1. A little exercise a day keeps the doctor away Plenary Session NHSScotland Event 2013 Collaborating for Quality

2. Dr Andrew Fraser Director of Public Health Sciences Session Chair 3. A message from the Chief Medical Officer of Scotland, Sir Harry Burns 4. The National Physical Activity Pathway Every Step Counts Dr David White Scottish Government Physical Activity Champion 5. Life expectancy: Scotland & other Western European Countries, 1851-2005 Source: Human Mortality Database 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 51-1853 1855-1857 1859-1861 1863-1865 1867-1869 1871-1873 1875-1877 1879-1881 1883-1885 1887-1889 1891-1893 1895-1897 1899-1901 1903-1905 1907-1909 1911-1913 1915-1917 1919-1921 1923-1925 1927-1929 1931-1933 1935-1937 1939-1941 1943-1945 1947-1949 1951-1953 1955-1957 1959-1961 1963-1965 1967-1969 1971-1973 1975-1977 1979-1981 1983-1985 1987-1989 1991-1993 1995-1997 1999-2001 2003-2005 6. The BIGGEST public health problem of the 21st Century 7. Key Statistics 2500 Scots die prematurely each year due to a lack of physical activity 9% of our population die due to physical inactivity Physical inactivity costs Scotland over 800 million each year 8. Coronary artery disease Heart failure Heart rhythm disturbances Hypertension Hyperlipidaemia Metabolic syndrome Peripheral arterial disease Asthma Chronic obstructive pulmonary disease (COPD) Cystic fibrosis Pregnancy Menopause Osteoporosis Dizziness and balance disorders Multiple sclerosis Parkinsons disease Post-polio Cancer Gastrointestinal diseases Dementia Back problems (chronic) Osteoarthritis Parkinsons disease Rheumatoid arthritis Stroke Alcohol dependence/abuse Anxiety Dementia Depression Schizophrenia Stress Diabetes Mellitus Type 1 Diabetes Mellitus Type 2 Obesity Cystic fibrosis Spinal cord injury Kidney disease (chronic) and kidney transplant Pain syndromes 9. Prioritisation of Physical Activity National Framework Indicator Single Outcome Agreement National Physical Activity Plan - Recognition of key role of NHS staff 10. 1) Embed physical activity as normal within the NHS National Physical Activity Pathway across both primary and secondary care 2) Improve education of physical activity for health within undergraduate and postgraduate curricula, and in CPD workforce development across the entire healthcare workforce 3) Support a Health Promoting Health Service by facilitating PA for both staff and patients 3 Strands of Healthcare section: 11. CEL (01): A new hospital policy under direction of Chief Medical Officer and SG All boards are expected to deliver on physical activity commitments by March 2015. Action 18.7: NHS staff routinely highlight the importance of physical activity for patients in hospitals as part of their rehabilitation and for prevention of future illness. 12. Chief Executive Letter, CEL (01) 2012: Consultation feedback issues: - Develop a Physical Activity Pathway? - Tackling knowledge and behaviour of staff - Measuring impact 13. Chief Executive Letter, CEL (01) 2012 Consultation Feedback: - Developing a Physical Activity Pathway - Tackling knowledge and behaviour of staff - Measuring impact 14. Chief Executive Letter, CEL (01): Consultation Feedback: - Developing a Physical Activity Pathway - Tackling knowledge and behaviour of staff - Every step counts - NHS HS E-module - Measuring impact 15. Chief Executive Letter, CEL (01): Consultation Feedback: - Developing a Physical Activity Pathway - Tackling knowledge and behaviour of staff - Measuring impact - Improvement methodology package - Must measure staff behaviour first 16. Contribution to the Quality Strategy A shift towards prevention and anticipatory care, delivered in the community Supported self-management of illness and a co-creation of health Promotion of a mutual NHS Disinvestment in medications Modernisation of current exercise referral schemes to become patient-centred A Mutual NHS 17. The Ask Make use of what has been created PA Pathway Every Step Counts film (Also available on YouTube and NHS HS Website) QI Package - Build the evidence base Form new working partnerships Collaborate for Quality Be a champion in your sphere of influenceat work and at home Get in touch: david.white@scotland.gsi.gov.uk 18. AHP Physical Activity Pledge Lynne Douglas AHP Director- AHP Directors Scotland Group 19. Physical Activity Pledge Scottish AHP Directors Pledge to increase Physical Activity in Scotland 2012/13 20. Triple Aim Increase Life Expectancy by over a year just by getting Scotland Active Reverse the trend of Increasing Health Inequalities by 2016 Prevent Spend (800M), and release cash- example 60M in prescriptions 21. Physical Inactivity Kills 9% of worlds population (The Lancet) Over 2500 deaths in Scotland annually Prevents and treats over 20 chronic conditions by 20-45% (Home Nations CMOs report.) 26% fewer sick days 22. The Pledge 23. Allied Health Professionals Outstanding example Pledge to make an assessment PA part of each consultation NHS opportunities to get active- coming soon 24. AHP Physical Activity Pledge Working with NHS Health Scotland, NES, SGHD and Public Health AHPs undertake E-learning module, 2013 Embed questioning and brief intervention/advice for ALL new contacts (750,000 per annum) 2013 Reporting mechanism identified- web based snapshot in 2013 25. Education 26. Go for Gold Challenge Scotland The aims of the Go for Gold Challenge are to: Promote and celebrate participation in physical activity amongst older people supported by the care sector. Build capacity in the workforce in the care sector to promote physical activity with older people on a day to day basis. Develop links between the care sector in Scotland and physical activity organisations. Contribute towards the 2014 Glasgow Commonwealth Games Legacy. 27. Man does not cease to play because he has grown old; he grows old because he ceases to play. George Bernard Shaw 28. Individuals or teams sign up: aim = >10% NHS workforce Complete e-learning module on Physical activity, Complete a 8-12 week challenge, start spring, finish to coincide with NHS event/Commonwealth Games 2014 Receive personal emails/social media encouragement Data pre during and after about individuals, knowledge, attitudes, values and activity provided 29. AHPDs walking, swimming & running the talk! 30. Summary Health Promoting Health Service objectives Physical Activity- Every patient every time Engage 10% Health & Social care Employees in PA Challenge Health Inequalities Transferable model 31. Lynne.douglas@nhslothian.scot.nhs.uk @lynneahpd @lesleyahpd @carolynahpdf @billyahpd Every board has an AHP Director, please contact them if you are interested in promoting & spreading PA message 32. Getting NHS staff on the move Chartered Society of Physiotherapists 33. Workout at Work Day 12 June 2013 Website: www.csp.org.uk/w@wd Twitter: #WorkoutAtWork Chartered Physiotherapists Caroline Davidson Isobel Hannen Caroline Davidson and Isobel Hannen 34. Workout at Work Day 12 June 2013 Website: www.csp.org.uk/w@wd Twitter: #WorkoutAtWork Chartered Physiotherapists Amanda Jones Caroline Bennett 35. Promoting Physical Activity in Primary Care Dr Kirsten Ness 36. NICE GUIDELINES May 2013 Physical Activity: brief advice for adults in primary care Identify inactive adults Delivery and follow up on brief advice Incorporating brief advice in commissioning Systems to support brief advice Information and training to support brief advice 37. 97% of population are registered with a GP and 88% will visit primary care team at least once per year 38. National Guidelines for Physical Activity Poor public knowledge Health care professionals 13% GPs aware of guidelines 9% practice nurses 7% health visitors 39. Feasibility pilot 16 sites across Scotland 6 GP practices 7 Keep Well practices 3 Lifestyle advisory services Training RIPA online module face-to-face training Online resources Data collection Templates developed for EMIS and Vision Patients recruited opportunistically, chronic disease clinics and new patient assessments Follow up of patients at 3-6 months Teleconferences, online focus groups Practitioner interviews and questionnaires 40. In Reality Challenges Time Multiple problems in one consultation Patient receptiveness Practitioner receptiveness Data recording Access to local facilities Benefits Improved knowledge, professionals and patients Patient centred Improved health of patients Dissemination to family Long term integration into health reviews 41. New QOF indicator 5 points CVD-PP003(S). The patients diagnosed with hypertension (diagnosed on or after 1 April 2009) who require lifestyle advice on increasing physical activity, as identified in CVD-PP002(S), in the preceding 12 months are given that advice utilising the Scottish Physical Activity Screening Questions (Scot-PASQ) 42. Future Roll out pathway across primary care in Scotland Enhanced services QOF indicator in its own right 43. Winning With Weight In Pregnancy Ante Natal Victoria Hospital Gwen Smith Midwife 44. Complications of obesity in pregnancy/labour Increased risk of pre-eclampsia Gestational diabetes increased glucose levels can cause malformation Increased risk of shoulder dystocia Increased rates of failed induction Small for dates Increased risk of DVT and pulmonary embolism Higher incidence of Intra uterine death Higher rate of c/s Poorer rates of breastfeeding 45. Cost to NHS Extra scans to check for size, malformations and presentation Extra hospital appointments Referrals for dietician Higher induction rates Referrals for anaesthetics Increased rates of operative delivery, longer stays Extra fragmin* both antenatally and post natally Special clinics for diabetes 46. How the group started Attended NHS health promotion classes, winning by losing, healthy eating, food and health Walk leader training, bums of seats All women with a BMI of 30 and above at booking, were offered referral to the group This was followed up by an invitation, by post to attend the group The postal invitation wasnt working only two attended for the first two weeks Decided to use social media facebook, twitter and texting 47. How the group runs Meeting in local areas for walks approx. an hour (bums off seats) Weigh ins (very competitive) Drinks and chats Advice in the form of games, food tasting, discussions based on winning by losing Dancing if raining macarena, slosh, time warp, cha cha slide etc Other members of staff sometimes come along on walks to chat (mobile parenthood) Can bring other children if childcare a problem 48. Facebook Page Advice- healthy eating , portion sizes, vitamins, appointments Meeting places each week Local facilities for swimming, paths for all walks, yoga, relaxation, aqua aerobics Facilities to ask questions privately, speak to others, requests to join group Women who cannot attend regularly ask questions and get healthy eating advice, times and locations for other physical activity 49. So Far 120 women have attended in last 2 years (as only have 10 per one walk leader) 5 women have come back in 2nd pregnancy (and maintained weight loss) Only one incidence of pre-eclampsia 2 incidences of gestational diabetes Much decreased levels of both elective and emergency c/s 1 preterm birth 95% of all women below booking weight at first postnatal visit 50. Barriers Money, money, money...funding Had a postnatal group, well attended, stopped through no funding Staffing, have limited amount of women able to attend because only me. Education of staff, some staff finding it difficult to approach the subjects of obesity, activity and diet Only women who can drive or live locally can attend Time for audit, record keeping hard to prove the success of the group without all the numbers. 51. Testimonials great support not just for weight management but for pregnancy advice and reassurance and I made good friendships at the group and Im sure I will continue to be friends with them. Kirsty the walking was good encouragement to make the effort to go out and stay active, even when it was difficult near the end. I came in both my pregnancys and in the second I joined much earlier for more support. Isla D Great class, help at every step of my pregnancy, great class for meeting new people and great for information about foods and a healthy lifestyle for me and my baby. will definitely be there in my next pregnancy thanks. Donna A I dont usually walk much but really looked forward to every walk, have kept in touch with everyone and we still meet and walk all the time. Tracey S 52. Hopes for the future Extra funding to be able to extend into other geographical areas Help, possibly volunteers, Clerical help for short periods An interactive page, where women can ask questions, have facilities to have video tours, a list of all physical activities within their local areas, even short fitness videos to let women in all stages of pregnancy take appropriate exercise 53. Physical Activity Champions in the NHS Dr Andrew Murray 54. Champions? 55. Large Ambitious Goals require A clear focus Teams to work together Innovation and Effort Champions to get things moving The rewards are great 56. Champions- Lets get active ourselves The commute When at work Leisure time Influence others 57. Primary care Spread knowledge to colleagues Spread knowledge to patients Ask the question, BA/BI Examples 58. Secondary Care Get colleagues active Clinics Inpatients Make it normal 59. Education 60. Why Champion 61. Resources DVD Physical Activity Pathway 23 hrs Active Scotland/ take30 Be creative!!!