Choosing Health Team

In late 2003 the emergence of the Wanless Report with its emphasis on the need to work “upstream” to address health problems and to fully engage local people in improving their own health, coincided with a visit to South Tyneside by the Head of the Neighbourhood Renewal Unit. This visit emphasised that, as part of South Tyneside’s transformation, action needed to be taken by member agencies of South Tyneside’s Local Strategic Partnership to improve the health of local people and narrow the health inequalities gap.

The action in response to this visit was also influenced by widespread consultation on health improvement with local people in May 2004 and the Health and Social Care Scrutiny Committee’s Commission into Obesity action in June 2004.

The resultant action plan identified the need for a “whole systems” approach to reducing obesity/CHD risks and linked morbidities and led to the creation of the “Choosing Health Team”. It was recognised that there needed to be an evidence based approach to setting up this intervention and the response was based on the successful smoking model (mixing primary care brief advice with specialist tailored support, which in 2002/3 had led South Tyneside having the most successful quit rate in England and Wales).

This primary prevention team has been created to receive referrals from GPs and local people to assist in the modification individual lifestyle risk factor behaviours and provide a managed and structured programme of self care though increased physical activity and changing dietary habits. It aims to bring together social and medical models of health to address health inequalities in South Tyneside.

1. Why was the “Choosing Health Team Set up?

Health in South Tyneside is particularly poor and Health and Lifestyle research published in March 2004 suggested that:

Health:

•Men and women are over 70% more likely to die from lung cancer compared to the national average

•Men are 8% and women 7% more likely to die prematurely from coronary heart disease

•South Tyneside’s life expectancy at 74.1 for men is two years lower than the national average

South Tyneside Lifestyles:

•52% in overweight/obese category

•30% of 16-44 “obese” (13% increase since 1992)

•Greater discrepancy in people’s perception of weight & BMI

•Physical Activity levels still poor

•More than 60% do not engage in even moderate exercise

2. What is the Choosing Health Team and what is it doing?

The team is made up of 6 PCT employed Health and Lifestyle Advisers (HLA) and 6 Community Health Officers (CHO) employed by South Tyneside Council, aligned to the 6 geographic Community Area Forums (CAF) areas. (One HLA and one CHO per CAF area). The philosophy of the team is “One Team, Two Roles, One Outcome”

The Choosing Health Team

• receive referrals from GPs and local people to assist modify individual lifestyle risk factor behaviours
• Provide a structured programme of care/health improvement for each client.
• work directly with these individuals or signpost them into community based or specialist support

In addition the team:

• Identifies health issues within communities throughout South Tyneside
• take responsibility for developing health action in defined geographic areas
• link the developing community health agenda into primary care through the development of local micro networks within communities

The team is managed by the primary prevention manager (employed by the Council) but the team work within the Public Health Development Department, under the line management of the Head of Health Inequalities, from the PCT headquarters. Their work is being evaluated by a PCT researcher whose work is intrinsic to the development of the initiative.

Action to address the needs of the Choosing Health team’s client group is not exclusively or even predominantly the domain of the NHS. It requires collaboration between sectors, communities and individual and there is weighty evidence to suggest not only clinical benefit but also cost-effectiveness in comparison to alternative interventions.

3. “One Team, Two Roles, One Outcome”

The Health and Lifestyle advisers:

• Identify goals, type of intervention that best suits the needs of the individual, careful monitoring of progress,
• Develop a programme of specific “bespoke” interventions (weight management groups, single gender groups, individual programmes etc.),
• In the event of a failure to continue within an initiative, identifying with the client why this was not suitable.

The Community Health Officers

• Signpost patients into community based schemes or specialist support ( e.g. Smoking Intermediate Advisors)
• Create programmes where gaps exist including links with the business and community sectors
• Work with a range of community based partners to increase community capacity to deliver interventions
• provide support to each client
• developing community health agenda through the development of local micro networks within communities

4. Links to other South Tyneside PCT initiatives

The Choosing Health Team is trained in giving brief advice on stopping smoking and makes referrals to the Stop Smoking Service. In addition there is close linkage with the long term conditions team and the exercise on referral scheme (which enables GPs to refer those with identified symptoms of CHD, Depression/Anxiety and diabetes to exercise at a range of facilities, including national centre of excellence in exercise referral, Temple Park Centre). Work is currently being developed to streamline this work into one simple primary prevention referral process for GPs.

South Tyneside PCT has been included as a pilot PCT in the Department of Health’s Working in Partnership Programme “Self care for people Project”. This project will link to the Choosing Health Team by utilising their community contacts to develop a detailed programme which aims to help local people/patients understand self care and make more informed decisions about their health and use of health related services through a lay volunteer scheme.

The recent inclusion of South Tyneside PCT in the Strategic Health Authority’s spearhead pilot for “Health Trainers” will assist in the development of community health action capacity. This initiative will work alongside the existing initiatives being developed by the PCT funded STRIDE Community Health and Fitness capacity building action to enable the Choosing Health Team to widen their opportunities to signpost local people into local sources of health intervention.

The Choosing Health Team is one of the PCT’s Health Development Health Improvement Group (HIG) key priorities. This PCT planning group for inequalities action has a 50/50 split between statutory sector and HealthNet (coordinating umbrella group for community/Voluntary sector self care groups)

representatives, and is chaired by a representative from the Third sector. This HIG has been involved in the planning and consultation in the development of the Choosing Health team initiative.

5. Outcome/ Delivery

The Choosing health team project is clear in setting out an evaluative framework to measure the success of the project.

This initially falls into six key goal areas:

• Goal 1: Promote healthy lifestyle choices for clients
• Goal 2: Improve clients’ dietary intake as recommended in the balance of healthy eating guidelines
• Goal 3: Promote daily physical activity to the minimum national recommendations for a healthy lifestyle
• Goal 4:Target hard-to-reach groups in South Tyneside
• Goal 5: Opportunistic brief intervention &/or referral of clients in response to questionnaire and health check information
• Goal 6:Promote the profile and success of the Choosing Health interventions within South Tyneside and the wider Health community

Within each goal area actions, rationale for that action, resources required, time-line for delivery and evaluation methodology have been defined. (Twenty four in all) see appendix 1

This would include examples such as “Provide education on healthy lifestyle choices; Devise with the client an individually-tailored plan; Work with clients to identify physical activities that can be incorporated into their daily routine; Ensure the programme meets community needs and expectations”

Example of the plan includes:

Action

Rationale

Resources

Time-line

Evaluation

٠ Provide education on healthy lifestyle choices

To raise awareness; to provide a range of choices; To promote change in behaviour.

Trained Advisers/Officers

12 weeks 1 year

Impact & Outcome.

Appendix 1

Addressing Health Inequalities

Choosing Health Team

Overweight and Obesity Interventions

Draft Action Plan

Issue: Overweight and Obesity

Contributing Factor: Unhealthy Lifestyle Choices

Goal 1: Promote healthy lifestyle choices for clients

Action	Rationale	Resources	Time-line	Evaluation
٠ Provide education on healthy lifestyle choices	To raise awareness; to provide a range of choices; to promote change in behaviour.	Trained Advisers/Officers	12 weeks 1 year	Impact & Outcome.
٠ Employ appropriate interventions to facilitate behaviour change.	To improve health outcomes for individuals. To ground interventions on acceptable information base.	Trained Advisers/Officers. Evidence based literature.	12 weeks initially	Against the current literature and practice.
٠ Devise with the client an individually-tailored 12-week plan.	To focus on individual’s needs, goals and circumstances; to provide motivation for change; to empower clients to take ownership of their programme.	Skilled team. Information from initial assessment. A quiet space.	12 weeks intensive program. Review in 6 weeks	Impact & Outcome.
٠ Provide positive support and encouragement:	To help people achieve their goals To improve motivation To promote retention and client satisfaction; To support client’s emotional wellbeing.	Teams spend time with clients, listening, reviewing progress, revising program as appropriate; acknowledging progress.	12 weeks intensive program.	Client satisfaction.

Issue: Overweight and Obesity

Contributing Factor: Poor diet

Goal 2: Improve clients’ dietary intake as recommended in the balance of healthy eating guidelines.

Action	Rationale	Resources	Time-line	Evaluation
٠Provide education on the balance of healthy eating.	To improve clients’ ability to identify and enjoy a balanced diet.	Questionnaire responses; Food diary, Balance of good health chart.	12 week programme, 1 year	Improved knowledge post intervention.
٠Develop clients’ skills and confidence in making healthy choices easy choices.	To broaden people’s options in accessing healthy foods. To help clients use nutritional information on food labels and contents lists.	Leaflets, visual aids, balance of good health chart. Individual questionnaire responses.	12 week programme 1 year	Self reported improvement. Increased knowledge.
٠Develop clients’ skills in assessing serve/portion sizes as well as nutritional balance.	To provide life-long skills that will help sustain change in eating habits.	Questionnaire responses; Group sessions and one-to-one work. Food diary.	12 weeks initially 1 year	Impact and outcome evaluation.
٠Provide support for small and gradual changes.	To promote more sustainable change. To avoid the “I’ve blown it for today/ this week” response to slips/lapses.	Questionnaire responses. Agreed strategies. Time with clients.	12 weeks 1 year	Impact and Outcome evaluation
٠Track interventions against achievements for individual clients.	To identify the interventions that resulted in the best outcomes.	Individual case study	12 weeks	Impact evaluation Case study.

Issue: Overweight/Obesity

Contributing Factor: Sedentary Lifestyle

Goal 3: Promote daily physical activity to the minimum national recommendations for a healthy lifestyle

Action	Rationale	Resources	Time-line	Evaluation
٠Educate clients on the contribution of physical activity to health.	To raise awareness of the benefits to health and wellbeing that can be enjoyed from engaging in moderate exercise.	Evidence based information, pamphlets, maps. Team trained in exercise management.	12 weeks; 1 year	Client’s awareness
٠Work with clients to identify physical activities that can be incorporated into their daily routine.	To provide a range of realistic exercise options according to the individual’s needs and capabilities. To support changes that are likely to be sustained by the client during and beyond the period of interventions	Questionnaire responses. Team members spend time discussing clients’ needs, goals and what is realistic for them.	Start of the program Throughout.	Client satisfaction; Behaviour change.
٠Refer clients to exercise groups/facilities already established in the area.	Effective use of existing community facilities and programs.	CAF area maps of facilities and programs. Networks and partnerships in the community.	12 weeks	Client participation. Impact & Outcome
٠Support small improvements made by the client and encourage increased activity when client is ready.	To achieve gains in physical activity likely to be sustained by the client beyond the12 week program.	Team members, family, other participants/group members. Pedometer diary/exercise diary.	12 weeks 1 year	Impact and outcome.
٠Self referred clients are signposted to GPs according to protocol.	Ensure that individuals at risk are safe to participate in an exercise program.	GP Practices.