Obesity and Healthy Living

1. Obesity and Healthy Living Telford and Wrekin LA and PCT Kit Roberts: Group Specialist Commissioner (01952 388890) Nat Davies: Community Nurse, Joint Community Learning Disability Team (01952 381420)

2. A SUCCESS STORY(However….one down, several more to go!!) Nat Davies and Jenny Gater

3. BACKGROUND • We are a Joint Community Learning Disability Team • Consisting of 8 nurses and 1 Health Facilitation Assistant • Referrals are made to nurses and then Jenny becomes involved

4. He only eats what I give him BARRIERS He’s not eating rubbish you know • No support network • Carers and family • Consistency of support from all involved • Knowledge base of all involved • Lack of accessible information • Level of understanding of the Service User • Accessibility of exercise • Coordinating appointment times • Consistent feedback from staff • Size – transport issues, exercise • Lack of transport available • Motivation of carers He’s taken Mr Kipling to college every day this week He hasn’t had any cake this week Can’t I just put something in the microwave

5. Weight loss, weight loss, weight loss!! College Individual He needs to have a pudding after his tea Weightwatchers that’s the answer!! Cabbage soup diet He’s in danger of developing health problems EVERYONE AT HOME Slimming World!!! How about eating everything in moderation? He needs his food, it keeps him quiet He’s a big lad, he needs more than that for his tea!! He should be on a diet and just eat salad Parents He can eat chocolate if he wants to Day Services

6. Keeping in touch • Contact with carers was maintained by Jenny , his key worker attended as many appointments as she could in order to maintain consistency of information but it was identified that it was difficult to engage all carers • Food Project Workers became involved and completed training sessions for carers • Exercise was increased at Day Services and Physiotherapy became involved develop a programme

7. The story….. • Referral made to Community Team, joint visit took place with Community Nurse and Jenny • Started attending day services and weighed weekly by Jenny • Jenny referred him to Why Weight Plus (BMI >30) • Supported by Jenny and carer for a 1:1 session every 3 weeks and continued weekly monitoring by Jenny • Jenny liaised with Day Services regularly. (They reported all large lunch boxes!!)

8. The story continued… • Jenny continued to liaise with all involved including Community Nurse , continued monitoring weekly + regular weigh in • Also continued input with carers to ensure that advice from Food Project Workers was being followed • OT became involved to support him in developing new skills – self care, how to make a sandwich • In 2 years he lost approximately 10 stone

9. And now….. • He has more of an understanding of a healthy eating plan • He has maintained his weight loss with minimal input (supported by carers alone) • He now plays football and goes bowling, swimming and walking

10. Ongoing • Training for carers with Food Project Workers – identifying all residential services and offering them FREE training • Jenny has developed close links with the Health Improvement Team • Hoping to develop healthy eating sessions that adults with a mild learning disability can access • Signposting – Walk about Wrekin Extend Gym session/gym buddies

11. Project Planning – back to Kit • PCT identified small sum of money (£40K) • Focus on two residential homes (Downing and Carwood) as they are self contained and allow us to maintain some boundaries and control during the project. • Target dates: • Dec 2011 – March 2012 – pre project • April – Dec 2012: Project live • Jan – March 2013: Project evaluation and de-briefing • April 2013: CCG, mainstreaming • Make sure we keep everyone aware and informed of progress

12. Involvement • Advocacy (Taking Part) central to the Project • Programme of consultation and engagement with service users, staff, carers, families, health and social care professionals, private and third sector organisations working with adults with learning disabilities (including LDPB, Listen Not Label, SPIC, carer’s Partnership Board, Links/Healthwatch) • Meeting Psychologist next week to discuss involvement • Recruitment and engagement of staff and clients onto the programme (due consideration should be made to mental capacity and those requiring specialist nutrition) • Development of programme plan incorporating consultation outputs

13. Project Objectives • To identify the component parts of developing a good practice model to achieve the aim of reduction in ALD obesity linked to healthy living (residents and staff); • To identify barriers to reduction in ALD obesity and a strategic approach, with action plan to address the same; • To undertake research into addressing and reducing ALD obesity with a strong link to healthy living • To produce evidence that demonstrates outcomes and achievements throughout the duration of the project • To evaluate the approach used during the project, so as to highlight best practice and model approaches that can be disseminated to others. • To establish an infra structure to addressing the issue of ALD obesity and healthy living enabling the practice to be mainstreamed throughout T&W, post project

14. Project Delivery • A holistic, consistent approach to discussing and supporting behaviour change (for residents and staff) • A range of opportunities for and facilitate physical activity for clients each day (including local leisure services provision). • Provide healthy food options for staff, clients and carers at every meal to meet the CQC Guidance document (any additional costs to be investigated) • Provide training/information/workshop sessions to clients, families & carers -make healthy choices & aid weight mgt. • Provide training to staff to facilitate the above in a consistent manner (this should be evaluated on a rolling basis to assess effectiveness and modifications made accordingly) • Invest in training and development for people with learning disabilities, families, carers to enable them to be better supported where they live. • Support clients to access mainstream or specialist weight management services where required (this may include slimming clubs, exercise referral or weight management activity classes, weight management clinics at surgeries or hospitals, dieticians etc depending on local availability).

15. Project Delivery • Provide early intervention, and timely support and services that will meet the individual needs (including communication needs) of clients who are showing early signs of developing weight management problems and the associated health conditions. • Provide improved data collection methods to support local needs analysis for learning disability and obesity agendas. • Work closely with local health promotion teams to ensure that the services offered are evidence based and guided by best practice. • Work closely with local GPs (with whom residents at Downing and Carwood are registered) to ensure that obesity, physical activity and healthy eating measures are incorporated into the annual health check at an individual level and feature in the residents’ individual care plans (Develop GP champions) • Incorporate messages on smoking cessation • Incorporate messages on safe and sensible alcohol consumption (CMO Guidelines) • Embed culture of making informed healthy behaviour choices throughout the settings

16. Project Evaluation (Wolverhampton University) • The overarching project will reflect the outcomes of the LD and obesity charter. Each project will reflect different sections of the "Actions to be taken" which are indicated in the Charter. On this basis there is potential for the following projects to be carried out: • A project on healthy life style choices with residents and staff using health needs assessment and gap analysis • A meta-analysis which will look at best practice in ALD and healthy life style • A policy analysis to look at current and local policy in this area and possibly compare this with international policy. • Epidemiological data collection of health measurements undertaken during the course of the project and other related surveillance data • An evaluative review of staff attitudes and views looking at potential barriers, success indicators etc. • Each project would have it’s own aims and objectives • Contribute to the overarching aims of the bigger project. • Each student would have their own academic supervisor • One key person to oversee the bigger project & reporting back to the PCT • Collate a research paper.

17. Project Link to ‘dog walking’ • Jodie Grimley – CareDogs to support the Healthy Lifestyles project for ALD.  • The work will centre around Downing and Carwood. • This will involve 4 phases of work: • taking suitable dogs into the homes to get to understand dogs, build confidence and be trained on how to handle dogs • walking in the dogs in a suitable location • walking the dogs in the locality • for those who are interested, exploring the opportunities to walk the dogs of people in the local community either on a voluntary basis or as a social enterprise. • Jodie’s approach will not focus on lecturing about healthy lifestyles but will focus on the benefits that the dogs feel by being active.

18. Obesity and Healthy Living Telford and Wrekin LA and PCT Kit Roberts: Group Specialist Commissioner Nat Davies: Community Nurse, Joint Community Learning Disability Team