Healthy weight service- workshop report April NHS Southwark Clinical Commissioning Group

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1 Healthy weight service- workshop report April 2015 NHS Southwark Clinical Commissioning Group

2 Developing a healthy weight service NHS Southwark CCG held two workshops on 21 and 22 April The workshops were advertised via the following: Southwark CCG engagement mailing list GP practices Twitter SilverFit Fusion- exercise on referral service SE1 online forum Southwark Council online community forums CoolTan arts Southwark Disability Association Men s Health Forum Southwark pensioners forum The workshops were targeted at specific, eligible people with a BMI of 40+ or 35+ if they had related illnesses such as diabetes. Both workshops were fully booked. 26 people and four facilitators attended the workshops in total. 44% of participants were White British. 36% were Black British/ African/ Caribbean. 20% were from other BME backgrounds. The age range of participants was between 30 and % of the participants were female. 75% of participants reported a health problem including mental health or disability.

3 What we did 1) The CCG developed three personas of Southwark residents who are struggling with their weight. The personas were developed using information from the survey we carried out during January and February 15 and talking to Clinical Leads in Southwark. The personas included the persons lifestyle, hobbies, likes and dislikes and thoughts and feelings. 2) Participants were then asked to put themselves in the shoes of the persona and think about what service would meet their needs. Participants were asked to think about how they would access the service, what would motivate them to go and what would be included within the service. Participants were asked what outcomes would measure the success of the service for them.

4 Findings: Accessing the new service There was a strong consensus that people should be able to self-refer to this service and referral should not be limited via a GP. Different models of referral and approaches to advertising the service were discussed. Advertising the service: A launch event Word of mouth- champions/ ambassadors Dedicated website Via MySouthwark website Via Southwark resident magazines Advertising on buses or at bus stops Schools Community centres Churches/ places of worship Leaflets Millwall football club Gyms and leisure centres Hairdressers/ salons/ barbers Supermarkets/ Shops Jobcentre Referring to the service: Referral helpline with screening Online referral GP referral Referrals from professionals incl non-nhs e.g. leisure centre staff GP s to screen patient list and contact eligible clients Someone to be available on-site for walkins Access to therapy at point of motivation i.e. when accessing the service no waits

5 Findings: Motivators for using the service We discussed why people would want to access the service and how we could motivate people to use the service. What would help motivate people to use the service? One short bus ride away or provide transport Motivations for accessing the service: Wanting to visit friends and family more Change of lifestyle Looking for love Better quality of life Health problems- physical and mental health Improvements to mobility and fitness Need help but don t know where to start Familiar/approachable setting Consistent reminder of the health link to longer life (with family) Advice on how to deal with chronic pain (which could be a barrier) A way to include family members Bringing a friend along/ peer support The ability to drop in and trial to determine suitability/taster sessions Incentivise: No cost attached/free The provision of choice

6 Findings: What will the service look like? We discussed what professionals and organisations should be involved in the service: GPs- Could start with an extended GP appointment to look at whole picture Different psychological services Different health professionals- dietician, obesity nurse, obesity doctor A dedicated mentor to keep up motivation throughout programme Citizens advice and debt advice Addiction advice Inspirational motivators Important to share health information (securely) between different people Passionate staff that keep in close contact with client about progress Someone who really cares!

7 Findings: What will the service look like? We asked participants to think about the different elements of the service and group activities by; nutrition, exercise, behaviour change and other. Nutrition: 1:1 Dietetic advise at intervals throughout Family nutrition classes (Regular group education sessions that a family member could also attend) Multi-cultural advice about food (culturally relevant online/ app recipes) Videos on food preparation Vouchers for healthy foods at local supermarkets Free cooking classes Food articles- up to date research in lay language Healthy eating and recipes (reducing fat and sugar in recipes) available online Sessions on portion sizes, food swaps, food combining, what to eat at what times of day Salad bar on site Sessions to be embedded in service not in an office off site. Advice needs to be relevant to the whole family Should be about daily healthy eating and not about dieting

8 Findings: What will the service look like? Exercise: Free gym and varied exercise sessions dedicated to people in the service (specifically for clients) Group exercise sessions that are community base and low cost/free Exercise classes could also be culturally relevant e.g. different dance classes One to one classes and help at gym for people who need/ want it Hydrotherapy pool very important Group yoga and mindfulness sessions Taster sessions so people can see what they prefer Online exercise videos and support Pilates and other exercises to manage and reduce pain and strengthen core. Outdoor competitive sports and other fun activities Free exercise at all hours Personalised exercise plans Organise group sessions for people at same fitness level (e.g mobility problems or LTCs) (Initial assessment to determine level of fitness) Pedometer for daily use to assess activity level Walking groups at different places and different times Chair exercise class Emphasise on things people can do in everyday life, such as playing with grandchildren/ hoovering/ walking

9 Findings: What will the service look like? There needs to be long term, on-going group sessions; like Alcoholic Anonymous- continues for the rest of their lives. Behaviour change: Must be a highlighted element of the service Should be mixture of 1:1 and group support sessions (Start one to one then progress to group sessions) Include a community of people who have used the service to encourage sustainable support afterwards Should be a phasing out of support Should emphasize personal responsibility Addiction services implemented into therapies Counselling Need to be aware of stigma associated with talking therapies Needs to be longer than 12 weeks Men and women only talking groups (separate) Hypnotherapy

10 Findings: What will the service look like? Other: Tackle other issues such as debt, benefit and housing Online community Bring partners, children, siblings, friends! Music Physically active volunteer/ work opportunities (e.g. training children, football coaching) Assistance with hygiene Goal setting with expert and patient Disabled access Sign-posting and referral to pain management services Award/ recognition/ certificate at milestones and after completing the service Day trips together as a group- walking and socialising (healthier alcohol options) Saunas Massage therapy Healthy shopping trips Use of text messages and apps to keep motivation once started using Thorough induction to each service and activity in the programme

11 Findings: What will the service look like? We discussed where we should have this service and other logistics. Location of service: Leisure centre Everything under one roof HOWEVER Some elements of the service could be provided out of a GP surgery e.g. advise and sessions from obesity doctors or nurses. Schools Non-medical settings/community settings Choice of centres is important Tenants and residents association halls Nonjudgemental, warm, supportive, encouraging environment The running of the service: Service to operate as a rolling programme rather than having to wait for start of next service Evening and weekend classes available Keep in contact with obesity nurse, GP and support group after service has finished. 2-3 months intensive programme (exercise multiple times a week) then on-going support Annual reviews Dietician weekly, Obesity Dr as required, nurse fortnightly/ monthly

12 Findings: Outcomes Health and wellbeing outcomes: Lose weight Maintain weight loss Health conditions improve e.g. diabetes, reduced medication, reduced cholesterol More energy and > levels of fitness Takes ownership of health Feels healthier and happier Improved mental health Increased wellbeing Control More mobile and physically active Confidence boost and better self esteem Provides hope Knowledge and awareness outcomes: More educated regarding nutrition and exercise Able to educate other people including family The right amount of support to now go on and do it by themselves Changed eating habits Know how to access information/services that will continue to help Social outcomes: Make new friends, improve health of current friends Improved housing situation Becomes advocate for others starting pathway Ready for employment Change in social network Sense of achievement Becoming a mentor for new starters/ health and wellbeing champions Improved love life gets more compliments on appearance Given children a better start To live again

13 Final thoughts from workshops People could become champions/ activists within their communities to promote access to the service and it s benefits. Essential to tackle public health/ community issues- lots of cheap takeaways and no healthy cheap alternatives in the community. We should not refer to people using this service as patients but as service users or clients. There is stigma around the term therapy, maybe call it talking sessions. There also needs to be an emphasis on prevention for people with lower BMI s. With thanks to everyone who participated in the two workshops

14

15 Engaging with Southwark GPs We asked for the views of local GPs to help develop the potential service outcomes as well as views on a referral model for the service. Referral and pathway development: People should be able to self-refer to this service to demonstrate motivation. Anyone with a BMI >30 should be referred to service with no exclusions Referral to dietician should be optional Each client should be treated as an individual and services should be built around their needs. Service should be tailored e.g. people with learning disabilities may need more support. Could be called weight and activity management service. Service must include a clinical psychologist. There should be a focus on recruiting young adults and teens as a preventative method. Needs to be dynamic and ensure people can move up and down levels of support. Outcomes: Needs to be measured at different periods of time and focus on sustained behaviour change. Outcomes need to be set with client as they need to take ownership for their own health outcomes. Incentivise people to use the service and achieve their outcomes.

16 Next Steps Developing the service: This report and the key recommendations will form part of the service business plan. The business plan will be agreed by the CCG in summer Potential providers will be invited to see how they can work together to deliver the service. We hope that the service will start in winter 2015/2016. We will pilot the new service for at least 12 months. Continuing engagement: We will keep in contact with all the people that helped us to develop this service. We will arrange a meeting in the summer to inform people of the CCG decision. We are keen to work with the people who took part in the workshops to monitor the pilot. We will support people to continue to champion this service.

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