90 per cent
• establishment of a Physical Activity Champions network to sustain culture change.

System change

• new data streams now capture physical activity outcomes
• KPIs embedded into commissioning frameworks
• alignment with CQC priorities, contributing to “Outstanding” in RBKC and “Good” in WCC.

Data Insights

Physical activity conversations are now being adopted by social care staff when they do their assessments. Early findings can be found below: 

1. Community Independence Service (CIS) provides short term support (up to 6 weeks) to people that have just been in hospital or are recovering from an illness. We found that 65 per cent of users of this service are interested in talking about physical activity now or in the future. Almost 3 in 5 want to increase their physical activity. 

2. Care and Assessment Services provide longer term adult social care support with reviews conducted at least every 12 months. This provides opportunities for improving physical activity over a longer period. Physical activity is now discussed in about half of the reviews.  When it was not discussed, this was often because of frailty, restricted mobility or deteriorating health. In particular, there was a strong interest in the small group of residents who access learning disability support. 

We received positive feedback from residents on wellbeing and confidence. Embedding physical activity into routine processes has directly increased engagement and motivation, demonstrating the value of structured prevention within ASC.

• Workforce confidence is critical. Training and peer support significantly shift practice, applying a bottom-up approach
• System change drives sustainability. Embedding physical activity into IT systems, contracts and governance ensures long-term impact.
• Residents are ready to engage. Many residents welcome conversations about movement when framed positively and strength-based.
• Prevention must be intentional. Cultural change requires leadership, data and accountability mechanisms.

The project has been highly effective in shifting both culture and practice. Measurable improvements in staff confidence, system integration and resident engagement demonstrate early success.

Physical activity is now hardwired into commissioning frameworks, strategies and in the near future, performance management structures across both boroughs.

Over the next year, a full evaluation will assess yearly impact and data insights,  workforce behaviour change and potential cost savings. Collaboration will expand to housing, provider services and community partners to ensure physical activity is embedded across the entire resident journey.

Key learning for other councils

1. Align prevention initiatives with statutory duties to secure leadership support.
2. Co-design with frontline staff to ensure feasibility and ownership.
3. Embed change into assessment systems and commissioning frameworks from the outset.
4. Build academic partnerships to strengthen the evidence base.
5. Develop strong referral pathways with leisure and community providers.

Martina Chiccoli, Public Health Officer [email protected]