Manchester’s Healthy Weight Resource Pack 2012: A directory of services to help support overweight and obese patients Contents Page Introduction 01 Healthy Eating Services 02 Physical Activity Services 05 Weight Management Services 16 Combined Healthy Eating and Physical Activity Services 24 Services which support a Healthy Weight 31 Healthy Eating, Physical Activity and Weight Management Training 42 Training which supports a Healthy Weight 45 Resources: what’s available and where 48 Care Pathways 52 Physical Activity, Healthy Eating and Weight Management Guidelines 59 Other Important Information 69 Appendix 79 Introduction Welcome to Manchester’s Healthy Weight Resource Pack: A directory of services to help support overweight and obese patients This resource aims to outline to front line workers the different services that are currently available in Manchester to support people to maintain a healthy weight, including all healthy eating, physical activity and weight management services. This resource pack contains information about services for all age groups and abilities. In addition the resource also contains information about services and interventions that contribute to a healthy weight, such as the stop smoking service and alcohol identification and brief advice. As well as outlining the services available the resource also aims to clarify how to refer to the services included. This document supports Manchester’s Healthy Weight Strategy: Tackling Overweight and Obesity (2010-2013) and this resource pack is focused on services that help people to maintain a healthy lifestyle. It does not include services for malnutrition or eating disorders. To enable you to quickly find the services available the resource has been split into several categories - please see contents page. Where possible, referral forms have been included in the appendix to enable you to refer to the service without delay. Also included in this resource are useful guidelines, information and websites for further information. Access to websites is available at every public library. Additional downloadable copies of this resource pack are available from the following websites: www.manchesterpublichealthdevelopment.org www.manchester.nhs.uk The resource pack will be updated regularly on these websites. If you want more information about this resource pack please contact Amy Ashton, Public Health Manager - Healthy Weight (NHS Manchester) Tel: 0161 234 3651 Email: [email protected] 1 Community Food Co-ordinators Introduction to this service There are 3 Community Food Co-ordinators based across Manchester, one in each district (South, North, Central). The Community Food Co-ordinators provide a variety of courses and support around healthy eating and weight management. What to expect from this service The Community Food Co-ordinators provide 8 week weight management courses including weekly taster exercise sessions and healthy eating topics and 6 week cooking courses for adults. All of the courses are free and are run in local schools, community centres and children’s centres across Manchester. Referral criteria This service accepts self-referral to all of its courses. There isn’t a referral form for this service so please contact the relevant co-ordinator directly. Contact details For more information or to obtain details of the courses please contact Eleanor Murphy Community Food Co-ordinator (South) Healthy Living Network Withington Community Hospital Nell Lane M20 2LR Tel: 0161 217 3951 or 07971331540 Bernie Murphy Community Food Co-ordinator (Central) Manchester Public Health Development Service Fallowfield Library - 1st Floor Platt Lane Fallowfield M14 7FB Tel: 0161 48 1767 or 07971331537 Rose Boyd Community Food Co-ordinator (North) Zest Project North Manchester Regeneration 4th Floor, Hexagon Tower Delaunays Road Blackley Village M9 8GQ Tel: 0161 655 7887 or 07971331539 2 Community Food Workers Introduction to this service Community Food Workers aim to raise awareness of food and health within the community. They encourage people to experience new ways of cooking, shopping, budgeting and eating healthily and help people to apply their new skills and healthy eating behaviour to their everyday life. What to expect from this service Community Food Workers support groups by giving nutritional information and advice, facilitating cook and taste sessions and developing recipes and skills. This service is citywide. It does not provide sessions on a 1:1 basis Referral Criteria This service does not have a referral system. However the service targets people who • • • • • Lack skills and confidence Struggle on a budget Are unable to make healthy food choices Lack understanding of food portion sizes, food labels. etc People who find it difficult to eat well and groups of • • • • • Young people Young parents The elderly People in supported housing Refugees and asylum seekers etc Contact details For further information about this service please contact Nandy Cousins Community Food Worker Levenshulme Health Centre Dunstable st Manchester M19 3BX Tel: 0161 861 2333/6 Email: [email protected] 3 Food Futures Introduction to this service Food Futures is a partnership that embraces a wide range of individuals and organisations with an interest in improving food in the city. Its ambitious goal is to create a culture of good food in the city, based on the belief that good food is enjoyable, safe, nutritious, environmentally sustainable, and produced ethically and fairly; and that everyone in Manchester has a right to good food – no-one should have this right denied because of where they live, their income or their background. What to expect from this service The Food Futures strategy embraces the whole food agenda for the city – from improving health, tackling health inequalities and reducing the environmental impact of food, to building sustainable communities and strengthening the local economy. Food Futures can provide policy advice and support to services, organisations and groups who want to do food related work. Food Futures also produces an e-bulletin - a monthly update featuring brief articles on local and national news, events and developments that relate to food. Contact details: If you would like to receive any of the resources or would like more information about Food Futures please contact the team Food Futures Public Health Manchester Room 4042 Town Hall Extension Manchester M60 2LA Tel: 0161 234 4268 Email: [email protected]. Website: www.foodfutures.info 4 City in the Community Introduction to this service Manchester City Football Club’s community scheme, City in the Community (CITC) has been working with the people of Manchester since 1986. CITC, which is made up of 25 full time members of staff and 20 part time members of staff, works with over 200,000 people a year across four main programme areas: Football and Multi-Sport; Skills and Enterprise, Community Cohesion, and Health and Activity. What to expect from this service CITC organises free football and sport activities for the community throughout the year. These include; healthy school programmes for primary schools, free after school and half term football courses for young people, weekly disability sports clubs across the city and football activities for unemployed men in East Manchester. Through its Community Cohesion Project, Kickz, CITC provides constructive and positive activities for young people between 12 and 19 years on Thursday, Friday and Saturday nights in the Fallowfield and East Manchester areas of Manchester. The community programme also runs a range of Enterprise programmes in schools designed to give young people the opportunity to gain nationally recognised qualifications in Business and Enterprise whilst learning about the various departments within the Football club. Referral criteria To refer to this service please contact the team directly. Contact Details For more information about the programme or to find out what activities are offer, when and where please contact the team City in The Community, City Of Manchester Stadium, Sportcity, Manchester, M11 3FF. Tel: 0161 438 7711 E-mail: [email protected] 5 Strike a Balance: MCFC Healthy Schools Project Introduction to this service City in the Community (CITC) launched its new Healthy Schools Programme Strike a Balance in September 2010. The five week programme is aimed at young people in year 5 in Manchester primary schools and is a partnership between CITC and Manchester Healthy Schools. It aims to raise awareness of the importance of eating healthier food amongst young people by using the diet of footballers to teach young people that healthy food does not have to be boring food. Since it was launched, over 80 primary schools have taken part in the project and CITC is now working with Manchester Healthy Schools to develop new initiatives for secondary schools in Manchester. What to expect from this service Using examples of Premier League footballers such as Joe Hart and Gareth Barry, each session covers a different area of healthy eating and is followed by a football session. Topics covered include: • • • • The balance of good health Why we eat what we eat The importance of physical activity Cooking healthy, balanced meals Participants take part in a fun cookery session which reinforces these lessons and they are encouraged to take home affordable healthy recipes for all the family. They are also taught the importance of making physical activity part of their everyday life, whether simply walking to school or taking part in organised sport. Every young person receives their own educational folder and MCFC apron, and schools who take part are invited to enter a football competition against other schools. Referral criteria The Strike a Balance project is free for all primary schools within Manchester. Contact Details For more information about the programme or to find out what activities are offer, when and where please contact the team Lisa Kimpton Healthy Schools Project Manager City in the Community City of Manchester Stadium SportCity Manchester M11 3FF Tel: 0161 438 7711 E-mail: [email protected] 6 Disability Sports in Manchester Introduction to this service Manchester Sports Development deliver sporting opportunities for disabled children that are adapted to meet individuals needs These range form recreation ‘Come & Play’ activities to competitive sports clubs. Sports on offer are: swimming, athletics, cycling, football, multi sports clubs. What to expect from this service Sports Development offer an inclusive school holiday programme that delivers activities to ALL children regardless of ability, our ethos is ‘Sport can be played by all’ Referral criteria For information on the referral process contact 0161 220 3856 or email: [email protected] Contact details To find out more information about the clubs which are on offer as well as venues etc please contact Nicky Boothroyd, Disability Sport Manager, Regional Athletics Arena, Gate 13 Sportcity, Rowsley Street, Manchester, M11 3FF. Tel: 0161 220 3856 Fax: 0161 274 7372 Email: [email protected] Website: www.manchester.gov.uk 7 Fighting Fit Manchester Learning Disability Partnership (MLDP) Introduction to this service Fighting Fit (FF) is MLDP’s initiative to encourage and support adults who are learning disabled to lead more physically active lifestyles and to achieve or maintain a healthy weight. The aim is for people to experience the significant health benefits and sense of well-being that stem from this. What to expect from this service The FF project has been co-ordinated by the physiotherapy team. This team raises awareness of health issues and provides training for staff and carers. It endeavours to provide initial opportunities for sport and exercise to encourage people to either independently or in groups access public facilities. This service has access to a dietitian one day per week, to work with overweight and obese adults with learning disabilities that live at home with their family. Referrals must be made through Fighting Fit. Referral process Referrals can be accepted: • Externally via contact centre (this would be G.P.s, people themselves or carers) • Internally via other health or social care staff • Directly from G.P. Step 1 Step 2 Step 3 Step 4 Referral is received Letter is sent to the person with a request fro further information Home visit is arranged Plan is drawn up with the person with clear goals and expected outcomes People and their carers will be asked to consent for information to be shared with their G.P. and others as necessary. Contact details For more information please contact Emma Clegg Community Learning Disability Team Moss Side District Office Bold Street Manchester M16 7AD Tel: 0161 226 8131 Fax: 0161 274 7373 Email: [email protected] 8 Getting Active Through Exercise (GATE) Introduction to this service The Getting Active Through Exercise (GATE) team promote the benefits of exercise in the over-65’s to improve health and prevent falls. The GATE team work closely with other health professionals, statutory agencies and the voluntary sector. This partnership approach has brought together a wide range of expertise to ensure that the older population benefit from an integrated range of services and resources. What to expect from this service Exercise classes have been established across Manchester and to assist those who cannot get to a class, home based programmes are available, free of charge. The project offers exercise opportunities to all Manchester residents over the age of 65 from the most frail to the more active. Physiotherapists, occupational therapist, other health professionals and nonclinical staff can refer people to classes. Contact details For more information or to obtain details of the exercise classes please contact Manchester Public Health Development Service, Victoria Mill, 10 Lower Vicker’s St, Miles Platting, Manchester, M40 7LJ Tel: 0161 861 2585 Fax: 0161 203 5817 Email: [email protected] 9 Get Walking Keep Walking Manchester Introduction to this service Get Walking Keep Walking is a FREE urban walking project developed by The Ramblers to increase regular independent walking among previously inactive or insufficiently active people in Manchester. It is especially targeted at people from lowincome groups and black and minority ethnic backgrounds, and people with physical and mental health issues. The aim of the project is to change peoples’ behaviour, to get them walking more as part of their everyday lives, thereby making a big contribution to physical & mental well-being. What to expect from this service Front line workers can contact Get Walking Keep Walking to set up Get Walking programmes for their clients. There are three easy, cost-free options for getting involved. OPTION 1: Get Walking Keep Walking one-off walk Includes: Short, fun workshop with a quiz or competition, free motivational materials (including a step counter), local circular led walk (approx one hour) and refreshments – all tailored to your requirements. OPTION 2: Get Walking Keep Walking four week programme Includes: Short, fun workshop and refreshments, free motivational materials including step counters, four local circular 3060 minute led walks which are different each week. Each participant will receive the routes to walk again in their own time and will receive encouragement in the weeks after the walks. There is also a celebration two months later to encourage people to keep walking. All tailored to your requirements. Ideal Group size for options 1 & 2: 10 – 30 people OPTION 3: DIY packs For those who are unable to get to an organised one-off walk or programme, or who prefer walking in their own time, we offer a DIY walking pack which includes: Get Walking Keep Walking booklet with hints & tips to increase independent walking, log book to keep track of walking progress, step counter and local walking information. Get Walking Keep Walking also offers volunteering opportunities with their walking programmes or to design walking routes. For more information please contact Annette Crane. Referral Criteria Get Walking Keep Walking programmes are open to any Manchester resident. Led walks range from 30 minutes to 11/2 hours so participants need to be able to walk the minimum of 30 minutes at a comfortable pace for them. Contact details For more information about this service please contact Jen Green, Project Co-ordinator. Tel: 0161 232 3106 Email: [email protected] Annette Bell, Outreach Officer Tel: 0161 232 3101 Email: [email protected] Website: www.getwalking.org.uk 10 Manchester City Council – Active Lifestyles Introduction to this service Active Lifestyles is a city wide Physical Activity and Wellness Programme. Active Lifestyles is part of Manchester City Council’s Community and Cultural Services and sits within the Neighbourhood Services Directorate. We want all Manchester residents to have the opportunity to lead an active, healthy and happier life. Active Lifestyles is committed to the people we serve, we deliver at the place you choose, and we take pride in all that we do. Our Commitment • • • • • Innovative…we will create new and inspiring ways to help you get active Reliable… we will deliver the highest standard of service provision Trustworthy… we will give you accurate information and deliver on our promises Cost efficient… we will show that resources have been used wisely Professional… we are serious in all that we do and strive for excellence Our commitment to excellence We pride ourselves on service delivery and ensure that you, the customer comes first. All Active Lifestyles instructors have nationally recognised qualifications and meet all of our minimum standards for service delivery. Our instructors are highly experienced and knowledgeable in their field of expertise. They are there for you, and will provide support and guidance along your journey. Innovation and Motivation We will help you track your progress; using the latest technology you will be able to see how much activity you are doing, and what that actually means for your health. We will help to keep you motivated ensuring you reach your goals, and keep active. What to expect from this service: Active Lifestyles programme guarantees to help people lose weight, get active and feel better through either an individual or family-based programme. With over 200 fun-packed activity sessions across Manchester every week for people aged 0 to 100. Whatever your age and ability, there will be something to suit. Our sessions are located in facilities that are best suited to you – we deliver in primary schools, church halls, dance studios, community centres, resource centres, leisure centres, youth centres, local parks and outdoor places – ensuring convenience and easy access. The Programmes Tots on the Move - 6 weeks – 5 yrs Get active with your little one with our range of indoor, outdoor and aqua programmes specially designed for babies, toddlers and children aged 6 weeks to 5 years. This is coupled with a pre and post natal programme of activity. Kidzone – Guideline Age 5 to 8 years. A wide range of activities and adventure that will help your child be active and stay active. Club Active – Guideline Age 5 - 10 years / 11 – 16 years New and exciting activity clubs in Dance, Gamezone (non traditional sports such as Ultimate Frisbee, Tri-Golf and Handball), Active Fit and Dodgeball – no experience necessary. Urban Mania – Guideline Age 11 – 16 years Fitness sessions just for teenagers. Active Choices – Guideline Age 16+ Tone, tighten, burn, build, relax and refresh with this range of activities just for adults. 11 Easy Rhythms A range of gentle physical activities programmes designed for older adults and people new to exercise. Commit 2 It! - Guideline Age 16+ Ever wanted to run a 5K or 10K or even a marathon? Then join our weekly running sessions and we will get you from walking to running in no time – perfect for absolute beginners. Weight No More! – Children, Family and Adults Structured and supported weight loss programmes for adults. Easy to follow diet plans, calorie burning exercise sessions, guaranteed results. Aquativity – Open to All With our great range of aqua activities we have something for everyone, whatever your age. Mother and Daughter 5+, Learn 2 Swim, Funquatics, Aqua natal, Aquacise plus much, much more. Fit Families Fit A brand new fitness programme aimed at helping families get healthier, lose weight and get active; with a Families bespoke 12 week ‘kick start plan’ we will help you with healthy eating topics, easy to follow food plans, personal development, motivation and lots, lots more. Follow the plan and we guarantee results. Active Lifestyles Community Support Active Lifestyles can also help local community groups that are new and/or existing. We can assist with set up, constitution, which includes support with completing appropriate documentation, applying and writing bids for external funding, sourcing local venues and instructors, providing the opportunity for greater independence. For those groups that do not have the capacity to be independent, that is they do not want to undertake any financial workings, or bid writing, Active Lifestyles can try to identify funding and apply directly on the groups behalf or work with partners to support in funding. We also have a vast amount of experience in working with groups and communities who may need additional requirements in order to be able to access our programmes – we work hard to ensure that all within our communities can participate, providing female only sessions, which guarantee privacy and female instructors, specialist support for vulnerable participants, and we do whatever else we can to remove any barriers people may face, ensuring that we provide the opportunity for all to lead an active lifestyle. Specialist Provision Active Lifestyles also provides specialist physical activity provision, supporting people who have or are experiencing ill health. We work directly with NHS Manchester’s Physical Activity Referral Service (PARS) which provides a specialist service for people who have serious clinical conditions, and delivers programmes such as cardiac and pulmonary rehabilitation. Active Lifestyles provides the after service for PARS ensuring that we support the long term recovery into an independent active lifestyle. Active Lifestyles provides weight management programmes, for adults, children and the family. Working closely with GPs, NHS Manchester, School Nurses, District Nurses and other health professionals, our bespoke programmes help those most in need of losing weight. If you are worried about your weight or your child’s weight, please contact us and we can help you with the right programme. We work closely with other services across Manchester such as Manchester’s Public Health Development Service, The Christie, and Mental Health Services to provide specialist care and support for those who may not yet be able or ready to attend our general activity programme. We provide dedicated support for young people, and deliver bespoke programmes catering for the various issues that young people face when trying to access mainstream services and programmes. Our aim is to provide the right support and care to ensure that everyone can eventually lead an active lifestyle. Referral Criteria Active Lifestyles is open to all. Contact Details 12 The Active Lifestyles Centre Tel: 0161 232 3100 Email: [email protected] Website: www.manchester.gov.uk/activelifestyles Manchester Amputee Fitness Initiative (MANFIT) Introduction to this service Manchester Amputee Fitness Initiative (MANFIT) is funded by the Joint Health Unit and Manchester Leisure. The project is evolving as we discover people’s wants and needs. The aim of the project is to give the participants confidence to get/keep fit and ultimately to integrate into “normal” sports centres. This follows on from the strength, stamina and flexibility that lead to better operation of the prosthesis. The social interaction during exercise and after during a free lunch, together with exercise induced endorphin release gives people the confidence to move on to integrated gym sessions or another place of their choice. What to expect from this service This service offers: •gym sessions which take place at The Manchester College (Openshaw Campus) fitness suite in the daytime and at Nicholls Campus in the evening for people who are not available during the day. •A weekly exclusive swimming group also takes place at Manchester Aquatics Centre. A personal plan is given to each participant by pool staff. All sessions are FREE. •Weekly, non-contact boxers sessions at Moss Side Fire Station (small participant fee). Referral criteria The inclusion criterion is people have to have been discharged from the DSC physiotherapists unless permission is gained from the DSC. The age limit is over 18 years of age unless accompanied by an adult. Referral to this service can include self-referral or referral from a health care professional. There is not a referral form for this service so please contact MANFIT directly on the details below. Questionnaires are distributed to all new members and feedback questionnaires are used to assess satisfaction. Both include personal and health/fitness related data. Fitness is also assessed periodically by gym trainers (BP, weight, BMI, aerobic capacity etc). Contact details To find out more information, to refer to the service or to enquire about the timetable of the sessions please contact Email: [email protected] Website: www.manfit.org 13 Manchester MENCAP Introduction to this service Manchester Mencap offers an Advocacy and Sport and Physical Activity service for adults with learning disabilities in Manchester. Manchester Mencap is an organisation, affiliated to Royal Mencap. What to expect from this service Manchester Mencap offers many sport and physical activities opportunities including Boccia, Football, Yoga, Dancing and Walking. These activities are offered throughout Manchester and are either free or of minimal cost. Manchester MENCAP offers free training for the Physical Activity and Citizen Advocacy volunteers. Referral criteria This service is available for adults with learning disabilities of the age 18+. To refer to the sport and physical activity groups, the person or professional should email the service. Contact details For further information please contact Email: [email protected] Website: www.manchestermencap.cswebsites.org 14 Physical Activity Referral Scheme (PARS) Introduction to this service The Physical Activity Referral Service work across Manchester, helping members of the community to increase their levels of physical activity. The aim of the Team is to: Improve the health and wellbeing of the people of Manchester through increased physical activity (i.e. getting more people more active more often) - specifically targeting those with existing, or at high risk of developing, long term health problems like COPD, Heart Disease, Diabetes etc. This is done in two ways through one-to-one referrals and community activities, which include the following: • Cardiac rehabilitation, pulmonary rehabilitation. • Swimming lessons. • Weight management classes (with a dietitian). • Cycling. • Health Walking groups (indoor and Outdoor) • Low cost gym sessions These activities may vary across the city. Health Walks are free and exercise classes cost £1. What to expect from this service Patients referred to PARS are seen by a fully qualified Physical Activity Referral Officer. A full assessment of the patient’s past medical history and current lifestyle will be completed. The assessment will include: • A discussion about past/current activity levels • A discussion about past and present medical history. • Physiological and psychological measurements •A discussion about what the individual wants to achieve from attending PARS activities both in the short and longer term and goal setting. •Advice on what types of activities are available and those that are most suitable and safe for the individual. •Specialist advice relating to specific conditions for example heart disease, angina, diabetes, asthma and many more specific conditions Everyone referred to PARS will be asked to come back for follow up at: • 12 weeks in clinic • 6 months in clinic • 12 months in clinic Feedback will be sent to G.P.s and referrer (if different) after the patient’s initial appointment and after three and twelve months. Referral criteria The project is for anyone over 18 years old with long term health conditions or with risk factors for developing heart disease or diabetes in the future especially where increased activity will improve the condition or is a treatment option. For condition inclusion and exclusion criteria please see referral form. Referrals can come from the following people; General Practitioners/Practice Nurses, Physiotherapists, Health visitors/ Cardiac nurses/ Practice nurses AND Other health professionals. To refer to this service please complete a referral form and return to the relevant team. Please see appendix 1. Contact details Please contact the team at Clayton Health Centre, 89 North Road, Clayton, Manchester, M11 4EJ Tel: 0161 230 1857 Fax: 0161 230 1820 15 Fit Families Fit Families (Family Weight Management Programme) Introduction to this programme This new programme developed and run by Active Lifestyles is a family based healthy lifestyle programme targeting overweight and obese families. The programme aims to increase physical activity levels whilst educating families on how to achieve a healthy balanced diet and maintain their weight through behaviour modification. What to expect from this programme •Sessions run twice per week; one early evening session and one weekend session. •Participants can attend the programme for 12 months. •The first 12-weeks provide personal development sessions and physical activity. The second 12-weeks provide healthy eating sessions and physical activity followed by a maintenance programme of physical activity sessions for 6 months. •Sessions are split into ages 5 – 10 years and 11 – 16 years and parents/ guardian. •Fun physical activity sessions •The whole family can attend Referral criteria Inclusion criteria •Children must be accompanied by at least one parent/ carer at each session, other family members can attend also. •Children aged 5 – 16 years •Children must be over the 91st centile on the UK 1990 BMI centile charts (Child Growth Foundation) or above the International Obesity Task Force overweight cut-off point. Exclusion criteria •Children with Diabetes •Children with any other medical diagnosis will be reviewed on a case by case basis. •Children with moderate/ severe behavioural and/ or educational problems. The physical activity sessions have been designed for children with no physical disabilities. The exercise sessions rely on group participation and assume all children are fully mobile. Families can self refer to the programme or be referred by any health professional. To refer either; • Complete the referral form – see appendix 2 • Self register by contacting the team below. Contact Details For more information or to refer a patient to this programme please contact Anne-Marie Keating Active Lifestyles Centre, Denmark Road Hulme Manchester M15 6FG Tel: 0161 232 3127/07931546227 Email: [email protected] Website:www.manchester.gov.uk/activelifestyles 16 Weight Management Service - Child and Family Introduction to this service The Child and Family Weight Management Service aims to help overweight children and their families to achieve and maintain a healthy weight. Aimed primarily at children, the service offers a programme of advice and support to families who are committed to making healthy lifestyle changes. Adult family members who seek personal weight management support may be signposted to appropriate local services. What to expect from this service • • • • • • Informal telephone assessment Tailored resources Healthy lifestyle days Face to face contacts Ongoing support and advice Signposting to local services The first stage of the programme consists of an informal telephone assessment whereby the child’s named carer has the opportunity to discuss any concerns with a member of the team. Initial personalised goals will be agreed and resources provided to support the proposed lifestyle changes. The carer shall be invited to contact the service after an agreed timescale to discuss the level of progress and to engage with the service further if necessary. Referral criteria Any overweight or obese child aged between 2-17 years, with a Manchester GP, can be referred into the service for initial assessment and advice using the service referral form Please see appendix 3 Contact details For more information please contact Sarah Vince-Cain, Community Paediatric Dietitian Lorraine Leonard, Public Health Nutritionist Dina Pieri, Public Health Nutritionist Levenshulme Health Centre, Dunstable Street, Levenshulme, Manchester, M19 3BX. Tel: 0161 861 2329 Fax: 0161 248 0389 17 Weight Management in Primary Care – Counterweight Introduction to this programme The Counterweight Programme is an evidence based weight management programme for adults. It is the only fully evaluated, cost-effective, evidence based primary care weight management programme being used in the UK, showing sustained weight loss at 2 years. The aim of the counterweight programme is: • • • • To achieve and maintain medically valuable weight loss of 5-10% or 5-10kgs To make sustainable changes to eating and physical activity behaviours Maintenance of weight loss long term To improve health status What to expect from this programme The Counterweight model is based on Counterweight Specialists (registered dietitian and nutritionists specialising in obesity management), working with Primary Care Trusts and Health Boards to train and support healthcare staff to put the Counterweight Programme into practice. It is anticipated that each trained practitioner can enrol at least 25 patients in one year. (Counterweight aims to train 2 practitioners per practice and each practice therefore should enrol 50 patients in one year). Counterweight promotes behavioural strategies which seek to change eating habits, activity levels, sedentary behaviours and thinking processes that contribute to a person being overweight or obese. The programme provides a range of options which promote active weight loss for 3 to 6 months followed by long term weight loss maintenance. Referral criteria Counterweight is recommended for an adult population: • 18 to 75 years old • BMI≥ 30 kg/m2 or BMI ≥28 kg/m2 with co-morbidities • Assessed as at the right stage of behaviour change to be receptive to the programme A number of Manchester General Practices are participating in the Counterweight Programme - further details from Frances Wilkinson (contact details below) Contact details If your practice is interested in delivering Counterweight or for further information please contact Frances Wilkinson Counterweight Dietician, Levenshulme Health Centre, Dunstable Street, Levenshulme, Manchester, M19 3BX Tel: 0161 861 2348 Email: [email protected] Website: www.counterweight.org 18 Weight Management Service - Central Manchester Community Nutrition Service Introduction to this programme This service provides evidenced based advice and support for weight management for adults, which is tailored to the individual’s needs. They also provide a service for people with other food related health problems. What to expect from this programme This service can give one to one advice to adults on weight management at various health centres across Central Manchester. They can also visit people in their own homes. Referral criteria This service accepts referrals for adults over the age of 18, from NHS, hospital and community staff and from other social care and community workers, using the referral form. Please see appendix 14. Contact details For more information about the programme or to send referrals please contact: Hazel Andrews (Community Dietitian) Central Community Nutrition Service, Levenshulme Health Centre, Dunstable Street, Manchester, M19 3BX Tel: 0161 861 2333 Fax: 0161 248 0389 19 Weight Management Programme - ‘Your Choice’ Introduction to this programme Organised and run by the Community Nutrition Service in order to offer overweight patients more support to lose weight. Your Choice provides practical support, dietary advice, activities and health checks. Self motivation is also a key factor and the regular health checks encourage this as well as the opportunity for more help with other professionals in this area. What to expect from this programme There are 3 key areas; 1.Nutrition - Delivered by Dietitians and Nutrition Assistants. Practical help. Group sessions. Further 1-1 help to make changes to diet that will reduce calorie intake. As well as providing a regular 3 monthly health check for patients to review their progress. 2.Activity - Delivered by P.A.R.S. (Physical Activity Referral Scheme for those with co-morbidities) and the Active lifestyle service (for those without co-morbidities). Patients can be referred to either of these services as part of their weight loss programme. 3.Motivation - Patients are involved in breaking down barriers and developing their own goals to achieve weight loss. Sometimes there are behavioural or psychological issues which prevent people from achieving their aims. We work closely with the Mental Health Team to help patients that need this extra support. ‘Your Choice’ was started in South Manchester where it is currently provided by experienced dietitians and nutrition assistants. Changes to NHS Manchester mean that a citywide weight management programme will be developed to provide a service for all Manchester residents. The program will include elements of the following; • E ducation Morning – A group session to discuss food, eating and energy intake we also look at activity and motivation to make these lifestyle changes to lose weight. •Activity - with help from P.A.R.S. (Physical Activity Referral Scheme) and the Active lifestyles service qualified instructors can work on helping the patient increase their activity. Activities to suit all levels of ability are available. •Health checks - The patient will be offered health checks to monitor their weight, BMI, body fat, blood pressure and waist circumference. •Drop-in – The patient can come along anytime during the half hour to have a chat and get weighed if they wish. Mondays – 12:00 to 12:30 upstairs at the Forum Health Centre •1 to 1 – An appointment with a Registered Dietitian Referral criteria The service accepts self referrals from people aged 16+ with a BMI of 30+. Please see appendix 4. The service will contact the patient directly following referral and provide them with an appointment that is closest to their home address. Contact details For more information about the programme or to send referrals please contact: Ray Green (Community Dietitian) Wythenshawe Offices Stancliffe Road Sharston M22 4PJ Tel: 0161 946 8210 Fax: 0161 946 8209 Email: [email protected] 20 Weight Management Service - Community Nutrition Assistants (South Manchester) Introduction to this service The role of the Community Nutrition Assistant (CNA) is to support the dietetic service delivery to clients. Community Nutrition Service CNAs have recognised nutrition qualifications and specific skills such as communication and community or group work skills, which provide motivational and practical support to clients. What to expect from this service Currently CNAs participate in regular weight management sessions in South localities only, for example they complete: • • • • Twice monthly group sessions in different venues Follow up and health check one to one sessions weekly in different venues Drop in weight monitoring sessions face to face, and telephone support Exercise programme on referral Referral criteria Any adult (>16 years) with a BMI over 30 or over 28 with co-morbidities can self refer to the ‘Your choice’ program using the referral form. GPs or health care professional can also refer patients to this service, using the referral form. Please see appendix 2. Contact details For further details about the CNA role or the ‘Your Choice Programme’ please contact Ray Green (Community Dietitian) Wythenshawe Offices Stancliffe Road Sharston M22 4PJ Tel: 0161 946 8210 Fax: 0161 946 8209 Email: [email protected] 21 Level 3 - Adult Specialist Weight Management Service Choose to Change Introduction to this service This service is focused on inspiring positive and lifelong behavioural change. The service balances psychological, physical and nutritional support and advice, and is designed to empower individuals to make healthier lifestyle choices. In order to make a real difference, the service sets realistic targets and celebrates successes at every stage of a patient’s journey with the message that ‘small changes are good changes’. What to expect from this service All clients will receive an initial multi-disciplinary assessment including a psychological assessment. All clients referred into the service are made aware of the level of commitment required and their readiness to change. Clients will be supported to develop an individual action plan that can consist of a 6 month group based lifestyle programme, 1:1 Psychological programme or 1:1 nutrition programme. Referral criteria Adults over 18 registered with an NHS Salford, Manchester or Oldham GP with a: • BMI over 35 • BMI over 30 and pregnant • Eligible for bariatric surgery and requires 6 month lifestyle intervention can be referred to this service, using the referral form. Please see appendix 15. Contact details For further information about the service or to make a referral please contact Melanie Taylor – Stakeholder Engagement Lead Shelley Evans – Programme Manager ABL Health Ltd 71 Redgate Way The Royal Bolton Hospital BL4 0JL Tel: 01204 570999 Email: [email protected] 22 Weight No More, Active Lifestyles Introduction to this service Developed and run by Active Lifestyles, Weight No More is a city-wide weight management programme for adult residents who are overweight and obese. The sessions are arranged to provide support including confidential weigh-ins, physical activity sessions, goal-setting, nutritional advice and lots of support and encouragement. What to expect from this programme •Fun physical activity sessions •Nutritional advice (if required). This can be omitted if a client is receiving nutritional advice from another weight management programme. •Ongoing support, guidance and advice. •Regular health checks •Encouragement and motivation and personal development workshops •Sessions run at various times in the daytime and evening, there are always two sessions at the same venue per week. Referral criteria To join Weight No More, residents can turn up to the advertised sessions, alternatively if you feel a resident needs more support then please refer them and we will contact them and go through the options available to them. • • • • Suitable for ages 16 – 65 years approx. No co-morbidities Sessions are suitable for those with a BMI over 25.00 Everyone referred to WNM will be contacted. Please see appendix 5. Contact details For more information or to refer a patient to this programme please contact Anne-Marie Keating Active Lifestyles Centre, Denmark Road Hulme Manchester M15 6FG Tel: 0161 232 3127/07931546227 Email: [email protected] Website:www.manchester.gov.uk/activelifestyles 23 Community Health Trainer Programme Introduction to this service Health Trainers are drawn from local communities and aim to reach people who want to adopt healthier lifestyles. The programme aims to: • • • • Improve public and patient access to information and services Target vulnerable and marginalised individuals Address the major lifestyle determinants of health Support clients to achieve and maintain positive lifestyle changes Health Trainers are based within different settings across the city. They encourage increased levels of physical activity and improve access to information and one-to-one support around food, diet and nutrition. The introduction of a more holistic health and well being assessment means Health Trainers work more broadly. They can now therefore offer assistance around alcohol consumption, smoking, stress and anxiety. The Health Trainers role is not to give advice, it is to structure a series of discussions to empower the client to develop and use skills to regulate their own behaviour. This brief intervention aims to assist clients in moving towards specific goals. What to expect from this service A Health Trainer will usually see a client on a maximum of 6 separate occasions. The first session includes a health and well being assessment in order to assess the person’s opinion of their current general health, well-being and health goals. Referral criteria Any adult (>18 years) can access the Health Trainer service by self referral or referral from a third party, using the referral form. Please see appendix 6. Contact details For further information about the service or to make a referral please contact Aurora Robb, Manchester Public Health Development Service, Manchester Mental Health and Social Care Trust, Victoria Mill, Lower Vickers St, Miles Platting, Manchester, M40 7LJ Tel: 0161 861 2548 Fax: 0161 203 5817 Email: [email protected] 24 Healthy Living Network South Manchester Introduction to this service SMHLN is a service which works with people and local organisations to bring them together to improve health and wellbeing. What to expect from this service SMHLN consists of the following projects: Volunteer project - supports local involvement in the NHS, volunteers are trained in smoking cessation, chair based exercise and outreach work. They support local focus groups, map gaps in existing health provision and act as sign posters for local NHS services. Partnership health project - supports local organisations and groups to improve health and wellbeing. The project builds capacity and helps towards sustainable community work. Community Food Project - Supports local individuals and community groups in weight management courses, healthy eating and food growing projects (see community food co-ordinators page for more details). Referral criteria Most sessions are open to all, and are free or very low cost. Some sessions are for specific target groups and ages. This service accepts self referral by contacting the SMHLN directly. Contact details For more information or to obtain a full list of healthy activities contact Health Improvement Manager Withington Community Hospital Nell Lane Manchester M20 2LR Tel: 0161 217 3667 25 Healthy Living Network Zest Introduction to this service Zest is an established healthy living network in North and East Manchester. Zest works in partnership with local people, communities and organisations from all sectors to increase choices and opportunities to improve health and well-being. Zest links in to the public health agendas of Manchester City Council and the NHS. What to expect from this service The service currently delivers over 40 regular healthy living activities in local, accessible venues, which are free or low cost and are mainly open to everyone. Zest works closely with individual communities and residents to ensure these activities reflect local need. Examples of the range of activities include: Yoga, Tai Chi, massage and relaxation, craft, dance, chair-based exercise, walking, Fun and Games. Food related activities include: cook and taste, cooking skills and weight management classes. (These are provided by the Zest Community Food Co-ordinator – see their page for more details) Other wellbeing programmes / workshops are delivered throughout the year in response to identified needs and in partnership with local groups and organisations. There is a Zest Co-ordinator for each of the following areas: • • • • • Charlestown / Higher Blackley Cheetham / Crumpsall Harpurhey / Moston MPAC ( Miles Platting, Ancoats and Collyhurst) / Newton Heath Beacons (Beswick, Clayton and Openshaw) Health Forums are supported in each area, where local health and well-being issues and solutions can be discussed, and information shared. These are open to all residents, partners and organisations. Referral criteria Most sessions are open to all and anyone can be directed to these. Some sessions are for specific target groups and ages. Contact Zest directly for further details. Contact details For more information or to obtain a full list of activities contact Debra Pearson, Zest Project Manager, North Manchester Regeneration, 7th Floor, Hexagon Tower, Delaunays Road, Blackley Village, M9 8GQ. Tel: 0161 655 7889 Fax: 0161 655 7801 26 Manchester’s Healthy Schools Service Introduction to this service Manchester Healthy Schools Service consists of three teams who provide support and resources to schools in Manchester, on health related issues: 1. The Safer Choices Team – Includes Sex and Relationship Education and Drug Education 2. The Healthy Lifestyles Team – Includes Healthy Eating and Physical Activity 3. The Well-Being Team – Includes Mental Health in Schools, Anti-Bullying and Pupil Voice The Healthy Schools approach is based on the holistic child, supporting good health and happiness inside and out. Healthy School involves the whole school and local community – children and young people, school staff and parents and governors are all supported to improve health and wellbeing, making the most of life and learning. What to expect from this service All three teams offer a range of targeted and universal training programmes and resources suitable for school staff to support children, young people, governors, parents, carers and families. The training and resources aim to support and skill professionals working with children and young people to tackle the specific health inequalities evident within Manchester. These include healthy eating and physical activity to help tackle obesity, poor mental health, sex and relationships and alcohol and substance misuse. Referral criteria All Local Authority Primary, Secondary and Special Schools in Manchester can access the training and resources offered by this service. Contact details For more information about this service please contact Tel: 0161 946 8270 Email: [email protected] website: www.manchesterhealthyschools.nhs.uk 27 Health Visiting Service Introduction to this service Health Visitors are qualified registered nurses with specialist qualifications in community health which includes child health, health promotion and education. They lead teams comprised of community staff nurses and nursery nurses. They provide a universal service to all families with children under four and a half years of age in a number of settings including in the home, at baby clinics, in Children’s Centres and can also give telephone advice. Their focus is on the prevention of ill-health and on the early identification of health problems. What to expect from this service Advice and support for parents around: • • • • • • Breast feeding Infant feeding and healthy weaning for babies Healthy eating for children and families Weight and growth monitoring Children’s development and behaviour Sign-posting/referral to local services such as healthy eating/cooking groups and exercise activities for toddlers Referral criteria Clients can access the health visiting service by self-referral or can be referred by any agency by phone or letter. Contact details Clients can find their Health Visitors contact details in their Personal Child Health Record (red book).Health Visitors can be contacted by phone, by calling in at their base/health centre or at the community baby clinic. You can access all children’s community health services via our website www.younghealthymanchester.nhs.uk Alternatively clients can locate their Health Visitor through their GP or local Children’s Centre who all have link Health Visitors. They will ensure a clients referral/request for Health Visitor contact is passed onto the Health Visitor for the family. 28 School Nursing Service Introduction to this service School Nurses are qualified registered Nurses with specialist qualifications in Community Health which includes Child Health, Health Promotion and Education. They provide a universal service to all families with children 4 and a half to 16 years of age. School Nursing is based on the child centered public health principles with a strong focus on the early identification of health problems and a preventative emphasis. The School Nursing Teams provide a range of health improvement activities. What to expect from this service With specific reference to addressing healthy weight, the School Nursing Service can: •Provide targeted 1:1 intervention – offering advice and support to enable the child and family to adopt healthier eating/ lifestyle approaches • Deliver group health promotion sessions about healthy eating/healthy lifestyle • Refer to Specialist Services if deemed appropriate by the School Health Advisor/Nurse School Health Nurses/Advisors use a partnership framework in their work, operating in collaboration with other colleagues and agencies in order to address the wider threats to health eg: housing, transport, crime reduction, social exclusion etc... School Health Nurses/Advisors also provide advice and help on a one to one basis with children and young people on areas such as personal relationships, managing stress and risk taking behaviours. They compliment Primary Care Services by providing a safety net for children and young people particularly the most disadvantaged. Referral criteria Referrals can be made by any agency or by self referral by client or parent/carer. Contact Details For more information please contact North District Charlestown Road Health Centre Tel: 0161 741 2000 Cheetham Primary Care Centre Tel: 0161 202 8775 Clayton Health Centre Tel: 0161 231 1151 Harpurhey Health Centre Tel: 0161 861 2400/ 861 2433/4 Central Levenshulme Health Centre Tel: 0161 861 2300 Alexandra Park Health Centre Tel: 0161 226 0101 The Vallance Tel: 0161 274 1550 South Northenden Health Centre Tel: 0161 945 3624 Wythenshawe Offices 1 Stancliffe Road Tel: 0161 946 0065 Newton Heath Health Centre Tel: 0161 684 9696 Plant Hill Clinic Tel: 0161 740 8004 29 Sure Start Introduction to this service Sure Start is a national government programme which aims to achieve better outcomes for children under 5 years old, parents and communities by: • increasing the availability of childcare for all children • improving health and emotional development of young children • supporting parents through parenting programmes and in their aspirations towards employment. There are 40 Children’s Centers in the City of Manchester. What to expect from this service For more information contact the local Children’s Centre or go online at: www.manchester.gov.uk/info/200016/childcare/3109/childrens_centres/1 Referral criteria Groups have differing referral criteria dependent on the focus of the activity. Referral criteria is always included in publicity. Contact details Websites:www.surestart.gov.uk www.manchester.gov.uk/info/200016/childcare/3109/childrens_centres/1 30 Services which Support a Healthy Weight Support for People Drinking at Higher Risk or Dependent Levels Introduction to this service Manchester Community Alcohol Team provides specialist alcohol assessments and structured treatment for anyone over the age of 16 drinking at higher risk or dependent levels. What to expect from this service Appointments are held with an Alcohol Linkworker and take place on a one-to-one basis in doctor’s surgeries or nearby health centres. Following initial assessment, the Alcohol Linkworker agrees a care plan with the patient aiming to enhance motivation, support reduction, stabilisation or abstinence from alcohol. If there is a level of alcohol-dependence requiring “planned withdrawal” with detoxification, the Alcohol Linkworker will advise the safest location to do this (e.g. at home or in a residential environment) and ensure a recovery plan is in place prior to treatment. Referral criteria This service is aimed at patients who have been identified as possibly alcohol dependent (AUDIT scores 20-40) or higher risk drinkers who have not responded to a brief intervention (AUDIT scores 16-19). Referrals can be made by telephoning the number below or by completing the referral form and faxing to the CAT on the details below. Please see appendix 7. Contact details For more information about this service please contact Manchester Community Alcohol Team Longsight District Office 523 Stockport Road Manchester M12 4LL Tel: 0161 225 9293 Fax: 0161 882 1344 Website: www.manchestercat.org 31 Expert Patients Programme Introduction to this service The Expert Patients Programme is a course for anyone with long-term health conditions. It aims to support people who would like to find ways of managing the impact of living with health problems, in order to improve their quality of life. The programme builds on the principal that people who live with long-term health problems or have difficulties in managing the impact of being over or under weight can affect their over all health and well being, It has been nationally recognised that people who live with health problems know best how their condition affects the way they feel on a day to day basis, how it affects their lifestyle and their ability to accomplish activities important to them. The course also looks at ways to positively manage symptoms, how to improve on daily activities and manage the changing emotions that can be brought about by living with long term health conditions. There is a wealth of evidence to back claims that the Expert Patients Programme has significant benefits for the individuals who participate. What to expect from this service The course is free and consists of 6 weekly sessions – each lasting 2 ½ hours. It is delivered by two nationally trained volunteer tutors who themselves have long-term health problems and have previously attended an Expert Patient Course prior to becoming a tutor. This means they understand the challenges people face in having health problems and coming on the course. Weekly sessions provide information on specific topics such as managing symptoms and medicine, relaxation techniques, healthy eating and physical activity; how and why this can help reduce symptoms and learn how to communicate effectively with health care practitioners and GPs. On each course there are between 8 and 10 participants. The venues are checked to ensure they are fully accessible. Referral criteria This programme is open to anyone with long term health problems. Any one can refer into the programme and the patient may also self refer if they wish to. To refer into the programme please complete the patient registration form – please see appendix 8. Contact details For more information about this service please contact Expert Patients Programme Referral Team, University Hospital of South Manchester NHS Foundation Trust, Newton House, Newton Silk Mill, Holyoak Street, Newton Heath, Manchester, M40 1HA. Tel: 0161 219 9424 Fax: 0161 219 9477 Email: [email protected] 32 Family Nurse Partnership Introduction to this service Family Nurse Partnership (FNP) is an intensive, preventative home visiting programme for young women who are having their first baby. A specially trained nurse will visit the mum (and partner) regularly throughout pregnancy until the baby reaches 2 years of age. What to expect from this service •The family nurse will share lots of information about pregnancy, giving birth and looking after babies and toddlers:•The nurse and young parents get to know each other really well. •The nurse will help parents to build strong networks of support in the community. •Make the home a safe place for baby to live and play. •The focus is on mums bonding and attachment interactions with her baby. •Supports with childcare, job training, housing and other support services available in the community. •Find ways to help mums to continue with their education and develop job skills. •Set goals for the family’s future and find ways to help reach them. •The nurse provides support/ information about stopping smoking better nutrition, feeding, weaning and ways to maintain a healthy weight. •It improves children’s emotional and behavioural development and readiness for school •It improves ante natal health, child health and parents’ economic self sufficiency, self efficacy and change behaviour. •It is a licensed programme developed and researched over 30 years in the U.S. Referral criteria Any young woman who is:Under the age of 20 years Pregnant with her first child Can join as early as 12 weeks gestation Must join before 28 weeks gestation Client can self refer There may be a short waiting list please see appendix 9. Contact details For more information about this service please contact Family Nurse Partnership, Manchester’s Science Park Ltd, 1st Floor, Unit 21 Enterprise House, Lloyds St North, Manchester, M15 6SE. Tel: 0161 227 0600 Fax: 0161 227 0605 33 Paediatric Physiotherapy for Children with Weight Management Issues and Associated Musculoskeletal Conditions Introduction to this service If a child aged between 0 and 16 has weight issues and also a musculoskeletal condition ie. back pain then the physiotherapy team could see the child and incorporate healthy exercise into their management plan. What to expect from the service The physiotherapy team would see the child until their pain had resolved or other services needed to be involved eg orthopaedics. Referral criteria When to refer • Children/young people who are 16 and under • Identification of weight issues using IOTF BMI centile cut offs •Associated joint pain e.g. In knees or back which is impacting on the child’s ability to take part in physical activity or increase their activity levels When not to refer • When a child and their family are not in agreement with the referral Please see appendix 10 and 11. Contact details For more information about this service please contact Paediatric Physiotherapy & Occupational Therapy Department Children’s Community Services Central Manchester University Hospitals NHS Foundation Trust Cornerstones Centre 2 Graham Street Beswick Manchester M11 3AA Tel: 0161 220 7110 Fax: 0161 220 3991 34 Partnership for Older People Project (POPP) Introduction to this service POPP is an 8 week programme of health promotion and supported exercise for people who have survived a stroke and/or a Transient Ischaemic Attack (TIA)- “mini-stroke”- and their carers. This is an ongoing project, which aims to give people affected by stroke an opportunity to improve strength, mobility and confidence, by trying physical exercise in a safe environment. The project will run in the form of an 8 week session based at a venue in Gorton and, if needed, transport can be provided. What to expect from this service Participants will have an increased awareness of the health benefits of taking regular exercise and be able to make other healthier lifestyle choices. They will be able to access other facilities and services in their community where they can take part in physical exercise after the programme has finished. Carer’s will either have the opportunity for respite or to relax with other carers during the sessions. It is hoped that this will improve carer’s confidence and emotional well being by helping them to feel less isolated. They will also be able to participate in the healthy living education programme, which will help carer’s to make healthier lifestyle choices. Referral criteria The following must apply to the referred person: • Have had a stroke or TIA at any time in the past • Any age can attend • Be a resident in the Central, South or North Manchester area To refer a participant please use the referral form in appendix 12. The referral form can be faxed or sent to the service once gaining permission of the referred person. This form may be copied if needed and completed with as much information as possible. Contact details For more information or to make a referral please contact Helen Gilbertson The Stroke Association 1st Floor Stamford House Northenden Road Sale M33 2DH Tel: 0161 972 0559 Fax: 0161 962 3323 Email: [email protected] 35 Stop Smoking Service Introduction to this service Manchester Stop Smoking Service is a free NHS service, dedicated to providing non-judgmental advice and support to help people give up smoking. What to expect from this service Trained specialist advisors offer one-to-one support on a drop-in or appointment basis. Anyone going to a drop-in or appointment can get help to plan their quit attempt as well as receive free or discounted nicotine replacement therapy (NRT). Advisors provide support from a number of venues around the city, including pharmacies, hospitals, health centres, GP practices, community centre’s, Childrens Centres, workplaces and local markets. Referral criteria Manchester Stop Smoking Service is open to people who live, work or are registered with a GP in Manchester. People can contact the service directly or be referred by a health professional. Contact details For more information about this service or to quit smoking please contact Tel: 0161 205 5998. If an interpreter is required Text ‘LANG’ plus the language the client would like to be called back in to 81025. Website: www.stopsmokingmanchester.co.uk 36 Supporting Health Programme Introduction to this service The Manchester Supporting Health Programme is in two parts, one part is focussed on improving physical health of people with severe mental illness and the other part is focussed on improving physical health of people with dementia and their carers. The programme team to develop the work includes Supporting Health Nurses and Public Health Development Advisors, based within Manchester Mental Health and Social Care Trust. To view reports, please look in the reports section of the mental health pages of the Public Health Development website at www.mphds.org. What to expect from this service The Supporting Health Nurses have built experience in providing detailed physical health checks to the client groups. This experience is now going to be utilised to support and guide others who have roles to offer health checks, both within primary and secondary care. They also work closely with specialist mental health services so that supporting improved physical health can become a part of care planning for the service user. Some of the key areas being developed are: •Appropriate support for people who want to improve their health •Improving access to information about health improvement •Improving pathways to healthcare and health promotion services in the community •Increasing the public health skills of mental health specialists •Offering mental health awareness and dementia awareness training for staff/volunteers of services engaged in health and community work Contact details Supporting Health Nurses - Severe Mental Illness Sue Blakeley Mobile: 07949765541 Email: [email protected] Margaret Muldown Mobile: 07553365349 Email: [email protected] Supporting Health Nurse – Dementia Pam Kehoe Mobile: 07553377135 Email: [email protected] To discuss access to health improvement opportunities for people with severe mental illness, resources and training Shamin Malik Tel: 0161 861 2539 Email: [email protected] To discuss access to health improvement opportunities for people with dementia and associated resources and training Alpa Raja Tel: 0161 861 2545 Email: [email protected] 37 Support for people with Mental Health Problems Services for Adults: Introduction to this service NHS services are divided into those that offer support and treatment for common mental health problems and those that offer support and treatment for serious mental illnesses. Primary care services Manchester Primary Care Mental Health Services offer short term support to residents, aged 16 and older, who are registered with a GP and have common mental health problems and/or associated social problems such as anxiety and panic, phobias, depression, bereavement difficulties, obsessions, compulsions and stress related problems. The service provides brief psychological interventions based on Cognitive Behavioural Therapy, and includes problem solving, guided self help, help with physical health, advice and information and signposting to other services. North and South teams provide counselling services and the Central team can sign post to counselling. There are three Primary Care Mental Health Teams in Manchester, who can accept referrals from GPs, professionals and self referrals. These services can be contacted by frontline staff if you need advice and guidance about someone experiencing mental distress. Primary Care Mental Health Team (North Districts) 0161 231 0017 Primary Care Mental Health Team (Central District) 0161 861 2236 Primary Care Mental Health Team (South Districts) 0161 946 8260 Manchester Psychological Wellbeing Service The Psychological Wellbeing Service provides one-to-one assessment and treatment for common mental health problems. Psychological Wellbeing Service - 0161 226 3871 Manchester computerised Cognitive Behavioural Therapy (cCBT) service - 0161 232 7854 Secondary care services Secondary Care services help people who are diagnosed with a severe or enduring mental illness under a care plan, including people with dementia. Conditions such as psychosis, schizophrenia, bipolar disorder and severe depression are considered to be the more serious mental health problems. In Manchester, most of the secondary care services provided for adults and older people are by the Manchester Mental Health & Social Care Trust (MMHSCT). This can be contacted on 0161 882 1000 or visit www.mhsc.nhs.uk for a service directory which holds details on the Trust’s services, including descriptions, contact details and referral methods. Services on offer include hospital and specialist services that support people during a mental health crisis and offer continuing treatment when the crisis has stabilised and a wide range of services to support the recovery and social inclusion of individuals in the community. It is very important for individuals to seek help early; identifying that there is a problem and getting treatment early leads to better recovery and longer term outcome. How to get support for clients or make a referral If you are concerned that someone is suffering from a severe mental health problem: •They should see their GP. They will consider whether to make a referral to a specialist mental health service where an assessment can be made by a psychiatrist, a psychologist or other specialist; this is usually through the Single Point of Access (SPA). • You or they can telephone the Manchester Contact Service for Social Care (see below). • Alternatively as a professional you can make a referral into the SPA or get advice from them (see below). 38 Manchester Contact Service for Social Care If there is a concern that someone may have a mental health problem, referral to NHS secondary care mental health services would in most cases be through the Manchester Contact Service for Social Care on 0161 255 8250 in the first instance. Anybody can contact this number including self, friends, family and neighbours. This number can be used if you are concerned about someone’s mental health, about the mistreatment of a child or vulnerable adult or to report a hate crime. Single Point of Access Referral to individual services provided by the MMHSCT Trust for people who have mental health problems, can be made through the Single Point of Access (SPA): contact 0161 276 6155. Any professional can make a referral; most referrals come from GPs and the Manchester Contact Service for Social Care. Crisis Resolution and Home Treatment Team They support clients who are in crisis (risk to self or others). Referrals are only accepted from medical staff and mental health professionals who must have seen the individual within 12 hours. Referrals need to be made by phone. They will do their best to see someone within 48 hours. • CRISIS Central: Tel: 0161 901 7380/0161-276-5368 Fax: 0161-276-4730 • CRISIS North: Tel: 0161-720-2045 Fax: 0161-720-4200 • CRISIS South: Tel: 0161-882-1029 Fax: 0161-882-1035 Early Intervention Service Many people will experience their first ‘psychotic episode’ between the ages of 14 and 35. If you notice that someone is experiencing persistent changes in mood and behaviour, is becoming isolated and not getting on with people, has strange thoughts, ideas or odd behaviour, or is using drugs or alcohol more, then these could be just some of the signs that they are experiencing difficulties. It is vital to act early. The Manchester Early Intervention Service offers assessment and treatment to young people in Manchester aged between 14 and 35. They can be contacted on 0161 277 6830. Voluntary and community sector organisations In Manchester there are a large number of voluntary and community sector organisations (e.g., charities) that provide a wide range of services. Some of these are mental health specialists providing services like counselling and self-help groups. Others offer a wider range of services that can support good mental health, e.g., housing advice or social support and volunteering. There are a few organisations that provide services specifically for black and minority ethnic communities. Please see Manchester Psyscological Wellbeing Service information on page 36. 39 Support for People with Mental Health Problems Services for Children and Young People Child and Adolescent Mental Health Services (CAMHS) Child and adolescent mental health services in Manchester offer a range of services including psychiatry and psychology for 0-16 year olds. Contacts are: Central Manchester - The Winnicott Centre, 0161 248 9494), North Manchester - The Bridge, 0161 203 3250/3251) and South Manchester - The Carol Kendrick Centre, 0161 902 3400). CAMHS services accept referrals from GPs, Community Paediatricians, School Doctors, Educational Psychology, Health Visitors, School Nurses, Social Services and Youth Offending Teams. Most CAMHS services do not accept self referrals. Emerge 16/17 Community Mental Health Team is part of CAMHS. Emerge offers confidential support for 16 and 17 year olds around mental health issues; this is one to one and group support. The service will accept referrals from young people, family members, carers and professionals; contact 0161 226 7457. Voluntary sector services for young people There is a range including: •42nd Street offers individual support for anyone aged 13 to 25 and under stress. Services include counselling, groups and individual support. Contact: 0161 832 0170 Swan Buildings, 20 Swan Street, Manchester, M4 5JW •Young Adult Advice and Support Project (YASP) is a community based Young Mental Health Project providing practical advice and support for 15-25 year olds around issues such as housing, benefits, money, health, education, relationships and sexual health Contact: 0161 221 3054 832 Stockport Road, Levenshulme, Manchester, M19 3AW Emergency and crisis for young people Options to deal with emergencies are: • • • • Contact GP Go to the nearest Accident & Emergency hospital department Call 999 and ask for an ambulance Police Current users of Manchester Mental Health & Social Care Trust services who are in crisis should contact the 24 hour crisis line on 0161 901 1477. Website for further information and directory of services For more information about the range of services for adults and young people, visit www.mhim.org.uk. A directory of mental health services across Manchester and a list of counselling services can be downloaded from the site. 40 The Common Assessment Framework Introduction to this service The Common Assessment Framework (CAF) is a key component in the Every Child Matters: Change for Children programme. The aim is to identify, at the earliest opportunity, a child or young person’s additional needs and provide timely and coordinated support to meet those needs. This can include children who are overweight and obese. What is the CAF? It has three elements: • A simple pre-assessment checklist to help practitioners identify children or young people who would benefit from a common assessment; • A process for undertaking a common assessment to help practitioners gather and understand information about the needs and strengths of the child – based on discussions with the child, their family and other practitioners as appropriate; • A standard form to help practitioners record and, where appropriate, share with others the findings from the assessment in terms that are helpful in working with the family to find a response to unmet needs; agreeing with the child and family what support is needed. CAF benefits The CAF provides an assessment that is common across services. It will help embed a shared language, support better understanding amongst practitioners, reduce the number of different assessments, facilitate early intervention and speed up service delivery. The lead professional is the one practitioner who takes a ‘lead role’ to ensure that front-line services are coordinated, coherent and achieving intended outcomes. This way all children and young people who require integrated support from more than one practitioner should experience a seamless and effective service. What is the role of a lead professional? The lead professional is not a new role. Instead s/he delivers three core functions as part of their work: • Act as a single point of contact for the child or family; • Coordinate the delivery of the actions agreed; • Reduce overlap and inconsistency in the services received. A lead professional is accountable to their home agency for their delivery of the lead professional functions. They are not responsible or accountable for the actions of others. Implementation CAF and the lead professional role are being implemented in Manchester. Practitioners, children and families are already seeing the benefits. Contact details For more information please contact Email: [email protected] 41 Health Exercise Nutrition for the Really Young Introduction to this training HENRY is a health promotion, prevention and early intervention scheme that aims to tackle child obesity by enhancing the skills of practitioners working with parents of babies, toddlers and preschoolers. Henry aims •to make professional training widely available for all those working on the promotion of a healthy lifestyle with young families (health visitors, community nursery nurses, Children’s Centre staff, nutritionists, etc.) • to work with Children’s Centres to optimise their efforts in developing community resilience to an obesogenic environment •to offer parent groups with a particular focus on intervening to arrest the development of obesity in babies and young children (0–5 years) within a framework of emotionally healthy parenting • to provide informative, entertaining resources for professionals and parents HENRY training courses include • 2-day Core Training for community practitioners and Children’s Centre teams • e-learning course •2-day Group Facilitation Course, which enables the trainee to deliver the ‘8 week Lets Get Healthy with HENRY’ parents/ carers course •1-day HENRY in Childcare course for Private Nursery Providers and Childminders Lets get healthy with HENRY Lets get healthy with HENRY is a course for groups of parents/carers. This course offers 8 weekly 2½-hour sessions aimed at developing the parent/carers knowledge about and skills in adopting a healthier lifestyle for themselves and their families, and helps them find the motivation and confidence to give their children a healthy start in life. Contact details For more information about this training please contact Jane Brophy Greater Manchester Sub-Regional Programme Manager - HENRY Programme Tel: 07929 465251 Email: [email protected] For local information and to identify trained staff please contact Amy Ashton, Public Health Manager - Healthy Weight (NHS Manchester) Email: [email protected] 42 Physical Activity, Healthy Eating Management Training Courses and Weight Introduction to these courses Manchester Public Health Development Service provides a number of training courses, relating to healthy weight. The courses delivered include: • • • • • • • • • • • Getting Manchester Moving Turning people on to Active Transport Cook and Taste Groups: a practical guide Healthy Weight Manchester – Be Aware Healthy Weight Manchester Food Safety RSPH level 2 (Royal society of Public Health) Healthy Eating for All Level 1, 2 and 3 (RIPH accredited) Active travel - walk, cycle or take the bus Food and Mood Supporting Healthy Weight - A Practical Approach Motivating Behaviour Change Referral criteria to these courses All courses are free of charge. Applicants can book onto a course by self-referral. Contact details For further information about the courses or to enquire about the date/s of each course please contact Ruhana Miah Manchester Public Health Development Service, 1st Floor Fallowfield Library Platt Lane Fallowfield M14 7FB Tel: 0161 248 1766 43 X-PERT – Structured Diabetes Education Programme Introduction to this programme The aim of the X-pert programme is to empower people with diabetes to develop the knowledge, skills and confidence to make informed decisions regarding their lifestyle and diabetes self –management. What to expect from this programme The programme is aimed at adults with diabetes and is free to attend. The courses run across Manchester at a variety of venues. The programme is run over six weeks and participants are encouraged to attend all 2 ½ hour sessions. The sessions include: Week 1. What is Diabetes Week 2. Weight Management Week 3. Carbohydrate Awareness Week 4. Supermarket Tour Week 5. Possible Complications Week 6. Questions and Evaluation Clients are welcome to take along a family member or friend, however the session are not suitable for children. Referral Criteria Any adult with diabetes can self refer to the programme using the referral form. Health care professionals can also refer patients to this programme. The referral form can be faxed or posted to the detail below. Please see appendix 13. Contact details Amy Griffiths Community Dietitian – Long Term Conditions, Wythenshawe Offices, Stancliffe Road Sharston, Manchester, M22 4PJ. Tel: 0161 946 8210 Fax: 0161 946 8209 Email: [email protected] 44 Mental Health Training Courses Introduction to these courses Manchester’s Public Health Development (MPHD) – Public Mental Health team aim to support all organisations in the city to be able to promote better mental health for the people they work with and to be able to respond helpfully to people experiencing emotional distress and mental health problems. As part of this work, a range of training opportunities are available for people working in Manchester, including: Interventions for Mental Health in Everyday Practice (IMHEP) This is a two day course for frontline staff working with people who are vulnerable to poor mental health (for example, because of poverty, unemployment, poor physical health, insecure housing, discrimination). Participants will learn how best to help their clients manage their mental health. The course develops practical skills in identifying and responding to distress effectively, using a structured model of support. Understanding Mental Health This is a half-day introduction to mental health and the Manchester context and also an optional basis for further training. It is for staff working with people who are vulnerable to poor mental health (for example, because of poverty, unemployment, poor physical health, insecure housing, discrimination). Emotional Aspects of Your Consultations This training is for clinical staff working in Primary Care (GP practices) and Community Health Services (in the Acute Hospital Trusts) in Manchester who work with patients and suspect that their emotional health is a barrier to managing their physical health conditions and achieving better health. These brief workshops will provide simple tools to help move patients forward who have been experiencing difficulty in coming to terms with and managing their condition. This will not add to your current workload, but will provide you with some simple skills that you can use everyday. The training comprises two x 2 hour sessions - attendance at both parts of the workshop is required. For further information contact: Teresa Czajka, Wythenshawe Offices, 1 Stancliffe Rd, M22 4PJ. Tel: 0161 946 9446, Email: [email protected] Specialised Mental Health Topics and / or Specific training for your organisation From time to time we organise courses on specialised mental health topics. These are normally advertised through our website. We are happy to discuss the provision of our training courses adapted for your organisation’s needs, if you have a group of staff you want to train together. If you have specialised topics on which you would like us to consider offering training or would like us to run a course specifically for your organisation please contact Caroline Bedale. Referral criteria to these courses All courses are free of charge. Applicants can book onto a course by self-referral. Contact details For more information about the courses, contact: Douglas Inchbold, Tel: 0161 861 2543, Email: [email protected] For further information, dates of open courses, and evaluations of previous courses, see the MPHDS website: www.mphds.org/mphds/mental-health/mental-health-training.html For further information about Child and Adolescent Mental Health Training Programme (for those who work with children and young people up to 18 years old) contact: Kevin Buchanan, Tel: 07890 076 183, Email: [email protected] For applications for mental health courses, contact: Madge Strong, Tel: 0161 861 2547, Email: [email protected] 45 The Common Assessment Framework (CAF) Training Programme Introduction to these courses The CAF training programme has been devised following feedback from practitioners, local and national evaluations and has been developed in collaboration with The Workforce Development Group. CAF is a vital tool in ensuring that children’s needs are identified and met at the earliest opportunity, and relies on us all working together to help children reach the five Every Child Matters outcomes. The aim of the CAF training is to equip practitioners with the skills and knowledge to initiate a common assessment, complete a common assessment and act as the lead professional. In addition we aim to develop and foster the following: • A shared understanding of principles, processes, tasks, roles and responsibilities as outlined in national and local guidance • Improved communication between professionals, including a common language to describe children’s needs, and based on best practice in information sharing • Effective working relationships built on mutual trust and respect • More effective and integrated services • A commitment to helping all children achieve the best and fulfil their potential Wherever possible we aim to deliver the training in the districts in order to promote networking and knowledge of local resources. Which Common Assessment Framework (CAF) Training is for you? Level 1: Awareness Anyone who works with children and young people will need an awareness of what the Common Assessment Framework is. This short briefing gives an overview of what the Common Assessment Framework is and how it fits in with integrated working in Manchester. It also gives an overview of the lead professional role and information sharing - key elements of the CAF. This course is a pre-requisite for the Level 2 training. Level 2: Practitioner – for practitioners working closely with children and young people This is a practical one day training session which enables practitioners to: • Identify when a CAF should be initiated • Complete a CAF assessment • Undertake the lead professional role • Know when and how to share information with other services Level 2: Practitioner for Managers/Supervisors – for those who supervise other practitioners. This is a one day training session which provides an overview of the Common Assessment Framework from a management perspective. Managers/supervisors will look at: • How to complete a common assessment • How CAF fits with their existing assessments • What skills their teams will need to complete a CAF assessment • What skills their teams will need to take on the lead professional role • What implications CAF has for their organisation and how it can be implemented. Refresher training is also available Contact details For more information please contact Email: [email protected] 46 Alcohol Identification and Brief Advice Training Introduction to these courses Providing more help to encourage people to drink less Public Health Development Service provides training for frontline staff working in targeted settings where alcohol should be discussed routinely as part of a larger role within adult services (such as services that support people to maintain a healthy weight) . Various training options are available which aim to: •Raise confidence in identifying those at risk of harm from the amount of alcohol they drink as an integral part of practice •Equip staff to provide brief interventions that encourage people to drink less •Standardise knowledge and skills in using AUDIT-C/AUDIT as a validated identification tool and providing brief interventions •Contribute to the achievement of multi-agency targets to reduce alcohol related harm •Enable organisations and services to implement NICE guidelines We are also available to support you with setting up internal systems or protocols as well as on-going development through skills practice and staff updates. Contact details Alcohol Team, Manchester Public Health Development Service Tel: 0161 248 1750 Website: www.mphds.org 47 Health Information and Resources Library The Health Information and Resources Library (HIRL) supports your evidence based practice by providing access to information and has the resources to support your health promotion work. Where We Are The service is located at: Fallowfield Library 1st Floor, Platt Lane, Fallowfield, Manchester M14 7FB Who can Use the Health Information and Resources Library? NHS Staff, students and contractors and also health promoters working in Manchester. For full details of our services and terms & conditions of membership, please ask a member of staff. Library Services • • • • • • • • • Multidisciplinary collection of books, reports, journals and multimedia resources such as DVDs and CD ROMs Health promotion models and teaching resources Enquiry service Literature searching service Training on searching for information on the Healthcare Databases Current awareness: email bulletins of new information Wide range of electronic resources, available through NHS Athens Access to documents through our inter-library loan service Free leaflets and posters to order on a range of health promotion topics How can you find us? 1st Floor, Fallowfield Library, Platt Lane, Fallowfield, Manchester M14 7FB Tel: 0161 248 1769 Fax: 0161 248 1751 Email: [email protected] Website: www.mhsc.nhs.uk/services/library-services Open: Monday to Friday 9.00am to 4.30pm Emily Hopkins – Library Manager Email: [email protected] Carnell Bell-Smith – Resource & Information Advisor Email: [email protected] Sarah Race – Resource & Information Advisor Email: [email protected] 48 Mental Health Information and Self Help Guides There are a number of mental health resources available in the City, including: Self help guides to help mental health problems We distribute a range of self help guides on different aspects of Mental Health. For up to dates lists of whats available please visit: www.mphds.org/mphds/mental-health/mental-health-resources.html All these guides can be downloaded from www.mhim.org.uk Physical activity and mood Taking part in physical activity on a regular basis can have a positive impact on mental health and the symptoms that are associated with poor mental health. This guide will help people to think about the type and amount of physical activity they can do to improve their health. It gives practical guidance about how to include more physical activity in their life, how to do it safely and how to overcome the issues that may make it difficult to start or stick to a more active lifestyle. This guide can be downloaded from http://www.mhim.org.uk/document_uploads/stayingwell/Physical_Activity_&_Mood.pdf Food and mood What we eat and drink can affect our mental health and experiencing emotional distress and mental health problems can affect how a person feels about eating. Eating regularly and eating more of certain foods can have a positive impact on our mental health and the symptoms associated with poor mental health. This guide provides information on: • The benefits of certain foods and water to our mental health • Ideas and tips to make changes, including a food and mood diary This guide can be downloaded from http://www.mhim.org.uk/document_uploads/stayingwell/Food_and_Mood_Booklet.pdf All the above guides can be used as a one to one tool to assist someone to help themselves or be given to clients to work through on their own. Hard copies can be obtained from the Health Information and Resource Library (see library information). Further information and contacts about work to improve mental health in Manchester can be found on www.mphds.org/mphds/mental-health/mental-health.html 49 Getting Manchester Moving Website Introduction to this service Getting Manchester Moving is a website designed to encourage and support Manchester people to get more physically active, eat more healthily and in some cases to lose weight. What to expect from this service www.gettingmanchestermoving.org provides a one stop shop of information regarding physical activity, healthy eating and weight management provisions across Manchester. Contact Details To submit or amend information on the website please contact Sarah Race Resource and Information Advisor Public Health Development Service 1st Floor Fallowfield Library Platt Lane Fallowfield M14 7FB Tel: 0161 248 1753 Website: www.gettingmanchestermoving.org 50 Alcohol Resources Available Introduction Public Health Development Service has a number of resources available to support alcohol identification and brief advice as well as general alcohol awareness campaigns: • • • • • • • Unit calculators / kcal estimates for popular alcoholic products Measuring tumblers to support smaller home measures Copies of AUDIT questionnaires (Alcohol Self-Test) Brief advice and extended brief intervention tools Drink Smart self-help guides Posters for display in reception areas, clinics and interview rooms Standardised text and information for websites Contact details Contact Us - Alcohol Team, Public Health Development Service Tel: 0161 248 1750 Website: www.mphds.org 51 Manchester’s care Pathway for Child and Family Healthy Weight 52 Manchester’s Care Pathway for Overweight and Obese Adults 53 Guidelines for the use of Pharmacotherapy in the Management of Adult Obesity These guidelines are intended for use in conjunction with NHS Manchester’s care pathway for overweight and obese adults. Anti-obesity drugs are to be used to support healthy lifestyle and behaviour changes and not in isolation. Scope of the guideline These guidelines relate to the use of orlistat in adults over 18 years, in line with NICE (2006) guidance. It is anticipated that for most patients, the General Practitioner (GP) is the most appropriate prescriber; however anti-obesity drugs may be commenced by hospital specialists, as long as appropriate support is arranged. When should pharmacological management for obesity be considered? •D rug therapy for obesity should only be considered after dietary, exercise and behavioural approaches have been started and evaluated • Drug therapy may be considered for patients who have not reached their target weight loss or have reached a plateau on dietary, exercise and behavioural changes alone • Orlistat drug therapy should be prescribed only as part of an overall plan for managing obesity in adults who meet one of the following criteria: • a BMI of 28.0kg/m2 or more with associated risk factors • a BMI of 30.0kg/m2 or greater (NICE, 2006) Which drug? Orlistat may be used as first line therapy after discussing with the patient the mode of action, adverse effects and monitoring requirements. In a meta-analysis of randomised trials, orlistat reduced weight by 2.9kg more than placebo (Rucker, Padwal & Li et al, 2007). Anti-obesity drug sibutramine has had its license suspended and GPs are not to issue any new prescriptions for the drug. The suspension follows a review of the drug’s safety by the European Medicines Agency (EMEA) on the basis of data from the Sibutramine Cardiovascular Outcomes Trial (SCOUT). This review concluded there was an increased risk of non-fatal cardiovascular events, such as heart attacks or strokes, with sibutramine, compared with placebo (http://www.ema.europa.eu/pdfs/human/referral/sibutramine/3940810en.pdf). Prescribers are being advised not to issue any new prescriptions for sibutramine and to review the treatment of patients taking the drug. Pharmacists are asked to cease dispensing the medicine (http://www.ema.europa.eu/pdfs/human/referral/sibutramine/3940810en.pdf). Points to consider: •M any drug treatments cause weight gain. These include antipsychotics, antidepressants, corticosteroids, COC, beta blockers, oral hypoglycaemics and anticonvulsants •B MI may be less accurate in highly muscular people. These people may have an artificially high BMI because muscle is three times denser than fat (HSE, 2007). BMI results should therefore be interpreted with caution and used alongside other measures such as waist circumference •P atients following a very low fat diet may respond less well to orlistat due to its affect on fat absorption. Similarly, if a person has a very high fat diet and has difficulty knowing which foods/meals in their diet contain too much fat, the side effects of orlistat can help them develop a better understanding of their diet. This should prompt swift changes in the diet to reduce the fat content (with the aid of healthy eating advice from a health professional) 54 •D rugs should not be substituted or alternated with healthy eating and activity habits to provide ‘breaks’ or a ‘way out’ of making the necessary changes. The individual should be motivated to continue diet and exercise changes once they start on anti-obesity drugs •R ealistic targets for weight loss are a maximum weekly weight loss of 0.5-1kg and an overall aim to lose 5-10% of original weight. These should be modified in the light of other factors (see following points) •W eight loss may be slower for some people than others i.e. less than 1-2lb/week or less than 5% of their weight over 3 months. This may be due to medical conditions (e.g. diabetes, hypothyroidism), medication (e.g. beta blockers), physical disabilities, very little mean muscle mass or changes to metabolism due to a long history of dieting. Anti-obesity drugs may be complementary treatment to increase their average weight loss •R egular review is recommended to monitor the effect of drug treatment and to reinforce lifestyle advice and adherence •C onsider less strict goals for patients with type 2 diabetes, because they may lose weight more slowly. Agree goals with the patient and review regularly •B e aware of the potential for hypoglycaemia in diabetic patients who have managed to reduce calorie intake without appropriate adjustment of oral antidiabetic drugs (and possibly insulin) •A nti-obesity drugs are not appropriate for patients with any evidence of an eating disorder, such as compulsive over-eating or binge eating. These patients should be referred to an eating disorders or local psychology service •A nti-obesity drugs should not be available on repeat prescriptions without consultation with an appropriate health professional. Reinforce lifestyle advice throughout treatment • Combination therapy involving more than one antiobesity drug should not be used •D rug treatment may be used to help patients maintain weight loss, as well as to continue to lose weight. This should be limited to certain patients, e.g. diabetics •C onsider micronutrient intake whilst on a low calorie diet. A supplement providing vitamins and trace elements (e.g. Forceval capsules) can be prescribed, particularly for vulnerable groups who may be at risk of malnutrition • Orilstst improves total cholesterol and LDL cholesterol profiles • If withdrawing drug treatment, offer support to help maintain weight loss because the patient’s self-confidence and belief in their ability to make changes may be low •U se the British National Formulary (http://bnf.org/bnf/) or Summary of Product Characteristics (SPC) (www.medicines.org.uk) for full prescribing information 55 Drug Interactions The following table should be used in conjunction with the overview of drug therapy table and the appropriate flowchart (See following pages) Acarbose: Avoid concomitant use. Amiodarone: Clinical and ECG monitoring is recommended as orlistat may decrease amiodarone plasma levels. Orlistat Ciclosporin: Orlistat may decrease ciclosporin levels. If concomitant use is unavoidable, ciclosporin levels should be monitored more frequently, particularly after both addition and discontinuation of orlistat until stabilised. Fat-soluble vitamins: If a supplement is prescribed, it should be taken at least 2 hours after orlistat or at bedtime. Oral contraceptives: Additional precautions are recommended if severe diarrhoea occurs. Warfarin: Monitor INR. 56 Prescribing Orlistat 57 Orlistat MCH Medicines Management (2009) 58 8 Tips for Healthy Eating The two keys to a healthy diet are: • eating the right amount of food for how active you are and • eating a range of foods to make sure you’re getting a balanced diet. A healthy balanced diet contains a variety of types of food, including lots of fruit, vegetables and starchy foods such as wholemeal bread and wholegrain cereals; some protein-rich foods such as meat, fish, eggs and lentils; and some milk and dairy foods. 8 tips for eating well: 1. Base your meals on starchy foods Starchy foods such as bread, cereals, rice, pasta and potatoes are a really important part of a healthy diet. Try to choose wholegrain varieties of starchy foods whenever you can. Starchy foods should make up about a third of the food we eat. They are a good source of energy and the main source of a range of nutrients in our diet. As well as starch, these foods contain fibre, calcium, iron and B vitamins. Most of us should eat more starchy foods - try to include at least one starchy food with each of your main meals. So you could start the day with a wholegrain breakfast cereal, have a sandwich for lunch, and potatoes, pasta or rice with your evening meal. Some people think starchy foods are fattening, but gram for gram they contain less than half the calories of fat. You just need to watch the fats you add when cooking and serving these foods, because this is what increases the calorie content. Wholegrain foods contain more fibre and other nutrients than white or refined starchy foods. 2. Eat lots of fruit and vegetables Most people know we should be eating more fruit and vegetables. But most of us still aren’t eating enough. Try to eat at least 5 portions of a variety of fruit and vegetables every day. It might be easier than you think. You can choose from fresh, frozen, tinned, dried or juiced, but remember potatoes count as a starchy food, not as portions of fruit and veg. 3. Eat more fish Most of us should be eating more fish - Aim for at least two portions of fish a week, including a portion of oily fish. You can choose from fresh, frozen or canned - but remember that canned and smoked fish can be high in salt. Fish is an excellent source of protein and contains many vitamins and minerals. Some fish are called oily fish because they are rich in certain types of fats, called omega 3 fatty acids, which can help keep our hearts healthy. For children, women who are pregnant, breastfeeding or trying for a baby, see the NHS Choices – 8 tips for healthy eating website www.nhs.uk/livewell/goodfood/pages/eight-tips-healthy-eating.aspx. Don’t have more than one portion a week of shark, swordfish and marlin because these fish contain high levels of mercury. 4. Cut down on saturated fat and sugar Fats To stay healthy we need some fat in our diets. What is important is the kind of fat we are eating. There are two main types of fat: •saturated fat - having too much can increase the amount of cholesterol in the blood, which increases the chance of developing heart disease •unsaturated fat - having unsaturated fat instead of saturated fat lowers blood cholesterol 59 Try to cut down on food that are high in saturated fat e.g. meat pies, sausages, hard cheese, butter, cakes, cream and have foods that are rich in unsaturated fat instead, such as vegetable oils (including sunflower, rapeseed and olive oil), oily fish, avocados, nuts and seeds. For a healthy choice, use just a small amount of vegetable oil or a reduced-fat spread instead of butter, lard or ghee. And when you are having meat, try to choose lean cuts and cut off any visible fat. Look at the label to see how much fat a food contains. Generally the label will say how many grams (g) of fat there are in 100g of the food. High is more than 20g fat per 100g Low is 3g fat or less per 100g Saturated fat - what’s high and what’s low? High is more than 5g saturates per 100g Low is 1.5g saturates or less per 100g Sugar Most people in the UK are eating too much sugar. We should all be trying to eat fewer foods containing added sugar, such as sweets, cakes and biscuits, and drinking fewer sugary soft and fizzy drinks. Having sugary foods and drinks too often can cause tooth decay, especially if you have them between meals. Many foods that contain added sugar can also be high in calories so cutting down could help you control your weight. How do I know if a food is high in added sugar? Take a look at the label. The ingredients list always starts with the biggest ingredient first. But watch out for other words used to describe added sugars, such as sucrose, glucose, fructose, maltose, hydrolysed starch and invert sugar, corn syrup and honey. If you see one of these near the top of the list, you know the food is likely to be high in added sugars. Another way to get an idea of how much sugar is in a food is to have a look for the ‘Carbohydrates (of which sugars)’ figure on the label. But this figure can’t tell you how much is from added sugars, which is the type we should try to cut down on. High is more than 15g sugars per 100g Low is 5g sugars or less per 100g 5. Try to eat less salt - no more than 6g a day Lots of people think they don’t eat much salt, especially if they don’t add it to their food. However every day in the UK, 85% men and 69% women eat too much salt. Adults - and children over 11 - should have no more than 6g salt a day. Younger children should have even less. Three-quarters (75%) of the salt we eat is already in the food we buy, such as breakfast cereals, soups, sauces and ready meals. So you could easily be eating too much salt without realising it. Eating too much salt can raise your blood pressure. And people with high blood pressure are three times more likely to develop heart disease or have a stroke than people with normal blood pressure. How do I know if a food is high in salt? Check the label to find out the figure for salt per 100g. High is more than 1.5g salt per 100g (or 0.6g sodium) Low is 0.3g salt or less per 100g (or 0.1g sodium) 6. Get active and try to be a healthy weight Physical activity is a good way of using up extra calories, and helps control our weight. But this doesn’t mean you need to join a gym. 60 Just try to get active every day and build up the amount you do. For example, you could try to fit in as much walking as you can into your daily routine. Try to walk at a good pace. Children and young people should achieve a total of at least 60 minutes of at least moderate intensity physical activity each day. At least twice a week this should include activities to improve bone health, muscle strength and flexibility F or general health benefit, adults should achieve a total of at least 30 minutes a day of at least moderate intensity physical activity on five or more days of the week. Whenever we eat more than our body needs, we put on weight. This is because we store any energy we don’t use up usually as fat. Even small amounts of extra energy each day can lead to weight gain. 7. Drink plenty of water We should be drinking about 6 to 8 glasses (1.2 litres) of water, or other fluids, every day to stop us getting dehydrated. When the weather is warm or when we get active, our bodies need more than this. But avoid drinking soft and fizzy drinks that are high in added sugar. Alcohol There is nothing wrong with the occasional drink. But drinking too much can cause problems. Alcohol is also high in calories, so cutting down could help you control your weight. Women can drink up to 2 to 3 units of alcohol a day and men up to 3 to 4 units a day, without significant risk to their health. For good health, it’s a good idea to spread your drinking throughout the week and avoid binge drinking. Drinking heavily over a long period of time can damage the liver. 8. Don’t skip breakfast Breakfast can help give us the energy we need to face the day, as well as some of the vitamins and minerals we need for good health. Some people skip breakfast because they think it will help them lose weight. There is some evidence to suggest that eating breakfast can help people control their weight. Please see the following websites for information for use with patients/clients: NHS Choices - Healthy Eating www.nhs.uk/livewell/healthy-eating/pages/healthyeating.aspx NHS Choices - 8 tips for healthy eating www.nhs.uk/livewell/goodfood/pages/eight-tips-healthy-eating.aspx DH Eatwell Plate - 2011 www.dh.gov.uk/en/publichealth/nutrition/dh_126493 DH Eatwell Plate Flyer - 2011 www.dh.gov.uk/prod_consum_dh/groups/dh/digitalassests/documents/digitalassest/dh_126489.pdf 61 The Eatwell Plate If you want to get the balance of your diet right, use the eatwell plate. The eatwell plate makes healthy eating easier to understand by showing the types and proportions of foods we need to have a healthy and well balanced diet. Look at the eatwell plate to see how much of your food should come from each food group. You don’t need to get the balance right at every meal. But try to get it right over time such as a whole day or week. Try to choose options that are lower in fat, salt and sugar when you can. (To see a larger version of the eatwell plate, see the following page). The eatwell plate shows how much of what you eat should come from each food group. This includes everything you eat during the day, including snacks. So, try to eat: 62 plenty of fruit and vegetables plenty of bread, rice, potatoes, pasta and other starchy foods – choose wholegrain varieties whenever you can some milk and dairy foods some meat, fish, eggs, beans and other non-dairy sources of protein just a small amount of foods and drinks high in fat and/or sugar 63 Physical Activity Recommendations The chief medical officer’s report Start Active, Stay Active: A report on physical activity from the four home countries (2011) updates existing physical activity guidelines for children, young people and adults and includes new guidelines for early years and older people for the first time in the UK. Early years (under 5s): • Physical activity should be encouraged from birth, particularly through floor based play and water based activities in safe environments. • Children of pre-school age who are capable of walking unaided should be physically active daily for at least 180 minutes (3 hours), spread throughout the day. • All under 5’s should minimise the amount of time spend being sedentary (being restrained or sitting) for extended periods (except time spent sleeping). Children and young people (5-18 years): • All children and young people should engage in moderate to vigorous intensity physical activity for at least 60 minutes and up to several hours every day. • Vigorous intensity activities, including those that strengthen muscle and bone, should be incorporated at least three days a week. • All children and young people should minimise the amount of time spent being sedentary (sitting) for extended periods of time. Adults (19-64 years): • Adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes (2 ½ hours) of moderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least 5 days a week. • Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or a combination of moderate and vigorous intensity activity. • Adults should also undertake physical activity to improve muscle strength on at least two days a week. • All adults should minimise the amount of time spent being sedentary (sitting) for extended periods. Older adults (65+ years): • Older adults who participate in any amount of physical activity gain some health benefits, including maintenance of good physical and cognitive function. Some physical activity is better than none, and more physical activity provides greater health benefits. • Older adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes (2 ½ hours) of moderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least 5 days a week. • For those who are already regularly active at moderate intensity, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or a combination of moderate and vigorous activity. • Older adults should also undertake physical activity to improve muscle strength on at least two days a week. • Older adults at risk of falls should incorporate physical activity to improve balance and co-ordination on at least two days a week. • All older adults should minimise the amount of time spent being sedentary (sitting) for extended periods. 64 The Definition of Overweight and Obesity Overweight and obesity are terms which refer to an excess accumulation of body fat, to the extent that health may be impaired. Overweight and obesity in adults is most commonly measured using Body Mass index (BMI), which is defined as the body mass in kilograms divided by the height in meters squared (World Health Organization (WHO) 2004). The calculation produces a figure that can be compared to various thresholds that define the weight status of an individual (see table 1). Table 1. WHO (2004) classification of ‘healthy’ and ‘unhealthy’ weight in adults: Classification BMI (kg/m2) Underweight Less than 18.5 Healthy weight 18.5-24.99 Overweight 25.0-29.99 Obese I 30.0-34.99 Obese II 35.0-39.99 Obese III (Morbidly obese) 40.0 or more BMI is a widely accepted method used to define overweight and obesity, however it is not a direct measure of adiposity (fat tissue) and it fails to distinguish between mass due to body fat and mass due to muscle (North West regional public health group, 2008). Therefore people who are muscular may not appear to be overweight or obese but may have an artificially high BMI because muscle is three times denser than fat (HSE, 2007). BMI results should therefore be interpreted with caution and used alongside other measures such as waist circumference (National Institute of Clinical Excellence (NICE), 2006). NICE (2006) recommends the use of BMI in conjunction with waist circumference to measure weight status and determine health risks for those with a BMI less than 35kg/m2 (see table 2) (NICE, 2006). For adults with a BMI of 35kg/m2 or over, health risks are assumed to be very high with any waist circumference (NICE, 2006). Table 2. NICE (2006) waist circumference thresholds and risk categories for adults: BMI classification Waist circumference Low <94cm Male <80cm Female High Very High 94-102cm >102cm 80-88cm >88cm Healthy weight 18.5-24.99 No increased Risk No increased Risk No increased Overweight 25.0-29.99 No increased Risk Increased Rrisk High risk Increased Rrisk High risk Very high risk Obese I 30.0-34.99 Source: NICE (2006) Measuring overweight and obesity in children and young people is more complex than adults. This is because the relationship between BMI and being overweight and obese in childhood is subject to variation by age, height and gender (NICE, 2006). To overcome these problems BMI reference charts are used. NICE (2006) recommends the use of the UK 1990 BMI growth reference standards to give age and gender specific information (NICE, 2006). A child above the 91st centile is considered overweight and above the 98th centile obese (Cole, Freeman & Preece, 1995. Cole et al, 2000. NICE, 2006). Among children aged from birth to 4 years of age new UK-WHO Growth Charts developed for the Department of Health by the Royal College of Paediatrics and Child Health were launched in May 2009. These growth charts replace UK 1990 charts for this age group, which were based on predominately formula fed babies. The new charts are based on the World Health Organization (WHO) children growth standards which describe the optimal growth of healthy breast fed children. The new UK-WHO growth charts will provide more accurate measurements for infant growth of breastfed babies and will also help healthcare professionals and parents to identify early signs of overweight or obesity and provide support (DoH. 2009). 65 NHS Manchester’s Checklist before using Commercial Weight Management Organisations (CWMO) At present [June 2010] NHS Manchester has not entered into any agreements with CWMO, it is not possible therefore to recommend or endorse any schemes specifically. However the following principles should be checked before considering using any CWMO; NICE compliant; this means that they include; • Information and encouragement on activity sessions tailored to the requirements /needs of individuals. •Use behaviour management techniques to support new healthier lifestyle habits and long term maintenance of weight loss. • Recommend evidence based dietary changes i.e. food choices based on the Eat Well plate and portion control advice. • That expected weight loss is no more than 0.5-1kg per week. Extract from NICE guideline 43: Management of weight Commercial, self-help and community organisations • Discuss the range of weight management options and help people decide what is best for them in the long term. • If recommending commercial, community and/or self-help weight management programmes, continue to monitor patients and provide support and care. • Check that any you recommend to patients meet best-practice standards by: • helping people decide on a realistic healthy target weight (usually to lose 5–10% of their weight) • aiming for a maximum weekly weight loss of 0.5–1 kg • focusing on long-term lifestyle changes • addressing both diet and activity, and offering a variety of approaches • using a balanced, healthy-eating approach • offering practical, safe advice about being more active • including some behaviour-change techniques, such as keeping a diary and advice on how to cope with ‘lapses’ and ‘highrisk’ situations recommending and/or providing ongoing support. 66 NHS Manchester - Referral Criteria for Bariatric Surgery Since 1st April 2009 a Greater Manchester contract has been in place for bariatric surgery, this sets out the NICE criteria for bariatric surgery but also identifies priority categories, agreed by all Greater Manchester PCT’s, which NHS Manchester has decided to adopt. Therefore referrals for bariatric surgery from GPs contracted to NHS Manchester must meet the following criteria; • BMI above 50 with no co-morbidities •BMI 45 and above with significant co-morbidities [i.e. Diabetes , CVD … And people needing obesity surgery to enable other surgery to be successfully performed e.g. knee replacement,] The bariatric review panel of NHS Manchester require full information, including dates and weights and the non surgical treatment completed by people seeking obesity surgery, in these priority categories. NICE guideline 43: Management of weight: States that bariatric surgery should be considered for people with severe obesity if: •they have a BMI of 40 kg/m2 or more, or between 35 kg/m2 and 40 kg/m2 and other significant disease (for example, type 2 diabetes, high blood pressure) that could be improved if they lost weight • all appropriate non-surgical measures have failed to achieve or maintain adequate clinically • beneficial weight loss for at least 6 months • they are receiving or will receive intensive specialist management • they are generally fit for anaesthesia and surgery • they commit to the need for long-term follow-up NICE guideline 43: Management of weight: States that bariatric surgery should be considered as a first-line option for adults with a BMI of more than 50 kg/m2 in whom •surgical intervention is considered appropriate; consider orlistat before surgery if waiting time is long. 67 Evidence Based Advice to Protect Dental Health •Breast feeding should be promoted as it provides the best nutrition for babies. There is no clear evidence that breastfeeding can cause dental decay •From six months infants should be drinking from a cup and from the age of one the use of bottles should be discouraged, especially at night •Sugar should never be added to drinks or weaning foods •Sugary foods and drinks should not be consumed more than 4 times daily and never close to bedtime •If a child requires medication it should be sugar free whenever possible and especially when it is required regularly •Teeth should be brushed as soon as they erupt with a smear (for under 3s) or a pea size amount (for over 3s) of a family fluoride toothpaste (contains 1350 -1450 parts per million fluoride) for maximum protection and parents should supervise the brushing of teeth Smear for under 3s Pea-sized blob for 3-6 s •Children’s toothpastes containing less than 1000 parts per million of fluoride do not give adequate protection against decay and should not be used •Everyone should brush their teeth with fluoride toothpaste at least twice daily – last thing at night and on one other occasion • Everyone should be encouraged to spit out after brushing and not rinse with cups of water • Adults and children should attend dental services regularly for examination and preventive interventions 68 National Institute for Health and Clinical Excellence Promoting Physical Activity – Brief Intervention in Primary Care Recommendations NICE public health guidance (2006) - Four Commonly Used Methods to Promote Physical Activity: endorses the delivery of brief interventions for physical activity in primary care as both clinically and cost effective in the long term Brief interventions involve opportunistic advice, discussion, negotiation or encouragement. They are commonly used in many areas of health promotion, and are delivered by a range of primary and community care professionals. The interventions vary from basic advice to more extended, individually focused attempts to identify and change factors that influence activity levels. Recommendation 1 Primary care practitioners should take the opportunity, whenever possible, to identify inactive adults and advise them to aim for 30 minutes of moderate activity on 5 days of the week (or more). They should use their judgement to determine when this would be inappropriate (for example, because of medical conditions or personal circumstances). They should use a validated tool, such as the Department of Health’s general practitioner physical activity questionnaire (GPPAQ), to identify inactive individuals. Recommendation 2 When providing physical activity advice, primary care practitioners should take into account the individual’s needs, preferences and circumstances. They should agree goals with them. They should also provide written information about the benefits of activity and the local opportunities to be active. (See Physical Activity section of this resource pack) They should follow them up at appropriate intervals over a 3 to 6 month period. 69 Raising the Issue of Weight in Children and Young People 1 WHEN TO INITIATE A DISCUSSION ABOUT WEIGHT • If the family expresses concern about the child’s weight. • If the child has weight-related co-morbidities. • If the child is visibly overweight. 2 RAISE THE ISSUE OF OVERWEIGHT Discuss the child’s weight in a sensitive manner because parents may be unaware that their child is overweight. Use the term ‘overweight’ rather than ‘obese’. Let the maturity of the child and the child’s and parents’ wishes determine the level of child involvement. If a parent is concerned about the child’s weight: ‘We have [child’s] measurements so we can see if he/she is overweight for his/her age. If the child is visibly overweight: ‘I see more children nowadays who are a little overweight. Could we check [child’s] weight?’ If the child presents with co-morbidities: ‘Sometimes [co-morbidity] is related to weight. I think that we should check [child’s] weight.’ 3 ASSESS THE CHILD’S WEIGHT STATUS Refer to UK Child Growth Charts and plot BMI centile. Explain BMI to parent: eg ‘We use a measure called BMI to look at children’s weight. Looking at [child’s] measurements, his/her BMI does seem to be somewhat higher than we would like it to be.’ If the child’s weight status is in dispute, consider plotting their BMI on the centile chart in front of them. In some cases this approach may be inappropriate and upsetting for the family. Overweight Severely overweight BMI centile BMI centile >91st centile >98th centile 4 ASSESS SERIOUSNESS OF OVERWEIGHT PROBLEM AND DISCUSS WITH PARENT If child is severely overweight with co-morbidities, consider raising the possibility that their weight may affect their health now or in the future. This could be left for follow-up discussions or raised without the child present as some parents may feel it is distressing for their child to hear. ‘If their overweight continues into adult life, it could affect their health. Have either you [or child] been concerned about his/ her weight?’ Consider discussing these points with the parent at follow-up: • Age and pubertal stage: the older the child and the further advanced into puberty, the more likely overweight will persist into adulthood. •P arental weight status: if parents are obese, child’s overweight is more likely to persist into adulthood. • Co-morbidities: (see overleaf) increase the seriousness of the weight problem 5 REASSURE THE PARENT/CHILD If this is the first time that weight has been raised with the family, it is important to make the interaction as supportive as possible: 70 Together, if you would like to, we can do something about your child’s weight. By taking action now, we have the chance to improve [child’s] health in the future.’ 6 AGREE NEXT STEPS Provide patient information literature, discuss as appropriate and: • If overweight and no immediate action necessary: arrange follow-up appointment to monitor weight in three to six months: ‘It might be useful for us to keep an eye on [child’s] weight for the next year and refer to available services as listed in the resource pack’ • If overweight and family want to take action: offer appointment for discussion with GP, nurse or other health professional; arrange three-to six-month follow-up to monitor weight and refer to available services as listed in the resource pack. • If overweight and family do not wish to take action now: monitor child’s weight and raise again in six months to a year. • If overweight with co-morbidities: consider referral to appropraite services in this resource pack or to secondary care: ‘It might be useful for you and [child] to talk to someone about it.’ BACKGROUND INFORMATION Identifying the problem Ascertaining a child’s weight status is an important first step in childhood weight management. Parents who do not recognise the weight status of their overweight children may be less likely to provide them with support to achieve a healthy weight. In a British survey of parental perception of their child’s weight, the overwhelming majority (94%) of parents with overweight or obese children misclassified their child’s weight status.1 Given this low level of parental awareness, health professionals should take care to establish a child’s weight status in a sensitive manner. Assessing weight status in children The child growth charts for the UK allow easy calculation of BMI based on a child’s known weight and height.2 Measures of body fat in children can also be a useful way of assessing a child’s weight status. Details of body fat reference curves for children are now available,3 although, in practice, body fat cannot be assessed without the necessary equipment. Assessing the severity of the problem A number of factors are known to increase the risk of childhood obesity and the likelihood that a weight problem will persist into adult life. Considering these factors will help you to make an informed decision about the most appropriate mode of action. • The older the child, the more likely it is that their weight problem will continue into later life and the less time they have to ‘grow into’ their excess weight. • A child is 20–40% more likely to become obese if one parent is obese. The figure rises to around 80% if both parents are obese. • While weight problems can lead to psychosocial issues such as depression and low self-esteem, weight loss may not necessarily resolve these problems, so don’t rule out referral to CAMHS. Health risks of excess weight in childhood 4,5 Being obese in childhood or adolescence increases the risk of obesity in adult life. Childhood obesity will also increase the chances of developing chronic diseases typically associated with adult obesity: • insulin resistance and type 2 diabetes; • breathing problems such as sleep apnoea and asthma; • psychosocial morbidity; • impaired fertility; • cardiovascular disease; • dyslipidaemia; • hypertension; • some cancers; • orthopaedic complications. 71 Importance of weight control For many overweight children, prevention of further weight gain is the main goal because as long as they gain no more weight, they can ‘grow into’ their weight over time. This goal can be achieved through lifestyle changes: • improving the diet, eg by increasing fruit and vegetable consumption, reducing fat intake and portion sizes, considering intake of sugary drinks, and planning meals; • increasing activity, eg playing football, walking the dog; • reducing sedentary behaviours such as time spent watching TV or playing computer games. If the child is more severely overweight, or has already reached adolescence, ‘growing into’ weight is more difficult and weight loss has to be considered. Need to offer solutions Unless the child is severely overweight with comorbidities, be led by the parents’ and/or child’s wishes. Encourage action if appropriate. Health professionals should be ready to offer referral support so that they are seen as taking the issue seriously. If the child is very overweight and has co-morbidities, the child (and family) may require on-going support despite referrals, eg through continued weight monitoring, additional specialist referrals, or help with family-based lifestyle modification. Carnell S et al (2005) Parental perceptions of overweight in 3–5 year olds. Int J Obes 29: 353–5. Cole T et al (2002) A chart to link child centiles of body mass index, weight and height. Eur J Clin Nutr 56: 1194–9. 3 Jebb S et al (2004) New body fat reference curves for children. Obes Rev (NAASO Suppl) A156. 4 McCallum Z and Gerner B (2005) Weighty matters: An approach to childhood overweight in general practice. Aus Fam Phys 34(9): 745–8. 5 British Medical Association Board of Science (2005) Preventing Childhood Obesity. BMA. 1 2 © Crown Copyright 2006 274544 1p 60k Apr06 (BEL) Produced by COI for the Department of Health. First published April 2006 72 Raising the Issue of Weight in Adults 1. RAISE THE ISSUE OF WEIGHT If BMI is >25 and there are no contraindications to raising the issue of weight, initiate a dialogue: ‘We have your weight and height measurements here. We can look at whether you are overweight. Can we have a chat about this?’ 2 IS THE PATIENT OVERWEIGHT/OBESE? BMI (kg/m2) Weight classification <18.5 Underweight 18.5–24.9 Healthy weight >25–29.9 Overweight >30 Obese Using the patient’s current weight and height measurements, plot their BMI with them and use this to tell them what category of weight status they are. ‘We use a measure called BMI to assess whether people are the right weight for their height. Using your measurements, we can see that your BMI is in the [overweight or obese] category [show the patient where they lie on a BMI chart]. When weight goes into the [overweight or obese] category, this can seriously affect your health.’ WAIST CIRCUMFERENCE Increased disease risk Men Women >40 inches (>102cm) >35 inches (>88cm) Asian men Asian women >90 cm >80 cm Waist circumference can be used in cases where BMI, in isolation, may be inappropriate and to give feedback on central adiposity. In Asians, it is estimated that there is increased disease risk at >90cm for males and >80cm for females. Measure midway between the lowest rib and the top of the right iliac crest. The tape measure should sit snugly around the waist but not compress the skin. 3 EXPLAIN WHY EXCESS WEIGHT COULD BE A PROBLEM If patient has a BMI >25 and obesity-related condition(s): ‘Your weight is likely to be affecting your [co-morbidity/condition]. The extra weight is also putting you at greater risk of diabetes, heart disease and cancer.’ If patient has BMI >30 and no co-morbidities: ‘Your weight is likely to affect your health in the future. You will be at greater risk of developing diabetes, heart disease and cancer.’ If patient has BMI >25 and no co-morbidities: ‘Any increase in weight is likely to affect your health in the future.’ 4 EXPLAIN THAT FURTHER WEIGHT GAIN IS UNDESIRABLE ‘It will be good for your health if you do not put on any more weight. Gaining more weight will put your health at greater risk.’ 73 5 MAKE PATIENT AWARE OF THE BENEFITS OF MODEST WEIGHT/WAIST LOSS ‘Losing 5–10% of weight [calculate this for the patient in kilos or pounds] at a rate of around 1–2lb (0.5–1kg) per week should improve your health. This could be your initial goal.’ If patient has co-morbidities: ‘Losing weight will also improve your [co-morbidity].’ Note that reductions in waist circumference can lower disease risk. This may be a more sensitive measure of lifestyle change than BMI. 6 AGREE NEXT STEPS Provide patient literature and: • If overweight without co-morbidities: agree to monitor weight and refer to services available. • If obese or overweight with co-morbidities: arrange follow-up consultation and refer to services available. • If severely obese with co-morbidities: consider referral to appropraite services in this resource pack and to secondary care. • If patient is not ready to lose weight: agree to raise the issue again (eg in six months). BACKGROUND INFORMATION Raising the issue of weight Many people are unaware of the extent of their weight problem. Around 30% of men and 10% of women who are overweight believe themselves to be a healthy weight.1 There is evidence that people become more motivated to lose weight if advised to do so 2 by a health professional.2 Health consequences of excess weight The table below summarises the health risks of being overweight or obese.3 In addition, obesity is estimated to reduce life expectancy by between 3 and 14 years. Many patients will be unaware of the impact of weight on health. Greatly increased risk • type 2 diabetes • gall bladder disease • dyslipidaemia • insulin resistance • breathlessness • sleep apnoea Moderately increased risk • cardiovascular disease • hypertension • osteoarthritis (knees) • hyperuricaemia and gout Slightly increased risk • some cancers (colon, prostate, postmenopausal breast and endometrial) • reproductive hormone abnormalities • polycystic ovary syndrome • impaired fertility • low back pain • anaesthetic complications Benefits of modest weight loss 4 Patients may be unaware that a small amount of weight loss can improve their health. Condition Mortality Health benefits of modest (10%) weight loss Diabetes • up to a 50% fall in fasting blood glucose • over 50% reduction in risk of developing diabetes • 20–25% fall in overall mortality • 30–40% fall in diabetes-related deaths • 40–50% fall in obesityrelated cancer deaths • 10% fall in total cholesterol, 15% in LDL, and 30% in TG, 8% increase in HDL Lipids Blood pressure • 10 mmHg fall in diastolic and systolic pressures 74 Realistic goals for modest weight/waist loss (adapted from Australian guidelines) 5 Duration Short term Medium term Long term Weight change Waist circumference change 2–4kg a month 1–2cm a month 5–10% of initial weight 5% after six weeks 10–20% of initial weight aim to be <88cm (females) aim to be <102cm (males) Patients may have unrealistic weight loss goals. The need to offer support for behaviour change The success of smoking cessation interventions shows that, in addition to raising a health issue, health professionals need to offer practical advice and support. Rollnick et al suggest some ways to do this within the primary care setting. Providing a list of available options in the local area may also be helpful as included in this resource pack. 6 Importance of continued monitoring of weight Weight monitoring can be a helpful way of maintaining motivation to lose weight. Patients should be encouraged to monitor their weight regularly. 7 Interventions for smoking cessation have found that behaviour change is more successful when follow-ups are included in the programme. 8 Wardle J and Johnson F (2002) Weight and dieting: examining levels of weight concern in British adults. Int J Obes 26: 1144–9. 2 Galuska DA et al (1999) Are health care professionals advising obese patients to lose weight? JAMA 282: 1576–8. 3 Jebb S and Steer T (2003) Tackling the Weight of the Nation. Medical Research Council. 4 Department of Health (2002) Prodigy Guidance on Obesity. Crown Copyright. 5 NHMRC (2003) Clinical practice guidelines for the management of overweight and obesity in adults. Commonwealth of Australia. 6 Rollnick S et al (2005) Consultations about changing behaviour. BMJ 331: 961–3. 7 O’Neil PM and Brown JD (2005) Weighing the evidence: Benefits of regular weight monitoring for weight control. J Nutr Educ Behav 37: 319–22. 8 Lancaster T and Stead LF (2004) Physician advice for smoking cessation. Cochrane Database of Systematic Reviews, 4. 1 © Crown Copyright 2006 274543 1p 60k Apr06 (BEL) Produced by COI for the Department of Health. First published April 2006 75 Useful Websites www.apho.org.uk - Association of Public Health Observatories www.babyfriendly.org.uk - There is lots of information on this site that can help services go Baby Friendly, as well as a comprehensive research archive and a section for parents www.bbc.co.uk/health - BBC Health Topics and Health News www.bhf.org.uk/keeping_your_heart_healthy/staying_active.aspx - Ways to get more active and information on the benefits of activity www.bmj.com - The BMJ is an international peer reviewed medical journal and a fully “online first” publication. NHS staff and students have full online access to the British Medical Journal using their NHS Athens details www.britishcycling.org.uk - Go to Skyride for information on led rides and mass participation events. Have a look at the Travel and Recreation sections for online cycling support, cycling routes and events www.cks.nhs.uk/obesity - The NHS Clinical Knowledge Summaries (formerly PRODIGY) are a reliable source of evidencebased information and practical ‘know how’ about the common conditions managed in primary care e.g. overweight and obesity. They are aimed at healthcare professionals working in primary and first-contact care www.counterweight.org - Weight management in primary care www.cwt.org.uk – Caroline Walker Trust, nutritional and practical guidelines for both young and old www.dancechampions.org.uk - Developed to support and encourage more people to be more active www.dh.gov.uk – Contains Your Weight Your Health (2006) which is a comprehensive package that comprises materials for health professionals as well as information to be given to patients www.dietaryadvicedirect.co.uk/ - Dietary advice direct is an online guide that helps people through the process of setting realistic and achievable goals to lose weight for life www.eatwell.gov.uk – Information from the Food Standards Agency www.evidence.nhs.uk - NHS Evidence www.food.gov.uk – Information from the Food Standards Agency, which has information about food safety only, not nutrition and advice www.foodfutures.info - Food Futures is a partnership that embraces a wide range of individuals and organisations with an interest in improving food in the city www.fph.org.uk - Faculty of Public health www.gettingmanchestermoving.org - Getting Manchester Moving is a project designed to encourage and support Manchester people to get more physically active, eat more healthily and in some cases to lose weight www.gmphnetwork.org.uk - Greater Manchester Public Health Network www.greatersport.co.uk – This website lists many physical activity opportunities for children and young people www.hpa.org.uk - Health Protection Agency www.ic.nhs.uk - The Information Centre 76 www.library.nhs.uk - NHS evidence www.manchester.gov.uk/health/jhu - The Joint Health Unit is a key part of the public health system in Manchester. It is a team that focuses on strategic planning and partnership working for health improvement and tackling health inequalities www.manchester.gov.uk/jsna - Manchester Joint Strategic Needs Assessment 2008 – 2013 www.manchester.nhs.uk – NHS Manchester Public Health http://manchester.plings.net/index.php - P laces to go, things to do. This website includes a list of sporting/physical activity opportunities for children in Manchester www.map-project.org.uk - Manchester’s Multi Agency Partnership for Disabled Children and Young People (includes a list of physical activities/clubs in Manchester) www.mendprogramme.org – Mind exercise nutrition do it - Fitter, healthier, happier families. MEND is an organisation dedicated to reducing global overweight and obesity levels among children and young people www.mhim.org.uk - Information about mental health www.mhsc.nhs.uk/services/library-services - Health Information and Resources Library in Manchester www.mphds.org/ - Manchester Public Health Development Service www.mymanchester.net - M y Manchester is a community portal, from Manchester Community Information Network which provides links to Manchester related information www.myschoollunch.co.uk/manchester - Making school lunch times the ninth lesson www.ncmp.ic.nhs.uk –National Child Measurement Programme results www.netmums.com - Netmums is a unique local network for Mums (or Dads), offering a wealth of information on both a national and local level e.g. local physical activity opportunities for parents and children. www.nhs.uk/livewell/healthy-eating/pages/healthyeating.aspx - NHS Choices - Healthy Eating advice www.nhsdirect.nhs.uk – NHS Direct www.nhs.uk/lifecheck - NHS Choices - NHS LifeCheck is an online health service for babies, teens and middle-aged adults www.nhs.uk/5aday - NHS Choices - Top tips for eating more fruit and vegetables www.nhs.uk/Change4Life - NHS Choices - Change for Life: Tops for healthy kids and families www.nhs.uk/livewell/alcohol - N HS Choices - How drinking can affect health, with alcohol units and recommended limits explained www.nhs.uk/LiveWell/Loseweight - NHS Choices - Articles to help with all aspects of attaining a healthy weight www.nhs.uk/ServiceDirectories/Pages/ServiceSearchAdditional.aspx?ServiceType=SportAndFitness&WT.mc_ id=090905 – NHS Choices - Find local physical activity/sporting opportunities close to home/work www.nhs.uk/livewell/fitness - NHS Choices - Information on becoming more active www.nhs.uk/News/Pages/NewsIndex.aspx - NHS Choices - NHS Choices (Behind the Headlines) www.nhs.uk/planners/nhshealthcheck/Pages/NHSHealthCheck.aspx - N HS Choices - The new NHS Health Check is for adults in England between the ages of 40 and 74. In this site you can learn more about what the check is, what it involves, and when and how you can get it 77 www.nice.org.uk – National Institute for Healthcare and Clinical Excellence www.nwpho.org.uk - North West Public Health Observatory www.promotingactivitytoolkit.com - The Promoting Activity toolkit helps bring the Change4Life campaign to life in local areas. It has photos, an online design tool to help create Change4Life posters, calendars of campaigns to help plan when to do marketing and an activity search tool to help make it easier for the public to find their local activity www.ramblers.org.uk - Details of many locally organised walking groups, catering for all levels of fitness www.smokefree.nhs.uk - Quit smoking information and advice www.sustrans.com - Information on starting off cycling and national cycle network maps www.walkengland.org.uk/walknowgettingstarted.aspx - A comprehensive website, with information on how to get active through walking, linking to lots of different local opportunities www.walkit.com - Walkit.com is an urban walking map and route planner that helps you get around town on foot www.whatisseries.co.uk - The “What is…?” series on Healthcare www.whi.org.uk - ‘Walking the way to health’ aims to encourage people, particularly those who take little exercise, to do regular short walks in their local community www.who.int - World Health Organisation http://www.yougo4it.co.uk/manchester - Advice about food and exercise for young people in Manchester If you would like also to receive a daily media digest of health news called presswatch, just send your email address to: [email protected] Access to websites is available at every public library 78 Appendix 1 79 Appendix 2 FAMILY CLUB Family Weight Management – Active Lifestyles Referral to the programme Preliminary child suitability assessment (please circle where appropriate) Is the child age between 5 – 16 years Yes/ No Is the child, together with a parent/ carer, able to commit to weekly sessions? Yes/ No If YES is answered to both of these questions please proceed with the referral Child’s Details First Name: Parent/ Carer’s Name: Surname: Sex: (Please circle) Relationship to child: Male/ Female Address: Date of Birth: Postcode: NHS Number: Telephone Number: Height & Weight (Please enter) Height (cm) Weight (kg) Date Taken: Medical History Relevant medical history: Current Medications: Additional social information, learning and/ or behavioural difficulties if relevant: Medically is the child able to participate in physical activity sessions? Please circle If NO please state the reasons for this: Referrers Details Referred by (print name): Address: Job Title/ Profession: Signature: Postcode Date: Telephone Number: Email: Referral Return Address – please send this completed form to: Active Lifestyles Tel 0161 232 3114/ 3117/ 3100 Denmark Road, Hulme, Manchester, M15 6FG Fax 0161 276 7483 Office Use Only 80 Yes/ No Appendix 3 81 Appendix 4 ‘Your Choice’ - Weight Management Programme Thank you for requesting information from us to try to help you to control your weight. Losing weight is not easy and we do not claim to be able to prescribe any miracle potions. We certainly cannot do it for you – the hard work and effort must come from you. One thing we will promise to do is to work with to provide the advice and support you require in order to achieve long term successful weight loss. You need to be a Manchester resident or have a Manchester GP (This does not include Trafford, Stockport, Tameside or Salford). What we do to help you; � Education Morning – A group session to discuss food, eating and energy intake we also look at activity and motivation to make these lifestyle changes to lose weight. � Activity - with help from P.A.R.S.* and qualified instructors if you wish you can work on increasing your activity. Activities to suit all levels of ability are available. � Health checks – You will be offered health checks to monitor your weight, body fat, blood pressure and heart rate to check if you are losing weight and getting fitter. We will help you set goals to achieve this. � Drop-in - You can come along anytime during the half hour to have a chat and get weighed if you wish. Mondays – 12:00 to 12:30 upstairs at the Forum Health Centre � 1 to 1 – An appointment with a Registered Dietitian � Initial Appointment with a Health Trainer if your Body Mass Index is less than 30 *Physical Activity Referral Scheme What do you need to do? If you are ready to make a start and want to lose weight, you need to fill in the referral form and return to us at the address at the foot of this letter. We will then get in touch and invite you to an education morning (usually 10am – 12.30pm) Yours sincerely, Ray Green, Suzanne Paul and Jen Bramley – Dietitian and Nutrition Assistants ‘Your Choice’ (Community Nutrition Service) Wythenshawe Offices, 1, Stancliffe Road, Sharston, Manchester, M22 4PJ Tel: 0161 946 8210 Fax 0161 946 8209, 82 YC/Ed Day/ YC Letters/ YC-1 Pat Interest Appendix 4 Referred by: Date: Self Referral Health Care Professional (Name and Designation) ‘Your Choice’ * Your patient will only be seen if they agree to the referral Weight Management Programme Application Form Please tick if your patient has agreed Please complete all sections of this form. We may otherwise need to return it to you for completion. If you need any help, contact our team or ask the person who handed you this form. First Name: Surname: Date of Birth: Telephone number: Address: Postcode: Doctors Name: Doctors Address: Current Weight: Height: Do you have any medical conditions (please state)? Do you take any medicine or tablets (please list)? Weight history over the past 2 years? Do you do require an interpreter? Referral Reason: Please return to: “Your Choice” Community Nutrition Service Wythenshawe Offices, 1, Stancliffe Road, Sharston, M22 4PJ YC/Ed Day/ YC Letters/ YC-1 Pat Interest Tel: 0161 946 8210 Fax 0161 946 8209 83 84 CounterWeight [ ] Your Choice [ ] Is the client currently on the Counterweight or the Your Choice programme? (please tick which programme if yes) Weight management history Postcode……………………………………………………………… Tel/ Mobile…………………………………………………………… Date of Birth…………………………………….…………………… Name…………………………………………………………………. Address………………………………………………………………. Client Details (Name)………………………………………………………………. (Date)………………………………………………………………… (Position)…………………………………………………………….. (Tel/ Email)…………………..………………………………………. ………………………………………………………………………… Referred by: Daytime and evening sessions on various days of the week; there will always be two sessions per week at the same venue. Nutrition/ Support advice workshops run for the first half-hour of sessions (these can be excluded if the resident is already receiving nutritional advice from another weight management programme). Additional Personal Development workshops will run as part of the programme. Sessions are at venues across the city. Health checks/ measurements recorded. Sessions are only suitable for residents with no co-morbidities and that have a BMI over 25.00 Programmes: Please complete this referral form if you know of a resident who would benefit from the Weight No More programme. Here’s a quick guide to show what is offered on the programme. [email protected] OR [email protected] Please address for the attention of Angela Matthews OR Ross McGuigan. For any enquiries please contact us on Tel: 0161 232 3114 / 3117. Email: Please send this form either by post:Active Lifestyles, Denmark Road, Hulme, Manchester, M15 6FG or Fax: 0161 276 7483 Thank you for completing this referral form. Once you have sent this to us we will contact the resident. …………………………………… …………………………………… …………………………………… …………………………………… …………………………………… …………………………………… Medical History Please list any relevant medical conditions and / or any medication that may affect participation: How mobile or active is the resident? (Please describe if possible) Current Weight (if known)…………………………………………………. Height (if known)……………………………………………………………. BMI (if known)………………………………..…Date taken….................. Blood Pressure (if known)…….......................Date taken………………. Is the client currently on any other weight management programme? (Please list/ describe) Weight No More - Referral Form Appendix 5 Appendix 6 Tel: 0161 861 2548 Fax: 0161 203 5817 HEALTH TRAINER REFERRAL FORM Client number: (Health Trainer use only) HT initials Year Client no Name of client referred: Client’s address: Telephone no: Client’s full postcode: Referrer’s name and position: Address: Referrer’s contact details: Tel: / Date: D D / M M Y Y Y Y Thank you for your interest in the Manchester Community Health Trainers service. Manchester Community Health Trainers aim to support people to adopt health promoting behaviour. Health Trainers do this by helping people to identify their own goals and stick to them. They will also give some practical support, particularly around losing weight, eating more healthily and doing more physical activity. Health Trainers can also provide information on other services that can help individuals to achieve their goals. What do you want to focus on? (tick all that apply) food (healthy eating) physical activity (exercise) smoking drinking other what? ……………………………………………. You can send the completed form or make further enquiries to this freepost address: Manchester Community Health Trainers, Business Reply Licence No RRBL-ASHX-YYCB, Manchester Public Health Development Service, Victoria Mill, Lower Vickers Street, Miles Platting, Manchester M40 7LJ Tel: 0161-861-2548; Fax: 0161-203-5817 Official use only Outcome: couldn’t make contact didn’t want service at this time booked in for first visit didn’t meet service criteria 85 Appendix 7 Manchester Community Alcohol Team Alcohol Linkworker Referral Form Details of person wanting advice / support Date of referral: DOB: Name: Address: Post code: Tel No: GP details (if known): Name: Practice Address: Tel No: Details of person making referral if different from above Name: Address: Tel No: Brief reason for referral: CAT Referral Form 2011-07-01 86 Organisation / relationship to person requesting help: Appendix 7 How to send your referral to Manchester Community Alcohol Team BY SECURE FAX: 0161 882 1344 BY POST: Manchester Community Alcohol Team Longsight District Office 523 Stockport Road Manchester M12 4LL When we receive referrals by post or by fax, we will telephone the person wanting advice / support so they have a chance to ask any questions about our service. 87 CAT Referral Form 2011-07-01 Appendix 8 88 Appendix 8 89 Appendix 9 Manchester Science Park 1st Floor, Unit 21 Enterprise House Lloyd Street North M15 6SE Tel: 0161 227 0600 Fax: 0161 227 0605 Family Nurse Partnership Referral form for Family Nurse Partnership Project Wave 1 & Wave 2 Supervisors Vanda Wellock & Lesley Lamb Young women under 20yrs who are pregnant for the 1st time? Date: Name: NHS Number: DoB: EDD: Address: Postcode: Home Number: Mobile Number: Weeks Gestation: GPs name: Telephone number: Referrers name: Contact Details: Is it O.K for Family Nurse to contact client: Yes/No 90 Appendix 10 Paediatric Referral Form for Children with Weight Management Issues and Associated Musculoskeletal Conditions Please fax completed form to 0161 220 5809 then send original in post Criteria For Referral (when to refer) • • • 17 and under Identification of weight issues using IOTF BMI centile cut offs Associated joint pain e.g. In knees or back which is impacting on the child’s ability to take part in physical activity or increase their activity levels (When not to refer) • When child and their family are not in agreement with the referral Name: Date of Referral ____/____/____ DOB: NHS No. Name of Referrer: Address: Address: Tel No: Postcode: Home Tel: GP Name: Address: Mob Tel: Postcode: Tel No: Name of Carer Relationship Reason for Referral: Relevant Medical Details: Current Weight Current BMI BP Summary of previous weight management interventions Associated joint pain Other services involved MSK Team – Cornerstone Centre, 2 Graham Street, Beswick, Manchester, M11 3AA. Tel No. 0161 220 7110 Fax: 0161 220 3991 91 Appendix 11 Children and Young People’s Services Referral Form Please select the service you are referring to by marking “X” in one of the appropriate boxes below: Audiology Children’s Community Nursing Team Physiotherapy Paediatrics Disabled Children’s Team Nursing Service Podiatry Occupational Therapy Speech and Language Therapy School Health / School Nursing Service Health Visiting Service Orthoptics Other – please state * Starred fields are mandatory. If any of these fields are not completed the form will be returned to the referrer. Surname: * Forename: * Previous Surname: Address: * Date of Birth: * NHS Number: * Gender: * Male / Female Home Telephone: * Mobile Telephone: Postcode: * Is copy appointment letter required: Yes / No E-mail Address: Please give details: Reminder required for appointments (if available): Text: Yes / No E-mail: Yes / No Appointment Preference (mark with x): Monday am pm Tuesday am pm Wednesday am pm Thursday am pm Friday am pm Common Assessment Framework (CAF) Completed: * Yes / No Multi Agency Case Planning: Language Spoken: * Interpreter Required: * Yes / No Ethnicity: * Religion: * Disability: * Y / N Access Needs: GP Name: * Practice Name: * Practice Address: * Yes / No Lead Professional / Key Worker: Name: Address: Nursery / School Attended: Manchester Health Record Holder & Base: Telephone: Other Professionals Involved: Diagnosis / Reason for referral / treatment required: * Additional information (including test results or provide clinic letter as appropriate): Referrer Name: (PLEASE PRINT) * Date of referral: * Designation: * Address: * Telephone: * Have parents agreed to referral? * Yes / No Has this child been referred to this service previously: Yes / No Office Use Only Date referral received …………………….....…............... Demographic details checked on child health system? Yes / No Name……………………………………………….……….. Date…………………………………… Date of appointment……………………………………… 92 CYPS1v6 November 2010 Appendix 12 Stroke Association – Healthy Living Referral Form to 8 week programme Name: Name of NoK: Male/Female: Relationship: Address: Address: Ethnicity: Telephone: Telephone: GP Name: Discharge Address if different: GP Address: Discharge Telephone if different: Date of Stroke: DoB: Ward/Consultant: Age: Marital Status: Married Single Widowed Div/Sep Lives Alone: Yes/No Transferred to: Stroke/TIA: Date of Discharge: Home Stroke/Neuro Outreach: (if applicable) Referrers Name: Discharged to: Details of carer if different from NoK Does the carer wish to attend the session? Date of Transfer: Referrers Job Title: Name: Relationship: Transport required or not: Address: Telephone: 1 93 Appendix 12 Brief Medical History: Comments with regard to current medication and medical status: Communication: Dysarthria � Dysphasia � Receptive: Dyspraxia � No Problem |____|____|____|____|____|____|____|____|____| Severe Expressive: No Problem |____|____|____|____|____|____|____|____|____| Severe Comments: Exercise experience prior to stroke: Present Mobility: Additional support needed: Flexibility: Other health problems: Comments with regards to suitability to programme: 94 Appendix 13 A STRUCTURED PATIENT EDUCATION PROGRAMME FOR PEOPLE WITH DIABETES Do you want to increase your skills, knowledge and confidence in managing your diabetes? The local X-PERT programme is a six-week group diabetes education programme. You will learn all about the up-to-date treatments and management of diabetes and will have the opportunity to explore and address problems/issues that you may have with your diabetes. The programme has been shown to improve diabetes control, increase self-management skills, improve lifestyle and quality of life. Comments from patients: You are invited to attend the X-PERT programme. It is important to attend all the weeks to get the most out of the course. You are welcome to bring along a family member or friend, however the session are not suitable for children to attend. ‘Very glad to be offered the course, much appreciated (Thank you NHS!). Feel much encouraged in dealing with myself and more understanding with latest knowledge’ Week Week Week Week Week Week 1. 2. 3. 4. 5. 6. What is Diabetes Weight Management Carbohydrate awareness Supermarket Tour Possible Complications Questions and Evaluation The sessions will last for 3 hours except on Week 4 that’s 2 hours and at your nearest Supermarket. ‘This is the first time in 10 years of being a diabetic that anybody has told me these things’ ‘I am more at ease with diabetes from what I have learnt and able to control it better’ ‘I was very impressed – the sessions have been delivered in a manner that had obviously gone beyond that required to make them understandable’ ‘Don’t feel as frightened as I did.....feel more confident in myself…things explained so that anybody & everybody can understand’ ‘This course was really helpful in helping me understand diabetes as all demonstrations were in laymen’s language - programme should have been implemented years ago’ 95 Appendix 13 If you would like to attend, please complete the reply slip below. If Reply Slip (Please Complete as much as possible) I would like to attend the X-PERT Programme. (Please circle) Yes No Your Name: Home Address: PostCode: Telephone Number: Date of Birth: GP Practice: Date of Diagnosis of Diabetes: Treatment for Diabetes (please circle) Diet Tablets Insulin Would like to bring a friend/carer/ family member? (please circle) Yes No Please return the reply slip to one of the diabetes team or post to: ‘X-PERT Diabetes’, Community Nutrition Service, Wythenshawe Offices, Stancliffe Road, Sharston, Manchester, M22 4PJ. If you would like any further information please contact: Amy Griffiths - Dietitian: 0161 946 8210 Helen Tyrer – Podiatrist: 07970 650787 Jackie Price – Diabetes Specialist Nurse: 0161 945 8203. 96 Appendix 14 Appendix 14 General Referral to Community Nutrition Service NHS No: First Name: ……………………………… GP Name:………………………………………….. Surname:………………………………… Address:……………………………………………. Address:…………………………………. ……………………………………………………… ……………………………………………. Current Weight: …………………………………… Postcode:……………………………….. BMI: ………………………………………………… Date of birth: …………………………… Ethnic Origin:……………………………………… Phone No: ………………………………. Medical History/Reason for referral: Medication: Relevant Social/Personal Information/disability: Please tick box if Home Visit is Required (We have a limited capacity to visit at home and will only do so if absolutely necessary) Referred By: Name (please print) Address Phone No:: Date: Send to: Community Nutrition Service Levenshulme Health Centre Dunstable Street Manchester M19 3BX Tel : 0161 861 2333 Fax: 0161 248 0389 Use from April 2011. 97 Appendix 15 Referral Form VERSION 1.0 Please complete the form as clearly and fully as possible to ensure no delay to the referral Level 3 Adult Specialist Weight Management Service for NHS Manchester, Oldham and Salford Manchester Salford Oldham Name of referring GP (Please PRINT name) Address of referring GP practice (Or use practice stamp) Client Personal Information NHS Number Mr/Mrs/Miss/Ms/Other First name Gender (Please circle) Ethnicity Male/Female Date of birth (DD/MM/YYYY) Address Preferred contact telephone 98 Client email Surname Appendix 15 Client Health Data Eligibility Criteria • Client has a BMI >35 • Client has a BMI >30 and pregnant • Client requests and is eligible for Bariatric Surgery Physical Health Data Please provide the following Height (m) Resting Heart Rate (bpm) Current weight (kg) BMI (kg/m2) BP (mmHG) Current Medication Please provide a list of medication the client is currently taking or attach a list of medication to the referral form Client’s Past Medical History (please tick and fill in relevant boxes) Type 1 diabetes Type 2 diabetes Myocardial infarction Ischaemic heart disease Hypertension Heart failure Cardiomyopathy CVA/TIA Hyperlipidaemia Peripheral vascular disease Polycystic ovarian syndrome Joint problems Obstructive sleep apnoea Severe dismobility Obesity hypoventilation Subfertility Back pain Hypothyroidism 99 Appendix 15 Specify other medical problems that the service may need to be aware of Biochemical Readings (these must be dated within 3 months) Cholesterol HDL LDL Triglycerides HBA1C Date: Date: Date: Date: Date: Does the patient have any communication difficulties, e.g literacy, vision or require an interpreter? Y / N If yes – please state the nature of support required Are there any safety/security issues around seeing this patient? Y / N If yes – please state the nature of issue Is the patient housebound? Y / N All patients will be assessed medically by our team and physical activity will be tailored according to their ability. From your personal knowledge of this patient, please outline any concerns you may have regarding their ability to partake in any form of physical activity? Signature Date of referral Please return the completed referral form to: Email: [email protected] Safe Haven Fax: 01204 570 965 Post: ABL Health Ltd, Royal Bolton Hospital, Farnworth, Bolton BL4 0JL If you wish to speak to a member of the team please telephone: 01204 570 999 between 8am and 6pm 100
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