First asign

Trevor Shaw Project proposal

Spend on health now to save on health costs
later. A project proposal by Trevor Shaw

K0953840
Date submitted: - 21st of November 2001

Word count: - 4298

K0953840 Page 1 Cohort 5


Spend on health now to save on health costs later by
Trevor Shaw K0953840

Aims and objectives

An ever increasing number of patients each year attend sleep apnoea clinics within this
Trust; sleep apnoea is defined as a temporary cessation of breathing during periods of
sleep, in obstructive sleep apnoea syndrome the frequent pauses in breathing sleep due to
the closure of the air passage in the pharynx.

The signs and symptoms of obstructive sleep apnoea are many and may include some of
the following at night; heavy snoring, apnoea, restless sleep, insomnia, nocturnal choking,
sweating and reduced libido.

This range of symptoms then leads on to the day time symptoms of excess sleepiness,
impaired performance, morning headaches, intellectual deterioration, impaired memory,
impaired concentration, depressive symptoms and even heart burn.

These symptoms can be distressing and debilitating to the patient having a direct impact on
both their social as well as their working lives, leading to a reduced quality of life and in
some cases depression.

Patients who are identified by their own general practitioner as having the condition and
associated symptoms, would at first be referred to an apnoea specialist for confirmation and
then be referred on from there to a CPAP clinic for treatment.

The purpose of the clinic is to assess the patient for this condition, and then to prescribe a
continuous positive air pressure (CPAP) device to be used by the patient at night, the CPAP
device supplies positive air pressure to the patient via a face mask to keep the airways open
and so help to aid restful sleep and elevate some if not most of the day and night
symptoms..

It is suggested by Apnex medical (2011) that worldwide 2% of women and 4% of men have
sleep apnoea that causes problems. Certain groups, however, have a much higher chance.
So if we surmise that just 6% of the population could be potentially suffering from this
debilitating condition that is 6% of the 62,435,709 population of the United Kingdom, giving a
total of 3,746,142 people each needing the resources of the NHS.



This staggering figure is only the tip of the ice berg it would be hard to assess the potential
cost implications this condition may be exerting on industry through lost production due to
sickness or to the economy as a whole, not to mention the impact on the sufferer of such a
debilitating condition.

The cause of sleep apnoea are many and may include such things as Obesity, the natural
shape and size of the pharynx, nasal obstruction, alcohol and hypnotic drugs, this list is not
exhaustive but it gives an indication of the probable causes of sleep apnoea.

As the main cause of obstructive sleep apnoea seems to be related to obesity, any
measures aimed at reducing excess weight and improving fitness may help to prevent it or
alleviate some of the symptoms.

In addition to sleep apnoea, it is suggested by the Endocrine society (2011) that obese
patients may also suffer from a whole host of other debilitating conditions associated with
obesity, this could potentially include:-

Type one or two diabetes.
High blood pressure.
Coronary heart conditions.
Poor blood circulation.
Increased risk of some cancers.
Bone joint damage.

So potentially an obese patient could represent a massive financial drain for the NHS over a
life span.

This project will become the basis of a community based partnership in which the patient will
be paid for losing weight over a specified period of time, this could be a nominal figure of
£100 per stone of weight loss, but the patient is also given a specific time frame which the
weight loss must occur, say for the figures, number of stones in weight loss in two year X
£100 would be the patients goal, the money would be paid to the patient on completion of
participation in the project for 2 full years.

To further help and encourage the patient on their road to recovery, the hospital Trust would
be required with the help of existing hospital staff, to provide specialist help and advice for
the patient on diet, nutrition and fitness and as part of the recovery plan the patient would
also be given some form of exercise plan tailored to their requirements.



If for the sake of figures each patient lost an average of approximately 10 stone this would
give the patient the sum of £1000, on these figures for the Trust’s initial outlay of £50,000 it
could make an immense difference to the lives of 50 people, over the 2 year that the project
would run. This would bring about immeasurable changes to the lives health and wellbeing
of the participants in this project.

The remaining £50,000 investment could then be used to set up the infrastructure needed to
run this project and provide any additional equipment and manpower needed for the project.

Aims

The aim of this project is to:-

Reduce the number of people requiring CPAP devices by 1% per year, by
introducing a program of monitory bonuses for weight loss and food awareness
classes.
Raise the Trust’s profile as progressive forward thinking Trust that treats not just the
patient’s symptoms but also the causes of the symptoms.
Reduce obesity in the target population.
Help 50 patients per year increase their quality of life and give them an improvement
in the quality of their health.

Objectives

The objective of this project would be to

Reduce the financial burden on the NHS, by reducing obesity in the target group.
Promote the fitness and wellbeing for the patients, to a level that will produce a
positive effect on their health.
Promote the general health for the participating patients and hope this has some
effect on their families and friends health.
Reduce the burden on the NHS and industry for the patients in the target group,
within 2 years.

Deliverables

A reduction in the amount of hospital support needed annually for each member of
the target group participating in this project.



Increases quality of life for each member of the target group.
Substantial weight loss for each member of the target group.
A reduction of burden on the NHS due to obesity in the target group.

Assumption

This plan assumes that the targeted patients have the will to lose weight and that the
monitory incentive will also help them in this quest. It is also assumed that the provision of
specialised help and advice on health and nutrition will spur the patients on to a healthier
fitter and brighter future, free form the majority of health problems that are associated with
obesity.

It is also assumed that this project would have the help and support of the dietetics
department, the physiotherapy department and the patient’s own doctor would also need to
assist in this project.

Measurement of success

The success of this project could be measured in a variety of different ways.

The patient’s own doctor could be asked to draft a report on the patient’s health
before and after their participation to assess any change in the health of the patient.
Annual review of the number patients attending the CPAP clinic could also be an
indicator of the success of the project.
A patient questionnaire could be generated to gauge what the patient thinks he has
gained for participation on the project.
A review Trust wide could be generated annually to gauge the project’s impact on
other obesity related illnesses such as dubieties and coronary heart complaints.

Requirements and project scope

This project is in essence a support and reward scheme aimed at the clinically obese; its aim
is to reduce the overall costs to the NHS imposed by an ever increasing obese population
and the medical and social problems that this condition is associated with, over time by
empowering the clinically obese patients to bring about changes in their own life style and
diet and reward them for taking part in this project.



This project will have to in the first instance identify 50 people from the target group that
have the will and the need to lose weight for medical, social or personal reasons and so
bring about a substantial change in their lives. Then put in place a system of support and
reward to help them achieve this goal, this will in turn enable them to live life free from the
symptoms of obesity, prolonging their life span, helping them become fit and healthy
productive members of society and in so doing reducing their impact on the NHS. This will
also have impact on their working lives cutting time off for sickness.

To enable this to happen this project has to give support and guidance to the patients on diet
to help educate them into a healthy eating life style.

The project must also support the patient by providing them with help and advice on the
suitable fitness regimes, available to them and also help them to map out a personal fitness
plan, this could be a simple thing like walk a half mile a day for the first week and then ramp
up the distance for subsequent weeks.

Provide monitory insensitive to the patient as a reward for taking part in the project.

In addition to this there will be the following requirements for this project to proceed:-

To enable this project to precede it is expected that the existing CPAP clinic staff
would weigh the patients in the first instance and then monitor the weight loss at
subsequent visits.
A new post for a member of staff would be created to co-ordinate resources and
assist CPAP staff.
A new hospital database would have to be set up to track patient’s progress.
New precise scales would be brought into service to measure the weight and body
mass index of the patients.
Existing staff from the physiotherapy and dietetics departments would have to be
available to provide advice on nutrition and fitness.
An infrastructure would have to be set up utilising existing NHS staff to verify weight
loss and pay the reward.
The patient’s own NHS doctor could be used to review patients past notes and give
feed back to the Trust on the health benefits the patient has experienced as a direct
result of the weight loss.



Key Stake holders

The key stake holders on this project would be as follows:-

The patient would be one of the major stake holders as with out there full commitment and
participation this project would certainly fail. The patient must at the beginning set
themselves goals and be focused on the task in hand, with help and support they will go on
to a longer, healthy, fitter life, free from many of the problems associated with obesity.

The NHS stands to gain the most from this project as it is suggested by our own prime
minister David Cameron, that obesity costs the NHS a staggering 4 billion pounds per year
and this figure is set to rise to over 6 billion, full fact.org (2011) if this project was a success it
could be seen as a future model that could be duplicated across the country. This
information is available at
http://fullfact.org/factchecks/NHS_reforms_David_Cameron_speech_obesity_costs_foresight
_Department_of_Health-2732 and the BBC News (2007) suggest that costs to the British
economy is set to rise to £22 billion http://news.bbc.co.uk/1/hi/health/7106219.stm.

The patient’s own family and friends could be considered as stake holders as the
success or failure could rest with them, for the patient to lose the substantial amount
of weight necessary, the friends and family would have to offer support and guidance
to the patient, after all they could give them the push to change their life style in
order to lead a longer healthy life.

Another group that stands to gain from the success of this project could be the government,
getting people fit and healthy and back into work could be seen as a way of reducing the
number of people dependant on the benefit system. Finally industry could be a potential
stake holder in this project getting people fit and healthy should have a ongoing effect on the
sickness figures.

Strategies and outcomes

The strategic analysis of this project can be Brocken down for this trust, to enable this to
take place the strengths weaknesses opportunities and threats must first be examined.

The main strengths of this project would be the fact that the hospital already has the
resources to make this project a reality, the highly trained specialist medical staff, the
premises’ to conduct the project and the most to gain from a healthier population. Add to this



the resources to employ an additional member of staff part time for the duration of the 2 year
project.

The main weaknesses’ with this project could be, the patients themselves, do the patients
have the resolve to lose weight? even with the right incentives and support, the patient still
may not have the will to stay on this project for 2 years and achieve the weight loss
expected, the need for a new hospital database is not a real weakness just a small part of
the puzzle to be completed in the project.

The opportunities this project present are potentially life changing and perhaps life saving for
the patients in the project, getting them fit and well would be the 2 year goal, and getting
them back into a healthy lifestyle, were they could go on to be less of a drain on the
resources of the NHS and also society, would then follow. This scheme could then go on to
bring good PR for the hospital, as a forward thinking Trust, treating the causes not just the
symptoms.

The main threats this project could potentially face, are many, funding may get cut due to
economic climate, as the NHS is coming under the spot light for cuts in government
spending, or the hospital management may change, forcing the premature closure of this
project but one of the main concerns could be public opinion, there could be public outrage
by some at the thought of giving away public money to the obese to lose weight causing
possible bad publicity for the Trust.

Strengths Weaknesses
1. Existing hospital staff and resources 1. The weight loss would solely be
could be utilised. controlled by the patient.
2. The clinics could be conducted in 2. Incentive may be too small to be
hospital provided venues. taken up
3. A temporary staff post would be 3. Staff may not want to take on extra
created. responsibilities.
4. Existing medical expertise could be 4. There would be a need for
utilised. investment in a new hospital data
5. Less expenditure on bariatric base.
equipment

Opportunities Threats



1. Get obese patients fit and well. 1. Funding may get cut due to economic
2. Get some obese patients back into climate.
work. 2. There may not be enough patients
3. Long term the patient would put less willing to change there lifestyle to
pressure on the NHS make this project work.
4. Good PR for the hospital. 3. Change of hospital management may
cut service.
4. Back lash from the general public.
5. Possible bad publicity.

Political Economic
1. The patient’s dependence on the 1. Present economic climate is driven
NHS funds would be lower. by cut backs and administration
2. Dependence on benefits would be changes
cut.
3. Hospital profile will rise.

Social Technological
1. It would give some patients back self 1. There are other faster ways to
esteem. achieve the same result such as
2. It would give some patients back slimming pills and gastric surgery.
mobility and a sense of self worth.
3. It would allow some patients to fend
for themselves again.

Legal Environmental
1. Would it be legal to give away money 1. This could become part of the NHS
to promote weight loss treat the symptom not the cause.
2. There could be legal challenges to
public money being used in this way.



Total budget request

The total budget requested for this project would be £100,000 this figure could be broken
down as follows:-

1. A new excel database needs to be set up and made available to all the departments
involved with this project, through the hospital intranet. It is envisaged that this task
will only take a few hours of in house development, by the Trusts information
technology department at a cost of £40 per hour, the total cost for this work to be
completed is expected to be no more than £100 to the project.
2. A temporary 2 year post will be created for a ward Clark’s position to assist, co-
ordinate and act as a liaison, between the patients and the various departments that
will form this project. This will cost the project approximately £15,000 per year and
will equate to £ 30,000 over the 2 years of the project.
3. It is hard to fully estimate the cost of the patient reward aspect of the project as it
contains many variables but as a general guideline it is expected that 50 patients will
be selected for this project and it is hoped they will lose around 10 stones per patient.
So at £100 per stone that would equate to £1000 per patient over the 2 years of the
project giving a total expenditure of £50,000.
4. There will be a requirement for new patient weighing scales to be procured it
expected that the total cost for the scales will not exceed £200
5. The project will require contact with the patients though the domestic mail system
and literature to be sent to the patients periodically it is expected that over the 2
years of the project this will not amount to more than £10,000

This brings the projected total cost for this project to the total of £90,300 of course there will
be sundry’s to pay out that is why the full £100,000 is to be requested.

How the results will be achieved

This project is in essence a support and reward scheme aimed at the clinically obese; its
aim is to reduce the overall costs to the NHS imposed by an ever increasing obese
population and the medical and social problems that this condition is associated with, over
time by empowering the clinically obese patients to bring about changes in their own life
style and diet and reward them for taking part in this project.



After identifying the patients they will be interviewed and assessed by their own GP, who will
look at their suitability for the project and assess the possible health benefits to be gained
from substantial weight loss for each individual.

The patient will then be invited to attend a series of clinics with the hospital dietetics and
physiotherapy departments to work out a personalised diet and fitness regime for each
individual.

The patient will at this time have their weight and body mass index taken to derive to starting
point for the weight loss.

The patient will then be invited back to the clinic periodically over the span of the 2 year
project to assess their progress.

At the end of the 2 year project the patient will be expected to revisit their own GP who will
assess the patient and give feedback on the possible health gains the patient may have
achieved.

The choice to run this project along the lines of a “diet club” instead of opting for the surgical
approach of gastric surgery are many, but the main benefits are as follows:-

1. The patient will have to change their diet and lifestyle instead of opting for the quick
fix that gastric surgery would produce; setting the patient up for a health fit life style.
2. It is hoped that the patient will be less likely to put the weight back on if it took a lot of
effort and time to lose the weight.
3. The patient will gain in self esteem knowing they have achieved goals.
4. “Gastric surgery also caries long term health risks for the patient” Smith-Squire
(2011).
5. The cost of gastric surgery is high in the rejoin of £7000 to £8000 clinic compair.com
(2009).

Work breakdown structure

The main deliverables for this project are:-

1. A reduction in the amount of hospital support needed annually for each member of
the target group participating in this project.
2. Increases quality of life for each member of the target group.
3. Substantial weight loss for each member of the target group.



4. A reduction of burden on the NHS due to obesity in the target group.

Bringing about each deliverable will be achieved as follows

A reduction in the amount of hospital support needed annually for each member of the target
group participating in this project, will be achieved by the target group simply by losing a
substantial amount of weight each, it is widely accepted by most clinical staff that obesity is
the trigger for a whole host of medical complaints and by reducing that element the patient
should go on to have less medical problems in the future and so reduce the burden on the
NHS.

Increases quality of life for each member of the target group, again by losing weight the
patient should gain mobility, health and self esteem leading to a better healthy active life.

Substantial weight loss for each member of the target group, each patient will be given all
the help and support needed to achieve this goal. They will be advised on diet health and
fitness by trained health professionals in a controlled monitored environment.

A reduction of burden on the NHS due to obesity in the target group, the NHS is stretched at
this time though cut backs and budgetary restraints, by reducing the number of obese
patients attending surgeries for routine as well as emergency care, the NHS would have
more money to spend on other projects, the burden of obesity on the NHS is set to rise to an
all time high of £6 billion in the near future. Act on obesity now to save in the future, each
patient attending hospital though obesity related illness adds to the NHS burden, table one
shows a sample of the costs compared with the costs of this project

Costs to the NHS and British economy from Costs to run weight loss program for 50
obesity people
Costs of equipment 50 people each loosing an £50,000
1. Cost of bariatric From £250 average of 10 stones @ £100 per
wheel chair stone
2. Cost of bariatric £4000 aprox Cost of 1 co-ordinator secretary for £30,000
hospital bed 2 years of the project.
3. Cost CPAP device £400 Cost of new hospital data base set £0.00
per patient. up in excel.
Hospital costs Cost of new weight scales £120
1. 1 I.T.U bed for 1 £1000 per set
day Existing staff to be used on this
2. Gastric surgery £7,500 project and so the new costs to the
3. Cost of heart £5,000 to hospital will be £0.00



arterial bypass £20,000
surgery dependant on
number of
bypasses
required
4. Cost to the NHS as £4 billion rising
a whole for obesity to £6 billion
related illness per
year.
5. Costs to the
economy from
obesity £22 billion
Table 1

Break down of tasks

The project manager will be in place for the full 2 years of the project, to oversee the
project and act as a buffer between Sponsor and the project workers. He will also direct staff
on the overall workings and budget requirements for the project. The project manager would
also act as a liaison for the interdepartmental management structure and also act as a point
of contact should problems arise.

The information technology’s department will have little input to the project apart from
setting up a database and making it available to all the departments involved, this database
is to track the patient’s progress, but they may need to be called upon to help with any
problems with the data base.

The Clark coordinators responsibilities would include booking patients appointments, with
the various departments, helping out in the CPAP clinic when necessary and keeping the
database up to date with accurate patient information.

The CPAP clinic staff will be tasked with firstly Identifying suitable patients for this project,
they will report to the Clark coordinator and they will also meet with the patients periodically
to take weight and take body mass index readings, to assess the patients progress and
identified any potential problems that may arrise.

The dietetics department will assess the patient at the start of the project and work out a
suitable diet to attain weight loss in a safe controlled manner and also to be available on
request to give further help and guidance to the patient, though out the 2 year period.

The physiotherapy department will assess the patient at the start of the project for fitness
and ability and from this work out a fitness plan for the patient that will help them consistently
lose weight over the 2 year project in a controlled safe manner.



Appendix

Apnex medical (2011) Obstructive Sleep Apnea FAQs [on line] Apnex medical available
from: http://www.apnexmedical.com/downloads/Apnex_Medical_OSA_FAQs.pdf (accessed
9th November 2011)

BBC News (2007) Cost of obesity 'over-estimated' [on line] BBC home available from
http://news.bbc.co.uk/1/hi/health/7106219.stm (accessed 3rd November 2011)

Clinic compair.com (2009). How Much does Gastric Band Surgery Cost? [ on line] Clinic
compair.com, available from http://weightloss.cliniccompare.co.uk/how-much-does-gastric-
band-surgery-cost (accessed 3rd November 2011)

Endocrine society (2011) Obesity-Related Diseases [on line] available from
http://www.obesityinamerica.org/understandingObesity/diseases.cfm (Accessed 1st
November 2011)

Full fact.org (2011) Promoting accuracy in public debate [on line] full fact available from:
http://fullfact.org/factchecks/NHS_reforms_David_Cameron_speech_obesity_costs_foresight
_Department_of_Health-2732 (Accessed 29th October 2011)

SMITH-SQUIRE (2011) The drastic weight-loss surgery that is quite literally wrecking
people's lives [on line] Mail online available from http://www.dailymail.co.uk/health/article-
487797/The-drastic-weight-loss-surgery-quite-literally-wrecking-peoples
lives.html#ixzz1daCRXxznhttp://www.dailymail.co.uk/health/article-487797/The-drastic-
weight-loss-surgery-quite-literally-wrecking-peoples-lives.html (accessed 1st November
2011)


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