Written Evidence Submitted by Mrs Meta Randles at Sport England (HAP0091)

Sport England Submission to the Healthy Ageing Inquiry

Introduction

Sport England is a public body and arm’s length organisation of the Department for Culture, Media and Sport. Our purpose is to ensure that everyone, regardless of age, background or ability, is able to access the benefits of sport and physical activity. Our ten-year strategy, Uniting the Movement[1], sets out our ambition to tackle deep-rooted inequalities and support individuals and communities to lead active lives.

We believe that tackling physical inactivity must become a national priority, because it is both where the greatest health and economic gains lie, [2] but also where the most significant inequalities persist. Inactivity contributes to long-term conditions, frailty, social isolation, and poor mental wellbeing. It places avoidable pressure on health and care services and reduces healthy life expectancy, particularly in our most disadvantaged communities.

This is about more than individual motivation or isolated interventions or programmes. Tackling inactivity requires a joined up cross-system approach that must be embedded in public services from health and care to transport and planning. National government sets the conditions, but implementation must happen through place-based systems, trusted community partners, and leadership that reflects local need.

Summary

Healthy ageing is shaped by how well we embed movement into people’s lives over time. Increased physical activity and reduced physical inactivity must be recognised as a shared national outcome, embedded in policy, funding, and service design from early years to end-of-life care.

Throughout our response, we advocate for:

• A national scaffolding: Government must prioritise physical activity as a core outcome across departments, strategies and funding.
• A focus on place: Delivery must be rooted in local systems, trusted organisations, and community leadership.
• Support that is adaptive and inclusive: People need ways to be active that reflect their lives, with a life-course approach that embeds movement into everyday life.

Success will depend on consistent national prioritisation, local capacity, and strong cross-sector partnerships.

This submission draws on evidence from our Active Lives surveys,[3] place-based work, commissioned research, and learning from delivery networks across the country. We welcome the opportunity to submit evidence to this inquiry and make the case for physical activity to be embedded across public policy and local delivery systems as part of a whole-system, cross-sector response to healthy ageing.

1. What are the opportunities in public health to promote physical activity to prevent physical and mental ill health at a population level as people begin to age and help them remain healthy into older age? How can this be delivered?

Physical activity plays a vital role in preventing and managing more than 20 health conditions, it is associated with lower rates of cardiovascular disease, stroke, type 2 diabetes, dementia, some cancers and depression. Even small amounts of movement can have a positive impact, particularly among people who are currently inactive.[4]

However, activity levels tend to decline with age. Just 43 percent of people aged 75 and over meet recommended activity levels, compared to 70 percent of people aged 16 to 34.[5] Both adults aged 55 to 74 and those aged 75 and over have seen small but steady improvements in activity levels over the last three years.[6] Nonetheless, 37 percent of people aged 55 and over remain inactive, compared to 25 percent of the overall adult population.[7] But physical activity is often not just about individual choice. People’s ability to move is shaped by the places they live, the services around them, and the social and environmental barriers they face. There are multiple opportunities to embed it into public health approaches to healthy ageing:

1. Preventing and Supporting the Management of Long-Term Conditions

People with long-term health conditions are almost twice as likely to be inactive as those without,[8] yet evidence shows that even small increases in movement can improve quality of life, physical function, and mental health outcomes.

We would encourage public health systems to embed physical activity as part of wider prevention strategies, including through the NHS, social care, and local authority health and wellbeing boards enabling physical activity to be a core and trusted support mechanism. This would work as part of a wider infrastructure that connects clinical settings with community-based support.

There is an opportunity to scale tools like Moving Medicine[9] and We Are Undefeatable[10] which help professionals and individuals incorporate physical activity into the prevention and management of conditions (for example people at risk of type 2 diabetes, etc). Personalised models of care, such as social prescribing, when well-integrated with local activity offers, can help people feel confident and supported to move more. As the NHS explores expanding community health and wellbeing worker roles, aligning these approaches could strengthen neighbourhood-level support for actives lives.

2. Designing Activity-Enabled Neighbourhoods

There is a clear opportunity to create environments that make movement a part of everyday life. The design of our streets, parks, pavements, and public spaces has a major impact on older adults’ ability and confidence to be active.

Creating and designing supportive environments is essential. The built and natural environment can either enable or discourage movement. We therefore recommend national and local policy prioritising accessible infrastructure that supports walking, wheeling and everyday movement.[11] Activity for all is the foundation to the Active Design Principles.[12]

3. Tackling Climate and Health Together

Public health can use investment in climate resilience and green infrastructure to support activity in later life. Older adults are more affected by urban heat, air pollution and flooding, which can reduce safe opportunities to move outdoors.

Active design principles[13] and sustainability are interconnected approaches that prioritise physical activity and environmental responsibility in the built environment.

By integrating physical activity into nature-based solutions, such as shaded walking routes, benches, accessible paths and blue-green infrastructure, we can deliver co-benefits for health and climate, while improving equity. 

4. Building Confidence at Key Life Transitions

Chronological age is not a reliable indicator of need or ability, and it is important to recognise that older adults are not a homogenous group; a 55-year-old may have little in common with someone who is 75. People of the same age may also have different motivations, capabilities and barriers. We encourage interventions to focus on life stage and lived experience, designing services and support around the needs of the individual, including moments of transition such as retirement, bereavement, becoming a grandparent or receiving a new health diagnosis, where new routines or identities can offer a key window of opportunity and a gateway to movement and social connection.[14]

Programmes that are designed with and for older adults, delivered in familiar settings, and focused on connection as much as activity, are more likely to succeed.

5. Early intervention and prevention

Active children and young people are more likely to become active adults. However less than half (47.8%) of children and young people (age 5-16yrs) are meeting the Chief Medical Officers recommended guidelines of an average 60 minutes of vigorous to moderate physical activity per day across the week.[15]

To prevent physical and mental health issues as people age and promote healthy ageing across the life course, we must start by ensuring that children and young people have positive, meaningful experiences with physical activity from an early age. How children move, think, feel, and connect during physical activity plays a vital role in shaping their lifelong relationship with movement. In addressing the challenges of healthy ageing today, we must also prioritise helping young people find enjoyment, meaning, and value in physical activity, nurturing a lifelong love for movement that supports the long-term health of future generations.

To realise the benefits of physical activity for population-level prevention, physical activity must be treated as a cross-departmental enabler and embedded across transport, youth, planning, housing, climate and health policy, with clear areas of focus underpinned by cross-system governance.

2. What are the opportunities for health services to promote physical activity to reduce the impacts of ill health and reduce the development of multimorbidity and/or frailty in older people who already have a long-term health condition? How can this be delivered?

Physical activity is one of the most effective non-clinical tools available to prevent, and reduce the impacts of, long-term conditions, delay the onset of frailty, enable people to manage their own health and live independently for longer. Despite this, it remains underused in clinical care.

The evidence is clear: movement, physical activity, and sport must be at the heart of a prevention-first healthcare system, forming a core part of NHS care. Supporting people to move more, particularly those who are the least active, offers an achievable and sustainable way to secure the future of the NHS and tackle many of the pressures it faces.

Regular physical activity reduces the risk of developing heart disease, stroke, type 2 diabetes, dementia and some cancers by 30 to 40 percent.[16] It is recommended in over 98 NICE clinical guidelines and quality standards, including those for MSK, cardiovascular, mental health and post-operative care.[17]

Movement also improves cognition, mobility, sleep and mood for people living with dementia.[18] Strength, balance and flexibility exercises have been shown to reduce falls in older adults by 23 percent.[19]

Furthermore, over 90% of adult bone mass is developed during childhood and adolescence[20] so, supporting young people to be active is vitally important as a protective measure for future bone health. We would welcome the integration of physical activity into government commissioning frameworks for children, young people, and families, ensuring the support to be active is not only consistent but also grounded in positive experiences. By embedding enjoyment, a sense of belonging and co-designing how physical activity is offered is essential to building a positive and long-lasting relationship with movement and protecting the long-term health of future generations.

These benefits are most powerful when physical activity is embedded across health and care, not as an optional add-on, but as a core element of personalised care, rehabilitation and recovery.

Health professionals need the tools, time and confidence to talk about movement. Training through the Moving Healthcare Professionals programme[21] and Moving Social Care (led by Disability Rights UK)[22] could be scaled to support this shift.

There are many strong examples of how physical activity can be embedded into clinical pathways to reduce the impacts of multimorbidity and frailty:

• The PREP-WELL programme in South Tees supports patients before surgery with personalised movement, nutrition and lifestyle support. It has improved activity levels, reduced hospital stays and delivered cost savings of over £800 per patient.[23] The new iPREP-WELL model expands this offer through flexible digital access.[24]
• Sport for Confidence[25] integrates occupational therapy with sport and physical activity coaches to provide tailored support in leisure settings. It removes barriers and enables people to engage on their own terms. Over 900 people were supported by their prevention and enablement model with the evaluation indicating that PEM could deliver an estimated £58.71 of social value per each £1 invested

• Our We Are Undefeatable campaign,[26] co-developed with major health charities, empowers people with long-term health conditions to be active in ways that work for them. Promoting/integrating the campaign in health and social care settings could support frail older adults and those with health conditions to get active.

• The Stronger My Way [27]accessible, beginner level, digital resources which support building muscle strength aimed at people living with LTHC through relevant health pathways for example to those with Musculoskeletal conditions.

To scale these, we recommend:

• Delivering action on NHS England's Four Ways Forward[28] to harness the benefits of physical activity and ensure it is hardwired into commissioning and integrated care system.
• Training health and care professionals to talk about physical activity so it becomes a normal part of clinical practice and supporting the sport and physical activity workforce to work confidently with older adults and people with health conditions through the undergraduate curriculum and CPD training.
• Strengthening the referral infrastructure between NHS services and local physical activity providers.
• Aligning activity programmes with local Joint Strategic Needs Assessments and MSK pathways.
• Investing in group-based strength and balance interventions for people living with frailty to support falls prevention outcomes.

Building on the learning from the Live Longer Better[29] Movement, which has active engagement from a large number of Active Partnerships and seeks to develop a culture that moves from care to enablement, physical activity should be treated as part of the ‘first mile’ of care. As the population ages, ensuring people are supported to move more will be essential for a sustainable NHS, reduced demand on services, and better quality of life in later life.

1. What interventions would have the most impact in reducing the gap in healthy life expectancy between older people living in the most and least deprived regions?

Reducing the gap in healthy life expectancy between older people in deprived and affluent areas requires community-based, locally tailored interventions. Hyper local areas of focus can be identified using a combination of metrics, including Sport England’s Place Needs Assessment,[30] Inequalities Metric,[31] and Inequality and nationally available socio-economic data (e.g., IMD) to identify and prioritise the neighbourhoods most in need. These hyper-local interventions are especially important because the conditions that shape health outcomes (e.g. housing, mobility, social networks, and access to services, green spaces etc) vary dramatically even within the same local authority.

Example of successful hyper local interventions include The Greater Manchester Active Ageing programme[32] shows that co-designed physical activity sessions, such as walking, gardening, and dance, delivered in trusted neighbourhood venues can significantly improve health and wellbeing. In the programme, inactivity dropped from 71% to 14.5% in six months, and participants reported improvements in wellbeing, as well as reductions in risk factors associated with falls, cognitive decline and metabolic conditions.[33]

Active Black Country’s Get Out Get Active (GOGA)[34] also shows how community-led, place-based interventions can reduce healthy life expectancy gaps. In Wolverhampton, GOGA worked through local faith centres, training faith leaders to promote physical activity among inactive adults in Black-led churches, mosques, temples, and gurdwaras. Over 90% of participants remained active after 4-6 weeks. By using trusted venues and local champions, the project reached those in deprived areas, addressing inactivity through culturally relevant, neighbourhood-based solutions aligned with health inequality metrics.

These place-based approaches target the underlying causes of poor health such as isolation, reduced mobility, and unequal access to services. However, interventions alone are not enough. Lasting impact can only be achieved through place-based systemic working that understands the conditions and context of that place and communities. Evidence from Local Delivery Pilots, such as Active Calderdale,[35] shows that where local systems align around a common purpose and invest in joined-up working, outcomes improve more significantly than in comparable areas with similar characteristics.

3. What are the key barriers to older people increasing their physical activity and how can they be encouraged and supported to do more?

Older people face a wide range of barriers to being physically active, shaped by their health, confidence, environment and access to opportunities. These barriers vary significantly between individuals and must be addressed through personalised, inclusive and locally relevant approaches.

Pain is one of the most frequently cited reasons for inactivity; the Bridging the Gap report found that pain was the most frequently cited barrier to being active, with 21% citing this.[36] In the North East, chronic pain affects around 43 percent of adults, and opioid prescription rates are three times higher than in London.[37]

The Flippin’ Pain campaign[38] provides a model for reframing physical activity as part of pain management, rather than something to be avoided. Delivered in partnership with the NHS and community organisations, the programme offers public outreach, ‘pain cafes’ and specialist training for healthcare professionals, social prescribers and community workers.

Environmental design also plays a critical role. Walking and cycling are the most common forms of activity for older adults, but many are put off by uneven pavements or poorly lit streets, a lack of benches or toilets and unsafe crossings or inaccessible public spaces

These physical barriers are particularly acute for people with mobility issues or sensory impairments. Sport England’s Accessible and Inclusive Sports Facilities (AISF) guidance[39] provides practical advice for designing environments that are inclusive and age-friendly, emphasising the importance of comfort, safety, and dignity for older users. We therefore recommend national policy and local planning prioritising these Active Design principles to prevent inactivity from being ‘built into’ local places.[40]

Social isolation compounds these challenges. People who live alone or who lack regular contact with others are less likely to engage in physical activity, particularly if they do not feel welcome or represented in existing provision. This is particularly true in disconnected or rural communities, or where language and cultural factors act as additional barriers.[41]

Sport England’s Talk to Me principles[42] and Together Fund learning[43] also reinforce the importance of co-design. Listening to lived experience and removing assumptions leads to more effective and inclusive provision.

Encouragingly, certain life transitions, such as retirement, bereavement or becoming a grandparent, offer the opportunity to influence and promote activity at scale. Interventions that build on these moments, and focus on confidence, purpose and connection, tend to have the greatest success.[44] There are opportunities to build in advice and promotion of activity from trusted sources at these transition points for instance workplaces, pensions and DWP providing lifestyle advice as part of pensions and retirement planning, helping to paint a positive picture of healthy ageing. Nature based programmes can play an important role in supporting older adults through these transitions, particularly when designed to be gentle, inclusive and rooted in local green space. Forestry England case studies,[45] such as Stroll and Stretch in the National Forest, Nordic Walking in Thames Chase, and Seated Exercise in Chopwell Wood, show how participants experiencing key life events found motivation, connection, and renewed energy through simple group-based activity in natural environments.

In Essex, the Able Like Mable[46] campaign encourages simple, everyday strength-building activity to reduce falls and maintain mobility. It uses inclusive, confidence-building messages, co-designed with older adults.

Tackling inactivity among older adults and narrowing the healthy life expectancy gap requires a locally tailored, inclusive approach that listens to older people, adapts to their lives, and removes social and environmental barriers to movement.

4. How can health services work with social care, the third sector, businesses and local government to support older people to be more physically active and address existing health inequalities?

Physical activity delivers co-benefits across the health, care, environment and community sectors. To support older people to be more active, public services must take a joined-up approach that treats movement as a shared outcome which is embedded in neighbourhood design, care pathways, workforce development and local investment.

There is opportunity for health services to work in partnership with social care, voluntary and community organisations, local authorities, transport, housing and environmental planning teams to shape inclusive, active places that enable older adults to live well.

Examples from Sport England’s Place Partnerships illustrate the power of cross-sector collaboration:

• Active Burnley[47] has embedded community-based activity support into local NHS Primary Care Networks. This includes “walk and talk” sessions, inclusive cycling hubs and park yoga, linking clinical care with green space access and social connection.
• Be Active Luton[48] partners with Adult Social Care to embed physical activity in care pathways. It supports gender-specific activity sessions in local faith centres, delivers workforce training through the Active Medicine programme, and funds a dedicated liaison role based in a priority neighbourhood.
• Active Calderdale[49] provides training for health and social care staff through Moving Medicine and has introduced “social strolls” for hospice patients, active-at-home resources for carers, and physical activity advice as part of routine care.
• Castle Point Borough Council is transforming its in-house leisure services into a network of Active Wellbeing Hubs, as part of a strategic shift towards prevention and community health.[50] Since rebranding from Castle Point Leisure to Castle Point Active, the service has worked closely with local VCS organisations to design and deliver activity programmes that promote ageing well, strengthen referral pathways, and build local workforce capacity.
   
• In Canvey Island, a new Healthy Ageing CIC[51] brings together partners to reduce isolation and inactivity through outreach and tailored programmes, targeting those most at risk of health inequalities.

Integrated Care Systems (ICSs) and Mayoral Combined Authorities have a key role to play in coordinating this system-wide approach. We encourage local strategies to embed physical activity in prevention frameworks, adult social care plans, transport policy, climate adaptation, and training for professionals across all sectors. This enables more consistent support for older adults across every part of the system, from clinical encounters to community provision.

Infrastructure is especially important and active design principles and sustainability are interconnected approaches that prioritise physical activity and environmental responsibility in the built environment. Older adults are vulnerable to the impacts of climate change, including heat, poor air quality and flooding, which limit opportunities for safe, outdoor activity. Research by the Joseph Rowntree Foundation[52] found that older people are more likely to be vulnerable to the impacts of climate change, due to a combination of age, health issues and greater social isolation.[53]

It is essential to develop policy approaches that recognise this interplay and the higher risk to older adults that comprises increased exposure and vulnerability to hazards and decreased capability to cope and adapt. This could be strengthened by national policy supporting shaded walking routes, accessible green and blue infrastructure, benches, and safe crossings, particularly in urban areas with poor existing provision.

We encourage cross-sector partnerships to embed activity in neighbourhood regeneration. Physical activity can be a driver of resilience, social cohesion and local pride when delivered through familiar, welcoming and community-owned spaces.

Programmes like 10 Today,[54] developed by Sport England, Demos and the BBC, show how small-scale, home-based interventions can be scaled nationally with the right media and public health infrastructure. The ten-minute audio and video routines helped older people improve mobility and mental wellbeing, while reducing social isolation and boosting confidence.

To unlock the full potential of physical activity for older adults, we recommend:

• Creating national coordination mechanisms that empower local delivery
• Including physical activity in Care Quality Commission frameworks and NHS Trust assessments
• Supporting workforce integration and referral pathways between clinical and non-clinical providers
• Investing in neighbourhood infrastructure that supports daily movement
• Funding cross-sector partnerships through long-term, place-based grants

5. What progress has been made since the 2019 NHS England Long-Term Plan set out its ambitions to support people to age well and how could it be improved in relation to physical activity? In particular, what progress has been made on:

a. Early detection and intervention of frailty and other undiagnosed conditions and falls prevention schemes.

b. Widening, diversifying and expanding access nationally to social prescribing.

c. Supporting people to manage their own health through prevention schemes and personalised care. 

Progress has been made in embedding physical activity into local health systems, but uptake remains inconsistent across regions. One example of promising practice is Active Calderdale,[55] where physical activity is now integrated across care pathways. Healthcare professionals have been trained to initiate active conversations with patients, and physical activity support has been embedded in carers’ services and hospice care. This kind of whole-system approach is beginning to shift local culture towards prevention, with early outcomes showing increased physical activity among inactive groups and stronger embedding of activity within end of life and carers’ support.

Nationally, evidence shows encouraging trends. Activity levels continue to rise among older adults, particularly those aged 55 to 74, where an additional 380,000 adults are now active compared to the previous year.[56] Over the longer term, this age group has seen a 6.4 percent increase in activity since 2015-16, while adults aged 75 and over have seen a 9.4 percent rise in activity over the same period.[57]

Inactivity levels are falling, but inequalities persist. One in four adults aged 55-74 remain inactive, and nearly half of those aged 75 and over still do less than 30 minutes of moderate activity per week.[58] These gaps highlight the need to ensure all systems reach the people who would benefit most.

98 percent of Active Partnerships are working with health and care partners on healthy ageing outcomes, with 88%  involved in supporting falls prevention.[59] Engagement with social care has increased by 21 percent between 2023 and 2024, and 72 percent of Active Partnerships are involved in the social prescribing agenda, helping to embed physical activity into community-based provision ensuring physical activity forms part of support for people’s holistic health needs.

In relation to self-management, more work is needed to ensure digital tools and data infrastructure fully support physical activity as a mainstream prevention tool. There is an opportunity to:

• Embed physical activity into the NHS app to support prevention and the self-management of health conditions, connecting it to a range of digital solutions that enable people to be active in a way that works for them, e.g. We Are Undefeatable, couch to 5k, Active10, couch to fitness, This Girl Can).
• Integrate physical activity data into NHS systems like EMIS, SystmOne and the NHS Health Check
• Embed signposting into NHS communication tools such as accuRx
• Adopt open data standards like Open Referral[60] and OpenActive[61] to improve trust and accessibility for clinicians, link workers and patients

To improve impact and reach, future action could:

• Focus on place-based systemic working and the co-location of services
• Address the postcode lottery of access to activity and services by ensuring consistent, high-quality support in every community.
• Empower services to diversify and adapt to meet the needs of underserved groups
• Ensure all offers, digital and non-digital, are designed around the person and are culturally relevant, inclusive and rooted in local assets

6. What should the Government prioritise in funding allocations for delivering services to support older people to become more active?

We’d welcome the development of a funding model that incentivises action and impact on tackling inactivity. While this could build on current incentivisation approaches within the NHS, there’s an opportunity to widen it to other public services that have a role to play including local government, social care and housing. We’d also support exploring ways to incentivise those areas that make the greatest progress in reducing inactivity. The new ‘Most Active Communities’ initiative, highlighted in the NHS 10-Year Health Plan,[62] could provide a useful mechanism to support this.

We would also welcome investment that empowers and supports cross-system, place-based delivery and active environments that promote health and resilience. The Active Burnley #OutdoorTown initiative[63] shows how green spaces, canal networks, and community-led PA programmes can reduce health inequalities while building climate resilience and supporting older adults to stay active.

Programmes like PREP-WELL also show a clear economic return: by supporting physical activity before surgery, it reduced hospital stays by two days, saving over £800 per patient while improving outcomes.

Programmes like Get Doncaster Moving[64] show the value of local collaboration. Initiatives such as Dance On,[65] tailored strength sessions and pain management tools like Donny Dot[66] demonstrate measurable impact across physical, mental and social wellbeing indicators.

To maximise return on investment and reach, we recommend funding supporting joined-up commissioning across health, care, leisure and community services, with a focus on long-term behaviour change and health equity.

We recommend prioritising long-term, sustainable investment in community-based delivery partners and active environments that support older people to move more, age well, and live independently.

This includes:

• Supporting trusted, local organisations to deliver inclusive, tailored activity that meets the needs of older adults.
• Investing in active environments; including green space, canal paths and neighbourhood infrastructure that enable movement and build climate resilience.
• Expanding falls prevention and strength-based programmes through leisure and community settings.
• Prioritising areas with the lowest activity levels and greatest health inequalities.
• Active design principles to be considered by the New Towns Taskforce to support the design of the environment to ensure activity for all is embedded as a key principle. This would support an ageing population to keep moving and help to provide a long-term sustainable solution creating resilient neighbourhoods.

7. What could the Government learn from examples of best practice that exist in local authorities, the third sector, NHS Trusts, or internationally?

1. What needs to happen to scale up the adoption of these examples across the country? 

There are multiple examples outlined throughout this submission of local innovation across England showing how joined-up, community-based approaches can support older adults to move more and live independently.

There is no single blueprint for success, but where physical activity interventions deliver sustained impact for older adults, they typically share key characteristics:

• Locally rooted leadership with strong cross-sector relationships
• Delivery by trusted organisations that understand the community and audience context
• Meaningful community engagement
• Offers that are co-designed with older adults, reflecting lived experience and local need
• Focus on confidence, identity, connection and enjoyment
• A consistent place-based approach, backed by multi-year investment and system alignment

To scale this type of practice, we recommend:

• Embedding physical activity as a core prevention tool to help address national and local health priorities.
• Empowering local systems, including ICSs, local government and VCSE partners to co-design and deliver solutions based on local need and lived experience.
• Training health and care professionals to talk routinely and confidently about physical activity with patients, by embedding it into the undergraduate curriculum and CPD of key and trusted workforces e.g. healthcare professionals and social care workers using trusted programmes like the Moving Healthcare Professionals programme and Moving Social Care.
• Improving digital and data integration and intra-operability between systems, to enable better referral pathways, tracking and personalisation.
• Strengthening cross-sector collaboration, particularly across housing, planning, transport and education, to embed movement into everyday life.
• Targeting funding and support to areas with the lowest activity levels and greatest health inequalities, ensuring communities most in need are prioritised in delivery and commissioning.

Scaling up what works will require long-term, consistent investment, support for local delivery infrastructure, and stronger coordination across policy areas and systems.