You’ve probably heard the old saying ‘an apple a day keeps the doctor away’. Well, did you know that even a little light daily exercise actually keeps the doctor away? Not even our fickle weather or the midges can deter ill-health from visiting Scots earlier than in any other western European country. As a result we now must think and act differently, learning to create health alongside treating disease. This session offers clear solutions and an opportunity for all to get involved in the drive to achieve a more active and healthier Scotland. Delegates were invited to be the catalyst for change – by spreading the physical activity message throughout their work settings, by becoming more active themselves and by encouraging their families and friends to get active. See more on the 2013 NHSScotland Event website http://www.nhsscotlandevent.com/resources/resources2013/resources

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
• Parkinson’s disease
• Post-polio
• Cancer
• Gastrointestinal diseases
• Dementia
• Back problems (chronic)
• Osteoarthritis
• Parkinson’s 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

16. 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

17. 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

18. 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”

19. 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 influence…at work and at home
Get in touch: david.white@scotland.gsi.gov.uk

20. AHP Physical Activity Pledge
Lynne Douglas
AHP Director- AHP Directors
Scotland Group

21. Physical Activity Pledge
Scottish AHP Directors Pledge to increase
Physical Activity in Scotland – 2012/13

22. 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

23. Physical Inactivity
• Kills 9% of world’s population (The Lancet)
• Over 2500 deaths in Scotland annually
• Prevents and treats over 20 chronic
conditions by 20-45% (Home Nations CMO’s
report.)
• 26% fewer sick days

24. The Pledge

25. Allied Health Professionals
• Outstanding
example
• Pledge to make an
assessment PA part
of each
consultation
• NHS opportunities
to get active-
coming soon

26. 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

27. Education

28. 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.

29. “Man does not cease to play
because he has grown old; he grows
old because he ceases to play.”
George Bernard Shaw

32. • 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

33. AHPDs walking, swimming & running the talk!

34. 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

35. 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

36. Getting NHS staff on the move
Chartered Society of
Physiotherapists

37. 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

38. Workout at Work Day 12 June 2013
Website: www.csp.org.uk/w@wd
Twitter: #WorkoutAtWork
Chartered Physiotherapists
Amanda Jones
Caroline Bennett

39. Promoting Physical Activity in
Primary Care
Dr Kirsten Ness

40. 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

41. 97% of population are registered with a GP
and 88% will visit primary care team at
least once per year

42. National Guidelines for Physical Activity
• Poor public knowledge
• Health care professionals
–13% GPs aware of guidelines
–9% practice nurses
–7% health visitors

44. 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

45. 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

46. 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)

47. Future
• Roll out pathway across primary care in
Scotland
• Enhanced services
• QOF indicator in its own right

48. Winning With Weight In
Pregnancy
Ante Natal – Victoria Hospital
Gwen Smith
Midwife

50. 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

51. 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

52. 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 wasn’t working only two attended
for the first two weeks
• Decided to use social media facebook, twitter and
texting

53. 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

54. 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

56. 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

57. 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.

59. Testimonials
“great support not just for weight management but for
pregnancy advice and reassurance and I made good
friendships at the group and I’m 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 pregnancy’s 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

60. 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

61. Physical Activity Champions in the NHS
Dr Andrew Murray

62. Champions?

63. Large Ambitious Goals require
• A clear focus
• Teams to work together
• Innovation and Effort
• Champions to get things
moving
• The rewards are great

64. Champions- Let’s get active ourselves
• The commute
• When at work
• Leisure time
• Influence others

65. Primary care
• Spread knowledge to
colleagues
• Spread knowledge to
patients
• Ask the question, BA/BI
• Examples

66. Secondary Care
• Get colleagues active
• Clinics
• Inpatients
• Make it normal

67. Education

68. Why Champion

69. Resources
• DVD
• Physical Activity Pathway
• 23 ½ hrs
• Active Scotland/ take30
• Be creative!!!