The WM LD and Obesity Work Programme, Findings, Resources

and ImplementationOpportunities

Karen Saunders

Senior Public Health Manager

Department of Health West Midlandskaren.saunders@dh.gsi.gov.uk

Background

• DHWM Equality Impact Assessment of the West Midlands Healthy Weight Programme

• Identified need for a focus on the needs of people with learning disabilities (LD) in maintaining a healthy weight, participating in physical activity and making healthy food choices

.

Programme of Work: Products

• Establish context: facts and policy• Interprofessional and multi disciplinary approach –

workshops/consultation• Framework for action/local delivery• Charter• Training audit• Data• Case studies/good practice• Template for collecting individual case studies and

consent forms• Summary Papers

The Facts

• Obesity appears to be more common among people with LD

• About one person in three with a LD is obese compared to one in five of the general population

• Less than 10% of adults with LD in supported accommodation eat a balanced diet, with an insufficient intake of fruit and vegetables

• Carers generally have a poor knowledge about public health recommendations on dietary intake

• People with more severe LD and people living in more restrictive environments are at increased risk of inactivity

National Context • The NHS White Paper, Equity and excellence: Liberating the NHS (2010) Healthy

Lives, Healthy People: Our strategy for public health in England (2010)• Social Care White Paper 'A vision for adult social care: Capable communities and

active citizens'• Public Health White Paper; Healthy Lives, Healthy People (2010) and the healthy

Lives Healthy People update and way forward document published in July 2011.• No Health Without Mental Health Strategy (2011)• The Quality, Innovation, Productivity and Prevention (QIPP) agenda• Commissioning for Quality and Innovation (CQUIN) payment frameworks.• Forthcoming Green Paper on Special Educational Needs and Disability • Sport England’s Grow Sustain Excel Strategy for 2008 – 2011 and the forthcoming

Sport England Strategy for 2011 – 2015.• The 2012 Olympic and Paralympic Legacy programme documented in the Coalition’s

programme for Government and the DCMS and Department of Health Business Plan. • Healthy Lives, Healthy People: A call to action on obesity in England• The 2011 update for the UK Physical Activity Guidelines

Public Health White Paper; Healthy Lives, Healthy People (2010)

• Increased priority for Public Health within Government plans• Life course approach to public health• Further document produced on obesity• PH moves to local government with a focus on wider determinants

of health• The new Public Health Service to focus on key outcomes:

- Health protection

- Tackling wider determinants

- Health improvement – promoting the adoption of health lifestyles

- Preventing ill health

- Healthy life expectancy

Healthy Lives, Healthy People: A call to action on obesity in England

• National ambitions for a downward trend in excess weight in both children and adults by 2020

• Wide ranging partnerships across the public, private and voluntary sector that will be needed to make the ambition a reality

• Partnership working• Health inequalities• Wider determinants

The LD & Obesity Framework for Action

• For organisations in the West Midlands (and elsewhere) to consider their role in supporting people with LD to maintain a healthy weight

• High level challenges and actions to guide local areas towards focussing on the needs of this group of people

• Five priority areas

Priority Areas

1. Local Action and Delivery – Charter; Framework for Action and Commissioner Checklists

2. Research, data and evidence

3. Training and development

4. Case studies

1. The Charter

The Charter aims to:•Promote and support prioritisation of the needs of people with LD to inform effective commissioning and delivery of specialist and community services to aid weight management•Strengthen commissioning processes and advise on the standards expected of providers when delivering services•Aid the local prioritisation of services that maximise opportunities for people with learning disabilities, their carers and families to be supported to maintain a healthy weight

The implementation of the Charter should:•Improve practice relating to the commissioning and delivery of weight management and related services for people with learning disabilities, their carers and families•Standardise the services offered to people with learning disabilities, their carers and families regarding weight management•Advise on the standards that are expected when commissioning and delivering services to people with learning disabilities to support them in maintaining a healthy weight

Key Aspects

• The Charter

• Checklist for Commissioners

• What staff can expect document

• What service users can expect document

Target AudiencesCharter Element Target Audience People with

Learning Disabilities

Family and Friend Carers

Service Deliverers – Workforce including paid Carers

Service Deliverers - Management

Public Health, NHS, Social Care Commissioners & Contract Managers

Public Health, NHS, Social Care Strategic Management

Full Charter Document       x x x

Easy read Charter Document – “What you can expect from services”

x x        

Workforce guide to the Charter

    x      

Commissioning Checklist       x x x

Commissioning & Contracting statements (contained in the Full Charter document)

      x x x

2. Audit of Training Needs in the West Midlands

Aim•Establish the current training and personal development needs of a range of professionals, family members and carers in supporting and enabling individuals with learning disabilities to eat more healthily, be more physically active and achieve/maintain a healthy weight.•Identified learning for future training delivery

Approach

• 15 questions asked survey monkey focusing on

i. individuals current experience and expertise in supporting individuals with learning disabilities to make healthier lifestyle choices;

ii. relevant training and personal development previously undertaken; and

iii. the views and opinions of individuals supporting people with learning disabilities as to what further resources and support might be required in order to maximise the healthy lifestyles support that they provide to people with learning disabilities.

Key Findings

• Professionals would benefit from further support and development, particularly in relation to working with people with learning disabilities on healthy weight

• Establish a core criteria for the local delivery of training relating to learning disabilities, healthy eating, physical activity and weight maintenance.

3. Health Data Sets

• A review of the datasets and metrics that relate to LD and Obesity to support the framework for action priorities of improving data and research:

• Develop a better understanding of what is happening to prevent/tackle obesity for people with LD

• Develop a better understanding of the healthy eating and physical activity needs of people with LD and their carers

Health Data Sets: Recommendations

• Locally develop systems to determine the number and type of organisations providing physical activity, healthy eating and weight management services for people with LD to enable gap analysis to be undertaken

• Develop effective links to the Improving Health and Lives Learning Disability Observatory to ensure that effective methods of data collection are shared across the country

4. Case Studies: LD and Obesity Projects

A bank of case studies detailing projects that support people with Learning Disabilities to become more active, eat healthily and manage their weight can be found at http://www.obesitywm.org.uk/panlist.aspx?id=OBESITY_GOOD_PRACTICE_LD

Case Studies: templates and consent forms for individuals

Aim: To support local partners in collating good news stories and promoting LD and Obesity projects and individual’s successes to provide the “someone like me” angle

Linked to the following elements of the Framework for Action •Work with partners to develop an understanding of the myths surrounding people with learning disabilities and develop a campaign and related programme to dispel these myths.•Develop a bank of inspirational case studies and individual stories to advocate and raise the profile of healthy eating and physical activity success stories for people with learning disabilities

How to Implement

• Using the resources provided local areas are encouraged to determine which actions align with their programmes of work and to determine which additional actions could be embedded into programmes of work within current resources to meet the needs of people with LD

How to embed the approach:Legislation and Reasonable Adjustments

• Disability Discrimination Act (1995 & 2005)• Equalities Act (2010) Disability Equality Duty

Example reasonable adjustments:• Larger print

• Easier to understand words, pictures and symbols

• Clear and easy to understand information and signs

• More time to explain and listen

• First or last appointments

• A different place to wait for appointments

• Involvement of carers/family but talking and listening to the person with learning disabilities

• Not speaking jargon or delivering complex information

• Familiarisation visits and adjustments to timings where needed

• Extended sessions

• Adjustments in procedures

Healthy Lives, Healthy People update and way forward (2011)

• New responsibilities for Local Authorities include:- Obesity and community nutrition initiatives

- Increasing levels of physical activity in the local population

- Behavioural and lifestyle campaigns to prevent cancer and long term conditions;

- Local initiatives to tackle social exclusion.

- Public mental health services;

PH Reforms and the Local Context• The context for the local delivery of the programme

should be determined by local partners working on joint priorities

- Learning Disability Partnerships- Health & Well Being Boards- Clinical Commissioning Groups- Health Watch- Scrutiny- JSNA- Health and Wellbeing Strategy- Political will – elected members

PH Outcomes Framework

• A set of supporting public health indicators to help focus understanding of progress year by year nationally and locally on those things that matter most to public health

• Excess weight in 4/5 and 10/11 year olds• Excess weight in adults• Proportion of physically active and inactive adults• Self reported wellbeing• http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/

digitalasset/dh_132410.pdf

Disseminating the Work

Copies of all of the West Midlands Learning Disability and Obesity programme documents can be downloaded from

http://www.obesitywm.org.uk/panlinks.aspx?id=OBESITY_LEARNING_DISABILITIES•The LD and Obesity Charter, Framework for Action and associated documents will be disseminated through the local LD Partnership Boards, health, local government and voluntary sector networks locally. The Framework will also be shared nationally. •2 summary papers have been developed to provide an overview of the WM LD & Obesity resources and reports. •LD Partnership health sub groups (these groups comprise of strategic health facilitators who have created links to local Clinical Commissioning Groups and GPs as well as linking to specialist LD services working in the community and acute sectors) and other key partners will be encouraged to embed the approaches documented into the health inequalities action plans that are being developed.