Jayne Tunstall Chief Operating Officer

1. Jayne Tunstall Chief Operating Officer Members Event Healthy Lifestyle (Long Term Conditions)

2. Ashley Smith Physical Activity Advisor Motivation

3. Alan Jarvis Head of Lifestyle Services Lifestyle services

4. Lifestyle Services Aim • Promote Positive Health Objectives Health promotion is a process of enabling people to exert control over the determinants of health & thereby improve their health. This is achieved by: • Practiced bespoke strategies • Enabling people to take action • Develop skills to achieve & maintain positive change • Take an holistic approach to health

5. Lifestyle Services Overview Lifestyle choices are the strongest determinants of many chronic diseases, including coronary heart disease, cancer, stroke and diabetes. It is these “chronic diseases of lifestyle” that are responsible for most of the avoidable morbidity & mortality of the Walsall population. The focus of all Lifestyle Services is to increase life expectancy and mental well being, through a programme of health improvement targeting areas with poorest health outcomes to reduce health inequalities. Lifestyles services, works in partnership across the health economy in Walsall to deliver a wrap around delivery model that aims to addresses the health needs of the Walsall population resulting in a positive patient experience

6. Lifestyle Services Lifestyles, Acute primary care and all other aspects of health delivery in Walsall should have a symbiotic relationship, working in partnership to deliver a wrap around delivery model that addresses the health needs of the Walsall population resulting in a positive patient experience.

7. Referrals Lifestyle Link Stop Smoking Service Substance Misuse Health Trainer Physical Activity Health In The Workplace Older People Mental Health and Wellbeing What are Lifestyle Services

8. Walsall Healthcare NHS Trust Lifestyle Link

9. Our Aim The aim of this initiative was to develop and maintain a single booking system for all lifestyle services that can be accessed easily by either telephone or online, this is open to the general public to self refer and referring agencies.

10. Why a single booking system NATIONALLY • The White Paper ‘Our health, our care, our say, a new direction for community health services’, DoH, February 2006 emphasises the importance of service delivery as close to the user as possible • The service will be fully compliant with the national quality requirements of the ‘Core Standard’ as set out by the Care Quality Commission . The service will comply with any reviews carried out by the Care Quality Commission. LOCALLY Simple, not only had we managed to confuse potential clients we had all confused NHS staff • Clients and staff were frustrated by having to repeat information

11. Comparison of bookings taken January – October 2010 vs January – October 2011 The object of Lifestyle Link was to encourage everyone to access the service via one number. • January – October 2010 2772 • January – October 2011 4196 • Bookings have increased by over 50% since the launch of this service.

12. Clients referals : • 1 November 2010 – 1 November 2011 there have been 4255 bookings taken, a selection of referrals coming from: • 757 of these have been referred from GP’s 1089 have been referred by Other Health Professionals which includereferrals from: • 32 from Cardiology • 29 from CPN’s • 26 from COPD • 21 from the Diabetes team • 20 from the Infertility Clinic at the Manor • 45 from Midwives • 21 from the Outpatients • 458 from Practice Nurses.

13. Walsall Healthcare NHS Trust Walsall Health Trainer Service Sue Caulfield -Health Trainer Manager Sue has worked in a number of roles within health promotion including smoking cessation and older peoples services. She currently manages Walsall’s Health Trainer Service. The service is made up 14 members of staff from varied backgrounds and a wide skill mix.

14. Background • Recommendations from the Choosing Health (2004) White Paper • Aim to reduce health inequalities • Health Trainers focus on encouraging and enabling individuals from disadvantaged communities to make healthier choices that are right for them. • One to one personalised support to help people to make changes to improve health

15. Service Offered • Locally based – service for local people, delivered by local people • Provides one to one personalised support and motivation • Cancer screening prompts • Key areas: alcohol consumption, physical activity, smoking cessation and weight management • Personal health plans setting SMART achievable goals • improves access to preventative services in deprived areas • communicates key health messages to individuals from deprived communities

16. A Service that can…… • Signpost to mainstream services • Collect & maintain accurate records & data systems • Evaluate effectiveness of services locally • Act as a catalyst to reduce the inequalities gap

17. Long Term Conditions and Lifestyle • Smoking, obesity, alcohol consumption, physical inactivity are all important modifiable risk factors that can impact on health outcomes. • Supporting people with long term conditions to adopt healthier lifestyles can halt the development of additional conditions and aid overall management of long term conditions.

18. Rapid Access Angina Clinic • ‘One Stop’ clinic approach • Reviewed by a consultant cardiologist • Referred to health trainer for 1-1 support • Family centred approach 

19. Patients with Impaired Glucose Tolerance • Prevalence in the south of Walsall higher than the local and National average

20. Strong evidence that type 2 diabetes can be delayed or prevented by lifestyle intervention. (1) • In the absence of any interventions about 50% of IGT patients will develop type 2 diabetes in 5 – 10 years. (1) • Working with area partnerships in the South of Walsall to raise awareness and increase referrals for lifestyle interventions for IGT patients • (1) Diabetes UK Position Statement (2009)

21. 2013 Delivery to Date • Since its launch in January 2007 the Health Trainer Service in Walsall has continued to grow and develop to meet the needs of the local population. • 19,109 referrals into the service since 2007 • 74% of all referrals from deprivation quintiles 1and 2 • 73% of clients referred achieved or part achieved goals • Total weight loss of clients for 2011/12 equates to 10,2181kg, or 1609 stone

23. Service Objectives To increase physical activity levels within Walsall by providing opportunities to take part in physical activity within communities across the borough for adults, children and families Increase awareness of the importance of physical activity and the relationship to health and the prevention of chronic diseases Encourage adults and children to increase their activity levels to the current guidance set by the CMO and Department of Health (2011) “150 minutes of moderate intensity activity per week” (this could be broken into 5 x 30 minutes per week) “60 min of physical activity everyday of the week for children including weight bearing activity on 3 days per week”

24. Benefits of Physical Activity Decreased risk of: • Cardiovascular Disease • Stroke • Type 2 Diabetes • Cancer • Falls • Depression, anxiety and stress Positive effects on: • Hypertension • Osteoporosis • Body Weight and Composition • Psychological Health • Social Health • Musculoskeletal Conditions

25. What do we do?... Deliver a weekly timetable of FREE opportunities for adults, children and families to take part in Physical Activity across the borough on a variety of days at a range of times Deliver Active Clubs/Active Ability Training for staff within schools, out of school clubs and parents to increase capacity and sustainability of PA opportunities Deliver physical activity awareness training to health care professionals part of “Weights Over”. Develop and deliver physical activity initiatives within workplaces to encourage activity in the workplace Delivery of Specialist physical activity sessions e.g. Aqua Natal, Level 4 Obesity Clinics and women’s only sessions to break down cultural barriers to participation in activity Make it Count which is a locally developed physical activity and obesity prevention/treatment programme for 4-7 yr old and their families.

27. Make it Count is a 12-week programme for 4-7 year olds and their families, and uses a family centered approach to increase physical activity levels and knowledge of healthy eating. The programme aims to support families making small changes to become healthier by promoting the national Change4Life message. Each week children and their families can take part in 60 minutes of fun by playing a variety of games and developing their knowledge of healthy and unhealthy food choices as well as understanding how the different areas of the Eat Well Plate help their bodies to develop. Children will build up a week by week folder of information about healthy living which includes colouring sheets, crosswords and word searches. Throughout the programme parents are encouraged to play the games with their children and act as an active role model. The parents will also get the opportunity to gain tips about preparing healthy meals and how to reduce salt, sugar and fat. For more information on the Make It Count programme phone Lifestyle Link on 01922 44 40 44.

28. Access to Service Between April 12 – March 13 we had 22,000 face to face contacts with people attending our physical activity sessions Currently 8500 people on the data base reflecting the number of Walsall people that have accessed the Physical Activity Service since November 2008 Over 180 school and out of school staff trained in Active Clubs Self Satisfying Questionnaires completed by service users during April 12 – March 13 evidenced that more than 96% of clients reported both physical and psychological benefits from being more physically active

30. Walsall Healthcare NHS Trust Walsall Stop Smoking Service Service lead – Erica Pugh Senior Advisors – Rebekah Few and Emily Bissell Advisors – Faye Bennett, Carol Shepherd and Sue Durkin Admin Team – Steph Coyne and Dinesh Patel

31. Walsall Stop Smoking Service Make a change, keep the change! The objectives of the Lifestyle Services Stop Smoking Team are to: • Provide training, education and information that supports a reduction of smoking in the Walsall borough • Provide a 12 week stop smoking course including treatment in both 1:1, group and home visit settings • Provide support to those with Smoking related illness in attempting a ‘quit’ • Support the Healthy Workplace Awards in promoting Stop Smoking • Provide specific support to smoking pregnant mothers • Provide a holistic service where signposting and referral to other services are carried out

32. Walsall Stop Smoking Service Service Offered • 12 week stop smoking course (if client continues to successfully quit) offering behavioral support • Nicotine Replacement Therapy or tablet Medication • Intermediate Advisor training, Annual Update Training and locality management for partners • 1:1 clinics, Group clinics and phone support • Home visits for housebound clients • Stop smoking groups within a work place • Support and information to other health colleagues • General smoking cessation promotion

33. Walsall Stop Smoking Service Treatment Offered Microtab Patches Mouth Spray Inhalator Cools lozenge Lozenge & Mini Lozenge Nasal Spray Gum

34. Smokeless tobacco; betel, paan, snuff Electronic cigarette Low tar cigarette Nicotine chewing gum ‘Normal’ cigarette Menthol cigarette Cigar Roll-up cigarette Herbal cigarette Pipe Shisha Walsall Stop Smoking Service Smoking Paraphernalia

35. Walsall Stop Smoking Service Benefits of Quitting • The quitting timeline • After 20 minutes your blood pressure and pulse return to normal. • After 24 hours your lungs start to clear. • After two days your body is nicotine-free and your sense of • taste and smell improve. • After three days you can breathe more easily, and your • energy increases. • After two to 12 weeks, your circulation improves. • After three to nine months coughs, wheezing and breathing improves. • After one year your heart attack risk is  half that of a smoker. • After 10 years your lung cancer risk is half that of a smoker

36. Walsall Stop Smoking Service Health Benefits of Quitting • You will reduce your risk of developing illness, disability or death caused by cancer, heart or lung disease. • You will reduce your risk of gangrene or amputation caused by circulatory problems. • You will protect the health of those around you by not exposing them to secondhand smoke. • You will reduce the chances of your children suffering from bronchitis, pneumonia, asthma attacks, meningitis and ear infections. • You will improve your fertility levels and your chance of a healthy pregnancy and baby. • You will improve your breathing and general fitness. • You will enjoy the taste of food more.

37. Walsall Stop Smoking Service 2011/12 Delivery and Current Figures • In 2011/12 - 3857 people set a quit date, 1628 were smoke free at 4 weeks giving the service a 42% success rate. In addition to this, 61% (1000) remained smoke free at 12 weeks. • So far in 2012/13 – 2900 people have set a quit date. To date 1117 were smoke free at 4 weeks giving the service a 39% success rate. We do not yet have the 12 week data. • 19 borough wide specialist advisor clinics • We have a total of 81 partners consisting of 39 in pharmacies, 23 in GP’s and 19 in other settings. All of these partners provide smoking cassation on behalf of the Walsall Specialist Stop Smoking Service Correct at 16/04/13

38. Walsall Healthcare NHS Trust Substance Misuse Service Emilie Stone & Amber Marshall

39. Substance Misuse Service Service provided in line with following guidance: • National Alcohol Strategy (2012) • National Drugs Strategy (2010) • NTA Families Matter (2008) (amongst others) ‘Drugs matter to the whole of society; as all of us feel the impact’ Drug Strategy 2010

40. Some examples of work: • Basic Drug & Alcohol Awareness Courses (full day & half day) • What is a drug? • Short & long term effects of alcohol & drug use • Risks of alcohol & drug use • Effects on family and wider society • ‘Legal highs’ • Calculating alcohol units & guidance on safer drinking • Possible reasons and indicators for abuse • Support services available in Walsall • Bite-size Drug & Alcohol Awareness sessions • 1hr and 2hr mini versions of the above

41. Some examples of work: • Identification & Brief Advice Training (IBA) • A proven way of helping those drinking above recommended guidelines reduce their intake. • Uses basic screening tools to identify problem drinking followed by simple, structured advice. • Raises awareness of harmful drinking patterns and associated effects. • Drug Use Screening Tool (DUST) Training • Developed with Safer Walsall Partnership and T3 Young Person’s Drug & Alcohol Service. • Easily accessible, quick-to-use tool aimed to help staff decide how best to respond to substance use. • Incorporates a referral form for T3 support.

42. Some examples of work: • Work in Schools • Training PSHE Co-ordinators • Lessons to pupils • Loan of resources • Community Awareness Raising • Attending Community Events and Health Days • Providing Information • Signposting to appropriate services • Awareness Campaigns • Developed in line with local strategy to reduce alcohol related hospital admissions

43. “Interesting. Enjoyed it. Thank you.” “Very good and Interesting course” Feedback From Our Training “Very educational” “I feel the sessions have been very helpful and informative and the children have taken in lots of useful facts.” “Good information, well presented, thank you.” “The children really enjoyed the session and came up with really good ideas. There were good discussions at the tables.” “Great interactive resources. Well Presented. Thank you.” “SHOULD GIVE OUT FREE SAMPLES.”

44. Walsall Healthcare NHS Trust Emotional Health and Wellbeing Service Steve Upton: Emotional Health & Wellbeing Manager Anne Pledger: Emotional Health & Wellbeing Specialist Joanne Stallard: Health Trainer for Emotional Health & Wellbeing

45. ‘There is no health without Mental Health’ Dept of Health, 2011 • The Emotional Health & Wellbeing Service: • Provide training, education and information that supports a reduction of suicide, improved mental health, increased wellbeing and resilience, particularly targeting high risk groups • Training sessions: MHFA and Youth MHFA – 2 day training session building up confidence and knowledge of recognising and supporting someone experiencing mental health problems • Supporting the Healthy Workplace Awards scheme by delivering: Start Living, Stop Stressing! and Preventing Stress: Positive Manager Behaviour • One to one support: up to 8 sessions of low level support for individuals who are experiencing low mood, anxiety or symptoms of stress. Based on the five areas approach, using CBT approach. Referrals via: Occupational Health, Health Trainers, Cardiac Rehab

46. Mental Health Promotion • The team also promote positive mental wellbeing and ways that individuals can improve their wellbeing • The main mental health promotion message is: The FiveWays to Wellbeing • World Mental Health Day (10th October) is the main mental health promotion event. The team plan events across the borough to promote community engagement and to encourage positive wellbeing – keep your eye out for this year’s events!

47. 2012 / 13 performance • The one to one support service launched in February 2012. • To date the team have supported: • Cardiac Rehabilitation: 49 referrals, 22 ongoing clients • Occupational Health: 84 referrals, 42 ongoing clients • Health Trainers: 58 referrals, 17 ongoing clients

48. Feedback from one to one sessions Just having someone to talk to and understand me was a big help. I can’t thank the service enough. I found the meetings very helpful. I felt so low and negative about myself and my attitude to weight loss. Both Anne and Eileen managed to change my mindset and I now feel in control and positive. Just like to thank you for all your help and support. I hope in a nice way that I don’t have to have your service as I feel a lot better in myself, thank you.

49. 2012 / 13 performance • MHFA: 97 trained mental health first aiders • YMHFA: 34 trained youth mental health first aiders • Healthy Workplace Award, worked with the following companies: whg, Echo Managed Services, South Staffs Water, Brownhills Job Centre, Job Centre Plus Walsall, Walsall Council • Bitesize Stress Management: 116 people trained • Preventing Stress: Positive Manager Behaviour: 110 managers trained

50. Feedback from training sessions A practical and realistic course, offering genuine guidance that can be used in my daily practice. Well presented, highly recommended Very useful information. I learnt a lot I greatly enjoyed the course Hopefully I now have the tools to recognise mental health problems and to be able to help It was good to hear someone reinforce the link between good management and stress Excellent and thought provoking