1. NHS Health Checks Weight Management –Adults Physical Activity Tool Walking for Health Lucy O’Loughlin (Public Health Specialist) Lara Snowdon (Advanced Public Health Practitioner) Public Health Devon Prevention/ Early Intervention Update: -

3. NHS Health Check Programme Mandatory programme for local authorities Started in Devon in April 2013 Consistent, universal vascular risk assessment Aim to reduce prevalence of vascular disease –Identifies previously undiagnosed disease & those at risk –Increase risk awareness & reinforce lifestyle messages –Minimise and manage risk

4. NHS Health Check Programme 100% of eligible population every 5 years Five-year programme Eligible population = 40-74 –(excluding those on existing disease registers) Offer 20% of eligible population every year Devon – 250,000 eligible/ 50,000 per year 50% uptake 66%75%

5. NHS Health Check Programme Devon Health Checks Offered 2013/14 - Benchmarking and Trend

6. NHS Health Check Programme Devon Health Checks Received 2013/14 - Benchmarking and Trend

7. NHS Health Check Programme Results at Year One July 2013 - May 2014, 33,153 (13.46%) offered and 14,142 (5.73%) delivered Uptake averaged at 43% Final quarter 56%

8. NHS Health Check Programme Existing model - 96 practices signed up in Devon HPD Outreach Pilot: –to deliver 300/400 checks in community settings –Test and determine shape of future outreach model –As mandatory duty to offer to everyone To target: –people who may not respond to GP invite –people with increased cardiovascular risk –test a community setting model where there are no GP practices offering health checks

9. NHS Health Check Programme Outreach model Development Market warming event – 26 th June

10. Lifestyle Services SERVICEPROVIDER Drug and Alcohol Treatment & Support Online Alcohol Treatment and Support Services Specialist Stop Smoking Service Stop Smoking Support (GP, pharmacy and other community settings) Various Providers Community-Based Weight Management Service Exercise Referral Scheme (not funded) Various Providers Get Active DevonVarious Providers (web tool)

11. Devon Tier 1 & 2 Weight Management Services Lucy O’Loughlin Public Health Specialist/ Commissioning Lead for Healthy Weight

12. Background Obesity is not distributed equally, for women and for men (using occupation-and qualification based measures) rates rise with increasing levels of deprivation The Health Survey for England estimates that in Devon 24.1% of adults (aged 16+) are clinically obese (BMI= >30 kg/m 2 ) In 2013 this equates to 158,053 people The cost to the NHS in Devon is estimated at £211.4 m in 2015, with much higher associated costs, such as loss of productivity The Health and Social Care Act 2012 transferred many public health responsibilities to local government from 1 st April 2013 Devon County Council is now responsible for issues associated with the prevention and management of excess weight in the population

13. Healthy Weight Care Pathway GAPs

14. What Do We Know About The Health Needs? 158,053 people BMI 30 kg/m 2 or above The population of Devon is mainly centred on the 28 Devon market and coastal towns and Exeter- many people live in rural areas, experiencing access issues. Inequalities in distribution and outcome Many people arriving at tier 3 without structured support. People seeking support have different preferences and need Rising childhood obesity

15. A New Service Model for Devon Weight Management Healthy Lifestyle Hub Service AService D Service B Service C

16. Tier 1 Eligibility Criteria BMI of 25-29.9(kg/m 2 ), with co-morbidities or 22.5 – 27.49 (kg/m 2 ) for South Asian populations BMI of 30-34.9 (kg/m 2 ) without co-morbidities or 27.5-32.49 (kg/m 2 ) for South Asian populations Considered ready to change by Health Professional Aged 16 years or more No indication of current eating disorder * type 2 diabetes or previous gestational diabetes, uncontrolled hypertension, hyperlipidaemia uncorrected by maximum doses of statins, sleep apnoea, severe osteoarthritis

17. Tier 1 Weight Management Services Brief Wt Mgmt Interventions Tailored advice and support Sign- posting to self-funded or free opportunities in their community. Wide Range of Front-line Professionals 2 year programme of training >200 professionals trained. New training package in procurement Healthy Lifestyles HUB Provide up to 4 phone-based support calls. Provide a tailored self-help guide, including local information, use of GAD.

18. Tier 2 Eligibility Criteria BMI >30 – 50 (kg/m 2 ) or South Asian population and >27.5 (kg/m 2 ) with co-morbidities* BMI >35 – 50 (kg/m 2 ) or South Asian population and >32.5 (kg/m 2 ) without co-morbidities Considered ready to change by Health Professional Aged 16 years or more No indication of current eating disorder * type 2 diabetes or previous gestational diabetes, uncontrolled hypertension, hyperlipidaemia uncorrected by maximum doses of statins, sleep apnoea, severe osteoarthritis

19. Tier 2 Weight Management Services 3 - 6 month, individually tailored package of support FREE to the client Intro session to ensure that client is satisfied with their choice Meet NICE guidance Practical, safe advice about physical activity & healthy eating Use evidence-based behavioural change techniques Provide on-going motivational support and follow up Aim for target weight loss of 5-10% body weight Aim for realistic pace 0.5-1.0 kg per week. Minimum 9 sessions in 12 weeks Extend to 24 weeks (if satisfy >2% wt loss and attend 75%)

20. Weight Management Service Lots LotDescriptionClients 1Weight Management Weight management support (incl nutrition, behaviour change and physical activity advise/support) ALL 2Weight Management- Clinical Weight management support (incl nutrition, behaviour change and physical activity advise/support) Overview by senior clinician (Band 6+). A range of clinical expertise available. Clinical risk-factor management advice. Link to client GP ALL 3Weight Management and Practical Physical Activity Support Weight management support (incl nutrition, behaviour change and practical physical activity support options available a minimum of 3 x per week) Physical activity flexible enough to fit in with client’s needs and availability. Low-mod risk

21. Physical Activity Services 3 – 6 month, individually tailored package of support Free intro session to ensure that client is satisfied with their choice Adhere to BHF Physical Activity and Health (2010) Exercise Referral Toolkit guidance. Aim to exceed CMO guideline of 150 mins of PA per week Use evidence-based behavioural change techniques Provide on-going motivational support and follow up Build links with other participants to develop confidence and social support Minimum of 3 opportunities for structured PA support per week

22. Physical Activity Services Lot LotDescription Clients 4Practical Physical Activity Support Practical physical activity support options available to the client a minimum of 3 x per week, flexible enough to fit in with client’s needs and availability. Low-mod risk

23. Providers Awarded Tier 2 Services District Lot 1 Weight Mgt Lot 2 Weight Mgt - Clinical Lot 3 Weight Mgt incl Practical Physical Activity Lot 4 Practical Physical Activity East DevonWW, SW DDOC LED ExeterWW, SW, WB DDOC P, WB Mid DevonWW, SW, WB DDOC WB North DevonWW, SW DDOC PP South DevonWW, SW DDOC -Tone TeignbridgeWW, SW, WB DDOC TDC, WBWB TorridgeWW, SW DDOC -- West DevonWW, SW DDOC -- WW=Weight Watchers, SW=Slimming World, LED=Leisure East Devon, Tone=Tone Leisure, P=Parkwood Leisure, WB=Westbank Healthy Living Centre/Mid Devon District Council Leisure, TDC=Teignbridge District Council Leisure, DDoc= A consortium of GP Practices and Pharmacies co-ordinated by Devon Docs

24. Referral Patients living within the Devon County Council boundary (green area on the map) Refer to Healthy Lifestyles Hub, operated by Health Promotion Devon. E-Mail: ndht.hpd@nhs.netndht.hpd@nhs.net Referrals will be accepted via a range of routes, including email, letter and emailed spread sheet. Referrals require the data outlined on the minimum data set (appendix 2 of info sent to practices) If any of the essential information is missing, Hub staff will need to contact the referrer or the patient’s practice to gain this information.

25. Co-morbidities defined as:  Type 2 diabetes or previous gestational Diabetes  Uncontrolled hypertension  Patients whose Hyperlipidaemia is uncorrected by maximum tolerated doses of Statins.  Sleep apnoea  Severe Osteoarthritis eg: requiring listing for joint replacement or in severe pain uncontrollable with analgesics.  (Patients with intracranial hypertension will require approval from Exceptional Treatments Panel) Referral Pathway for South and West Devon and all from Jan 2015 *For South Asian, Chinese, Black African or Caribbean, 2.5 kg/m 2 lower BMI

26. Interim pathway For patients living in RDEFT/NDHT areas Agreed by commissioners and specialist clinicians to minimise adverse impact on flow of patients to Tier 3 during intro period Transition period: Feb 2014 – Jan 2015, a sub-set of patients will continue to be routed directly to tier 3 via DRSS. Patients with BMI > 50 kg/m 2 Patients with BMI >35 kg/m 2 with Diabetes Patients who meet the tier 3 entry criteria AND disordered eating (binge eating, bulimia etc.) OR complex medical problems OR multiple therapies OR significant psychological problems eg: receiving care from a Psychiatrist NB: Hard work for referrers, DRSS and HUB- may need to review!!!!! Agreed by commissioners and specialist clinicians to minimise adverse impact on flow of patients to Tier 3 during intro period Transition period: Feb 2014 – Jan 2015, a sub-set of patients will continue to be routed directly to tier 3 via DRSS. Patients with BMI > 50 kg/m 2 Patients with BMI >35 kg/m 2 with Diabetes Patients who meet the tier 3 entry criteria AND disordered eating (binge eating, bulimia etc.) OR complex medical problems OR multiple therapies OR significant psychological problems eg: receiving care from a Psychiatrist NB: Hard work for referrers, DRSS and HUB- may need to review!!!!!

27. Interim Referral Pathway for Eastern and Northern Localities NEW Devon Assess BMI BMI< 35* OR BMI 35-40 and no co-morbidities REFER to HUB 2 Community based Weight Management Service (Tier 1 or 2) BMI 35-40* with co-morbidities OR BMI 40+ OR those eligible for Tier 3 who have successfully completed Tier 2 REFER to DRSS (formerly DART) 1 Who will triage to either Specialist Service or Community based Weight Management Service (Tier2)

28. Interim Triage Flow Chart To Be Used By DRSS for Patients in Northern and Eastern Localities REFERAL to DRSS Diabetes? Y REFER Specialist Service Diabetes? N YES to either of: eating disorders, multiple therapies or signif psych problems REFER to Specialist Service NO to any of: eating disorders, multiple therapies, signif psych problems REFER to HUB Wt Mgmt Service (Tier 2) Successful completion of Tier 2 and eligibility for Tier 3 confirmed REFER Specialist Service

29. Devon Tier 2 Service March-May 2014 Referrals by District East Devon22 Exeter41 Mid Devon8 North Devon5 South Hams40 Teignbridge50 Torridge16 West Devon4 Total Referrals186 Breakdown Declined Service9 Accepted Tier 1 instead1 Accepted Tier 2 (With suppliers)114 Waiting for suppliers (Slimming World)20 Unable to make contact, followed up x 342

30. Issues Simplification of Devon Tier 2 referral criteria before 2015? No current forum in NEW Devon area to consider pathway issues- eg: inconsistent eligibility criteria for tier 3 South and West Devon patients- access to tier 3 in Plymouth? Devon CYP programmes in procurement- no tier 3 as yet. How to progress? Need for maintenance support- voluntary sector solution? Obesity group across Devon/Plymouth and Torbay 2 x year? Links in to Pen HWt Group

31. Get Active Devon! Physical activity finder tool Response to primary care Uses patient info Generates a tailor-made list of activities Google www.getactivedevon.co.uk

36. Walking for Health Sustain and develop the existing structure of WFH in Devon Extend the WFH programme to ensure geographic coverage across Devon Extend the WFH programme to currently underserved population groups Target population groups in areas of high deprivation Target population groups with specific and/ or long-term health conditions.

37. Resources www.devonhealthandwellbeing.org.uk Please get in touch via: - lucy.oloughlin@devon.gov.uk lara.snowdon@devon.gov.uk www.devonhealthandwellbeing.org.uk lucy.oloughlin@devon.gov.uk lara.snowdon@devon.gov.uk