Manchester's Healthy Weight Resource Pack 2011:

IntroductionWelcome to Manchester’s Healthy Weight Resource Pack:A directory of services to help support overweight and obese patientsThis resource aims to outline to front line workers the different services that are currently available in Manchester to supportpeople to maintain a healthy weight, including all healthy eating, physical activity and weight management services. Thisresource pack contains information about services for all age groups and abilities. In addition the resource also containsinformation about services and interventions that contribute to a healthy weight, such as the stop smoking service andalcohol identification and brief advice. As well as outlining the services available the resource also aims to clarify how to referto the services included.This document supports Manchester’s Healthy Weight Strategy: Tackling Overweight and Obesity (2010-2013) and thisresource pack is focused on services that help people to maintain a healthy lifestyle. It does not include services formalnutrition or eating disorders.To enable you to quickly find the services available the resource has been split into several categories - please see contentspage. Where possible, referral forms have been included in the appendix to enable you to refer to the service without delay.Also included in this resource are useful guidelines, information and websites for further information. Access to websites isavailable at every public library.Additional downloadable copies of this resource pack are available from the following websites:www.manchesterpublichealthdevelopment.orgwww.manchester.nhs.ukThe resource pack will be updated regularly on these websites.If you want more information about this resource pack please contactAmy Ashton, Public Health Manager - Healthy Weight (NHS Manchester)Tel: 0161 765 4468Email: amy.ashton@manchester.nhs.uk1

Community Food Co-ordinatorsIntroduction to this serviceThere are 3 Community Food Co-ordinators based across Manchester, one in each district (South, North, Central). TheCommunity Food Co-ordinators provide a variety of courses and support around healthy eating and weight management.What to expect from this serviceThe Community Food Co-ordinators provide 8 week weight management courses including weekly taster exercise sessionsand healthy eating topics and 6 week cooking courses for adults. All of the courses are free and are run in local schools,community centres and children’s centres across Manchester.Referral criteriaThis service accepts self-referral to all of its courses. There isn’t a referral form for this service so please contact the relevantco-ordinator directly.Contact detailsFor more information or to obtain details of the courses please contactEleanor MurphyCommunity Food Co-ordinator (South)Healthy Living NetworkWithington Community HospitalNell LaneM20 2LRTel: 0161 217 3951 or 07971331540Bernie MurphyCommunity Food Co-ordinator (Central)Manchester Public Health Development ServiceFallowfield Library - 1st FloorPlatt LaneFallowfieldM14 7FBTel: 0161 48 1767 or 07971331537Rose BoydCommunity Food Co-ordinator (North)Zest ProjectNorth Manchester Regeneration4th Floor, Hexagon TowerDelaunays RoadBlackley VillageM9 8GQTel: 0161 655 7887 or 079713315392

Community Food WorkersIntroduction to this serviceCommunity Food Workers aim to raise awareness of food and health within the community. They encourage people toexperience new ways of cooking, shopping, budgeting and eating healthily and help people to apply their new skills andhealthy eating behaviour to their everyday life.What to expect from this serviceCommunity Food Workers support groups by giving nutritional information and advice, facilitating cook and taste sessionsand developing recipes and skills.This service is citywide. It does not provide sessions on a 1:1 basisReferral CriteriaThis service does not have a referral system. However the service targets people who• Lack skills and confidence• Struggle on a budget• Are unable to make healthy food choices• Lack understanding of food portion sizes, food labels. etc• People who find it difficult to eat welland groups of• Young people• Young parents• The elderly• People in supported housing• Refugees and asylum seekers etcContact detailsFor further information about this service please contactNandy CousinsCommunity Food WorkerLevenshulme Health CentreDunstable stManchesterM19 3BXTel: 0161 861 2333/6Email: nandy.cousins@cmft.nhs.uk3

Food FuturesIntroduction to this serviceFood Futures is a partnership that embraces a wide range of individuals and organisations with an interest in improving foodin the city.Its ambitious goal is to create a culture of good food in the city, based on the belief that good food is enjoyable, safe,nutritious, environmentally sustainable, and produced ethically and fairly; and that everyone in Manchester has a right togood food – no-one should have this right denied because of where they live, their income or their background.What to expect from this serviceThe Food Futures strategy embraces the whole food agenda for the city – from improving health, tackling health inequalitiesand reducing the environmental impact of food, to building sustainable communities and strengthening the local economy.Food Futures can provide policy advice and support to services, organisations and groups who want to do food related work.Food Futures also produces an e-bulletin - a monthly update featuring brief articles on local and national news, events anddevelopments that relate to food.Contact details:If you would like to receive any of the resources or would like more information about Food Futures pleasecontact the teamFood FuturesPublic Health ManchesterRoom 4042Town Hall ExtensionManchester M60 2LATel: 0161 234 4268Email: foodfutures@manchester.gov.uk.Website: www.foodfutures.info4

City in the CommunityIntroduction to this serviceManchester City Football Club’s community scheme, City in the Community (CITC) has been working with the people ofManchester since 1986.CITC, which is made up of 25 full time members of staff and 20 part time members of staff, works with over 200,000 peoplea year across four main programme areas: Football and Multi-Sport; Skills and Enterprise, Community Cohesion, and Healthand Activity.What to expect from this serviceCITC organises free football and sport activities for the community throughout the year.These include; healthy school programmes for primary schools, free after school and half term football courses for youngpeople, weekly disability sports clubs across the city and football activities for unemployed men in East Manchester.Through its Community Cohesion Project, Kickz, CITC provides constructive and positive activities for young people between12 and 19 years on Thursday, Friday and Saturday nights in the Fallowfield and East Manchester areas of Manchester.The community programme also runs a range of Enterprise programmes in schools designed to give young people theopportunity to gain nationally recognised qualifications in Business and Enterprise whilst learning about the variousdepartments within the Football club.Referral criteriaTo refer to this service please contact the team directly.Contact DetailsFor more information about the programme or to find out what activities are offer, when and where pleasecontact the teamCity in The Community,City Of Manchester Stadium,Sportcity,Manchester,M11 3FF.Tel: 0161 438 7711E-mail: citc@mcfc.co.uk5

Strike a Balance: MCFC Healthy Schools ProjectIntroduction to this serviceCity in the Community (CITC) launched its new Healthy Schools Programme Strike a Balance in September 2010.The five week programme is aimed at young people in year 5 in Manchester primary schools and is a partnership betweenCITC and Manchester Healthy Schools.It aims to raise awareness of the importance of eating healthier food amongst young people by using the diet of footballersto teach young people that healthy food does not have to be boring food.Since it was launched, over 80 primary schools have taken part in the project and CITC is now working with ManchesterHealthy Schools to develop new initiatives for secondary schools in Manchester.What to expect from this serviceUsing examples of Premier League footballers such as Joe Hart and Gareth Barry, each session covers a different area ofhealthy eating and is followed by a football session. Topics covered include:• The balance of good health• Why we eat what we eat• The importance of physical activity• Cooking healthy, balanced mealsParticipants take part in a fun cookery session which reinforces these lessons and they are encouraged to take homeaffordable healthy recipes for all the family.They are also taught the importance of making physical activity part of their everyday life, whether simply walking to schoolor taking part in organised sport.Every young person receives their own educational folder and MCFC apron, and schools who take part are invited to entera football competition against other schools.Referral criteriaThe Strike a Balance project is free for all primary schools within Manchester.Contact DetailsFor more information about the programme or to find out what activities are offer, when and where pleasecontact the teamLisa KimptonHealthy Schools Project ManagerCity in the CommunityCity of Manchester StadiumSportCityManchesterM11 3FFTel: 0161 438 7711E-mail: lisa.kimpton@mcfc.co.uk6

Disability Sports in ManchesterIntroduction to this serviceManchester Sports Development deliver sporting opportunities for disabled children that are adapted to meet individualsneeds These range form recreation ‘Come & Play’ activities to competitive sports clubs.Sports on offer are: swimming, athletics, cycling, football, multi sports clubs.What to expect from this serviceSports Development offer an inclusive school holiday programme that delivers activities to ALL children regardless of ability,our ethos is ‘Sport can be played by all’Referral criteriaFor information on the referral process contact 0161 220 3856 or email: disabilitysport@manchester.gov.ukContact detailsTo find out more information about the clubs which are on offer as well as venues etc please contactNicky Boothroyd,Disability Sport Manager,Regional Athletics Arena,Gate 13 Sportcity,Rowsley Street,Manchester,M11 3FF.Tel: 0161 220 3856Fax: 0161 274 7372Email: n.boothroyd@manchester.gov.ukWebsite: www.manchester.gov.uk7

Fighting FitManchester Learning Disability Partnership (MLDP)Introduction to this serviceFighting Fit (FF) is MLDP’s initiative to encourage and support adults who are learning disabled to lead more physically activelifestyles and to achieve or maintain a healthy weight. The aim is for people to experience the significant health benefits andsense of well-being that stem from this.What to expect from this serviceThe FF project has been co-ordinated by the physiotherapy team. This team raises awareness of health issues and providestraining for staff and carers. It endeavours to provide initial opportunities for sport and exercise to encourage people to eitherindependently or in groups access public facilities.Referral processReferrals can be accepted:• Externally via contact centre (this would be G.P.s, people themselves or carers)• Internally via other health or social care staff• Directly from G.P.Step 1Step 2Step 3Step 4Referral is receivedLetter is sent to the person with a request fro further informationHome visit is arrangedPlan is drawn up with the person with clear goals and expected outcomesPeople and their carers will be asked to consent for information to be shared with their G.P. and others as necessary.Contact detailsFor more information please contactEmma CleggCommunity Learning Disability TeamMoss Side District OfficeBold StreetManchesterM16 7ADTel: 0161 226 8131Fax: 0161 274 7373Email: emma.clegg@manchester.gov.uk8

Getting Active Through Exercise (GATE)Introduction to this serviceThe Getting Active Through Exercise (GATE) team promote the benefits of exercise in the over-65’s to improve health andprevent falls.The GATE team work closely with other health professionals, statutory agencies and the voluntary sector. This partnershipapproach has brought together a wide range of expertise to ensure that the older population benefit from an integratedrange of services and resources.What to expect from this serviceExercise classes have been established across Manchester and to assist those who cannot get to a class, home basedprogrammes are available, free of charge. The project offers exercise opportunities to all Manchester residents over the ageof 65 from the most frail to the more active. Physiotherapists, occupational therapist, other health professionals and nonclinicalstaff can refer people to classes.Contact detailsFor more information or to obtain details of the exercise classes please contactManchester Public Health Development Service,Victoria Mill,10 Lower Vicker’s St,Miles Platting,Manchester,M40 7LJTel: 0161 861 2585Fax: 0161 203 5817Email: Maureen.brimley@mhsc.nhs.uk9

Get Walking Keep Walking ManchesterIntroduction to this serviceGet Walking Keep Walking is a FREE urban walking project developed by The Ramblers to increase regular independentwalking among previously inactive or insufficiently active people in Manchester. It is especially targeted at people from lowincomegroups and black and minority ethnic backgrounds, and people with physical and mental health issues.The aim of the project is to change peoples’ behaviour, to get them walking more as part of their everyday lives, therebymaking a big contribution to physical & mental well-being.What to expect from this serviceFront line workers can contact Get Walking Keep Walking to set up Get Walking programmes for their clients. There arethree easy, cost-free options for getting involved.OPTION 1: Get Walking Keep Walking one-off walkIncludes: Short, fun workshop with a quiz or competition, free motivational materials (including a step counter), local circularled walk (approx one hour) and refreshments – all tailored to your requirements.OPTION 2: Get Walking Keep Walking four week programmeIncludes: Short, fun workshop and refreshments, free motivational materials including step counters, four local circular 30-60 minute led walks which are different each week. Each participant will receive the routes to walk again in their own timeand will receive encouragement in the weeks after the walks. There is also a celebration two months later to encouragepeople to keep walking. All tailored to your requirements.Ideal Group size for options 1 & 2: 10 – 30 peopleOPTION 3: DIY packsFor those who are unable to get to an organised one-off walk or programme, or who prefer walking in their own time,we offer a DIY walking pack which includes: Get Walking Keep Walking booklet with hints & tips to increase independentwalking, log book to keep track of walking progress, step counter and local walking information.Get Walking Keep Walking also offers volunteering opportunities with their walking programmes or to design walkingroutes. For more information please contact Annette Crane.Referral CriteriaGet Walking Keep Walking programmes are open to any Manchester resident. Led walks range from 30 minutes to 11/2hours so participants need to be able to walk the minimum of 30 minutes at a comfortable pace for them.Contact detailsFor more information about this service please contactJen Green, Project Co-ordinator.Tel: 0161 232 3106Email: jen.green@ramblers.org.ukAnnette Bell, Outreach OfficerTel: 0161 232 3101Email: annette.bell@ramblers.org.ukWebsite: www.getwalking.org.ukCurrently funded until 31st December 201110

Manchester City Council – Active LifestylesIntroduction to this serviceActive Lifestyles is a city wide Physical Activity and Wellness Programme. Active Lifestyles is part of Manchester City Council’sCommunity and Cultural Services and sits within the Neighbourhood Services Directorate. We want all Manchester residentsto have the opportunity to lead an active, healthy and happier life. Active Lifestyles is committed to the people we serve,we deliver at the place you choose, and we take pride in all that we do.Our Commitment• Innovative…we will create new and inspiring ways to help you get active• Reliable… we will deliver the highest standard of service provision• Trustworthy… we will give you accurate information and deliver on our promises• Cost efficient… we will show that resources have been used wisely• Professional… we are serious in all that we do and strive for excellenceOur commitment to excellenceWe pride ourselves on service delivery and ensure that you, the customer comes first. All Active Lifestyles instructors havenationally recognised qualifications and meet all of our minimum standards for service delivery. Our instructors are highlyexperienced and knowledgeable in their field of expertise. They are there for you, and will provide support and guidancealong your journey.Innovation and MotivationWe will help you track your progress; using the latest technology you will be able to see how much activity you are doing, andwhat that actually means for your health. We will help to keep you motivated ensuring you reach your goals, and keep active.What to expect from this service:Active Lifestyles provides a huge variety of physical activity programmes for all ages from baby and toddler funquatics to60+ back to bikes, aiming to appeal to all within Manchester’s communities. We want to provide you with as much choiceas possible to ensure that we can help you get active and stay active.Our sessions are located in facilities that are best suited to you – we deliver in primary schools, church halls, dance studios,community centres, resource centres, leisure centres, youth centres, local parks and outdoor places – ensuring convenienceand easy access.The ProgrammesActive Lifestyles has over 250 physical activity sessions a week to choose from.Tots on the Move - 6 weeks – 5 yrsGet active with your little one with our range of indoor, outdoor and aqua programmes specially designed for babies,toddlers and children aged 6 weeks to 5 years. This is coupled with a pre and post natal programme of activity.Kidzone – Guideline Age 5 to 8 years.A fun-packed range of activities and adventure just for children.Club Active – Guideline Age 5 - 10 years / 11 – 16 yearsNew and exciting activity clubs in Dance, Gamezone (non traditional sports such as Ultimate Frisbee, Tri-Golf andHandball), Active Fit and Dodgeball – no experience necessary.Urban Mania – Guideline Age 11 – 16 yearsAn exciting range of fitness based activities for thrill-seeking young people.Active Choices – Guideline Age 16+Tone, tighten, burn, build, relax and refresh with this range of activities just for adults.11

Easy RhythmsA range of gentle physical activity programmes designed for adults and older people.Commit 2 It! - Guideline Age 16+Achieve your goals and ambitions through this programme of structured and supported physical activityprogrammes that can lead you into one of Manchester’s great running, aqua or cycling events. Commit 2 it! helpsyou to achieve your goals in small, achievable steps, keeping you focused, encouraged and motivated.Weight No More! – Children, Family and AdultsStructured and supported weight loss programmes for children, families and adults.Aquativity – Open to AllA fun packed range of aquatic activities for all the family.Family FunA range of activities for all the family to participate in.Active Lifestyles Community SupportActive Lifestyles can also help local community groups that are new and/or existing. We can assist with set up, constitution,which includes support with completing appropriate documentation, applying and writing bids for external funding, sourcinglocal venues and instructors, providing the opportunity for greater independence. For those groups that do not have thecapacity to be independent, that is they do not want to undertake any financial workings, or bid writing, Active Lifestylescan try to identify funding and apply directly on the groups behalf or work with partners to support in funding.We also have a vast amount of experience in working with groups and communities who may need additional requirementsin order to be able to access our programmes – we work hard to ensure that all within our communities can participate,providing female only sessions, which guarantee privacy and female instructors, specialist support for vulnerable participants,and we do whatever else we can to remove any barriers people may face, ensuring that we provide the opportunity for allto lead an active lifestyle.Specialist ProvisionActive Lifestyles also provides specialist physical activity provision, supporting people who have or are experiencing ill health.We work directly with NHS Manchester’s Physical Activity Referral Service (PARS) which provides a specialist service for peoplewho have serious clinical conditions, and delivers programmes such as cardiac and pulmonary rehabilitation. Active Lifestylesprovides the after service for PARS ensuring that we support the long term recovery into an independent active lifestyle.Active Lifestyles provides weight management programmes, for adults, children and the family. Working closely with GPs,NHS Manchester, School Nurses, District Nurses and other health professionals, our bespoke programmes help those mostin need of losing weight. If you are worried about your weight or your child’s weight, please contact us and we can helpyou with the right programme.We work closely with other services across Manchester such as Manchester’s Public Health Development Service, The Christie,and Mental Health Services to provide specialist care and support for those who may not yet be able or ready to attend ourgeneral activity programme.We provide dedicated support for young people, and deliver bespoke programmes catering for the various issues that youngpeople face when trying to access mainstream services and programmes.Our aim is to provide the right support and care to ensure that everyone can eventually lead an active lifestyle.Referral CriteriaActive Lifestyles is open to all.Contact DetailsThe Active Lifestyles CentreTel: 0161 232 3100Email: activelifestyles@manchester.gov.ukWebsite: www.manchester.gov.uk/activelifestyles12

Manchester Amputee Fitness Initiative (MANFIT)Introduction to this serviceManchester Amputee Fitness Initiative (MANFIT) is funded by the Joint Health Unit and Manchester Leisure. The project isevolving as we discover people’s wants and needs. The aim of the project is to give the participants confidence to get/keepfit and ultimately to integrate into “normal” sports centres. This follows on from the strength, stamina and flexibility thatlead to better operation of the prosthesis. The social interaction during exercise and after during a free lunch, together withexercise induced endorphin release gives people the confidence to move on to integrated gym sessions or another place oftheir choice.What to expect from this serviceThis service offers:• gym sessions which take place at The Manchester College (Openshaw Campus) fitness suite in the daytime and atNicholls Campus in the evening for people who are not available during the day.• A weekly exclusive swimming group also takes place at Manchester Aquatics Centre. A personal plan is given to eachparticipant by pool staff.All sessions are FREE.• Weekly, non-contact boxers sessions at Moss Side Fire Station (small participant fee).Referral criteriaThe inclusion criterion is people have to have been discharged from the DSC physiotherapists unless permission is gainedfrom the DSC. The age limit is over 18 years of age unless accompanied by an adult. Referral to this service can includeself-referral or referral from a health care professional. There is not a referral form for this service so please contact MANFITdirectly on the details below.Questionnaires are distributed to all new members and feedback questionnaires are used to assess satisfaction. Both includepersonal and health/fitness related data. Fitness is also assessed periodically by gym trainers (BP, weight, BMI, aerobic capacity etc).Contact detailsTo find out more information, to refer to the service or to enquire about the timetable of the sessions pleasecontactEmail: info@manfit.orgWebsite: www.manfit.org13

MENCAPIntroduction to this serviceManchester Mencap offers an Advocacy and Sport and Physical Activity service for adults with learning disabilities inManchester. Manchester Mencap is an organisation, affiliated to Royal Mencap.What to expect from this serviceMencap offers many sport and physical activities opportunities including Boccia, Football, Yoga, Dancing and Walking.These activities are offered throughout Manchester and are either free or of minimal cost.MENCAP offers free training for the Physical Activity and Citizen Advocacy volunteers.Referral criteriaThis service is available for adults with learning disabilities over the age of 17. To refer to the sport and physical activitygroups, the person or professional should email the service.Contact detailsFor further information please contactEmail: mencapmanchester@btconnect.comWebsite: www.manchestermencap.cswebsites.org14

Physical Activity Referral Scheme (PARS)Introduction to this servicePhysical Activity Referral Service (incorporating the old PACE- North, ALFA - Central, SMILE - South) work across Manchester,helping members of the community to increase their levels of physical activity.The aim of the Team is to:Improve the health and wellbeing of the people of Manchester through increased physical activity (i.e. getting more peoplemore active more often) - specifically targeting those with existing, or at high risk of developing, long term health problemslike COPD, Heart Disease, Diabetes etc. This is done in two ways through one-to-one referrals and community activities,which include the following:• Cardiac rehabilitation, pulmonary rehabilitation.• Weight management classes (with a dietitian).• Health Walking groups (indoor and Outdoor)These activities may vary across the city. Health Walks are free and exercise classes cost £1.What to expect from this servicePatients referred to PARS are seen by a fully qualified Physical Activity Referral Officer. A full assessment of the patient’s pastmedical history and current lifestyle will be completed. The assessment will include:• A discussion about past/current activity levels• A discussion about past and present medical history.• Physiological and psychological measurements• A discussion about what the individual wants to achieve from attending PARS activities both in the short and longerterm and goal setting.• Advice on what types of activities are available and those that are most suitable and safe for the individual.• Specialist advice relating to specific conditions for example heart disease, angina, diabetes, asthma and many morespecific conditionsEveryone referred to PARS will be asked to come back for follow up at:• 12 weeks in clinic• 6 months in clinic• 12 months in clinicFeedback will be sent to G.P.s and referrer (if different) after the patient’s initial appointment and after three and twelve months.Referral criteriaThe project is for anyone over 18 years old with long term health conditions or with risk factors for developing heart diseaseor diabetes in the future especially where increased activity will improve the condition or is a treatment option. For conditioninclusion and exclusion criteria please see referral form.Referrals can come from the following people; General Practitioners/Practice Nurses, Physiotherapists, Health visitors/ Cardiacnurses/ Practice nurses AND Other health professionals.To refer to this service please complete a referral form and return to the relevant team. Please see appendix 1.Contact detailsPlease contact the team atClayton Health Centre, 89 North Road, Clayton, Manchester, M11 4EJTel: 0161 230 1857Fax: 0161 230 1820• Swimming lessons.• Cycling.• Low cost gym sessions15

Family Club (Family Weight Management), Active LifestylesIntroduction to this programmeThis new programme developed and run by Active Lifestyles is a family based healthy lifestyle programme targetingoverweight and obese families.The programme aims to increase physical activity levels whilst educating families on how to achieve a healthy balanced dietand maintain their weight through behaviour modification.What to expect from this programme• Sessions run twice per week; one early evening session and one weekend session.• Participants can attend the programme for 12 months.• The first 12-weeks provide personal development sessions and physical activity. The second 12-weeks provide healthyeating sessions and physical activity followed by a maintenance programme of physical activity sessions for 6 months.• Sessions are split into ages 5 – 10 years and 11 – 16 years and parents/ guardian.• Fun physical activity sessions• The whole family can attendReferral criteriaInclusion criteria• Children must be accompanied by at least one parent/ carer at each session, other family members can attend also.• Children aged 5 – 16 years• Children must be over the 91st centile on the UK 1990 BMI centile charts (Child Growth Foundation) or above theInternational Obesity Task Force overweight cut-off point.Exclusion criteria• Children with Diabetes• Children with any other medical diagnosis will be reviewed on a case by case basis.• Children with moderate/ severe behavioural and/ or educational problems.The physical activity sessions have been designed for children with no physical disabilities. The exercise sessions rely on groupparticipation and assume all children are fully mobile.Families can self refer to the programme or be referred by any health professional. To refer either;• Complete the referral form – see appendix 2• Self register by contacting the team below.Contact DetailsFor more information or to refer a patient to this programme please contactAngela Matthews or Ross McGuiganActive Lifestyles Centre,Denmark RoadHulmeManchesterM15 6FGTel: 0161 232 3114/ 3117 or 07852 569 181/ 07760 328 273Email: a.matthews@manchester.gov.uk OR r.mcguigan@manchester.gov.ukWebsite: www.manchester.gov.uk/activelifestyles16

Weight Management Service - Child and FamilyIntroduction to this serviceThe Child and Family Weight Management Service aims to help overweight children and their families to achieve and maintain a healthyweight. Aimed primarily at children, the service offers a programme of advice and support to families who are committed to makinghealthy lifestyle changes. Adult family members who seek personal weight management support may be signposted to appropriate localservices.What to expect from this service• Informal telephone assessment• Tailored resources• Healthy lifestyle days• Face to face contacts• Ongoing support and advice• Signposting to local servicesThe first stage of the programme consists of an informal telephone assessment whereby the child’s named carer has the opportunityto discuss any concerns with a member of the team. Initial personalised goals will be agreed and resources provided to support theproposed lifestyle changes. The carer shall be invited to contact the service after an agreed timescale to discuss the level of progress andto engage with the service further if necessary.Referral criteriaAny overweight or obese child aged between 2 and 16 can be referred into the service for initial assessment and advice using the servicereferral form Please see appendix 3Contact detailsFor more information please contactSarah Vince-Cain, Community Paediatric DietitianLorraine Leonard, Public Health NutritionistDina Pieri, Public Health NutritionistLevenshulme Health Centre,Dunstable Street,Levenshulme,Manchester,M19 3BX.Tel: 0161 861 2329Fax: 0161 248 038917

Weight Management in Primary Care – CounterweightIntroduction to this programmeThe Counterweight Programme is an evidence based weight management programme for adults. It is the only fully evaluated,cost-effective, evidence based primary care weight management programme being used in the UK, showing sustainedweight loss at 2 years.The aim of the counterweight programme is:• To achieve and maintain medically valuable weight loss of 5-10% or 5-10kgs• To make sustainable changes to eating and physical activity behaviours• Maintenance of weight loss long term• To improve health statusWhat to expect from this programmeThe Counterweight model is based on Counterweight Specialists (registered dietitian and nutritionists specialising inobesity management), working with Primary Care Trusts and Health Boards to train and support healthcare staff to put theCounterweight Programme into practice.It is anticipated that each trained practitioner can enrol at least 25 patients in one year. (Counterweight aims to train 2practitioners per practice and each practice therefore should enrol 50 patients in one year).Counterweight promotes behavioural strategies which seek to change eating habits, activity levels, sedentary behavioursand thinking processes that contribute to a person being overweight or obese. The programme provides a range of optionswhich promote active weight loss for 3 to 6 months followed by long term weight loss maintenance.Referral criteriaCounterweight is recommended for an adult population:• 18 to 75 years old• BMI≥ 30 kg/m2 or BMI ≥28 kg/m2 with co-morbidities• Assessed as at the right stage of behaviour change to be receptive to the programmeA number of Manchester General Practices are participating in the Counterweight Programme - further details from FrancesWilkinson (contact details below)Contact detailsIf your practice is interested in delivering Counterweight or for further information please contactFrances WilkinsonCounterweight Dietician,Levenshulme Health Centre,Dunstable Street,Levenshulme,Manchester,M19 3BXTel: 0161 861 2348Email: frances.wilkinson@cmft.nhs.ukWebsite: www.counterweight.orgOrAmy AshtonPublic Health Manager – Healthy WeightNHS Manchester, Public Health,2nd Floor, Parkway 3,Parkway Business Centre,Princess Rd, Manchester, M14 7LU.Tel: 0161 765 4468Email: amy.ashton@manchester.nhs.uk18

Weight Management Program - ‘Your Choice’Introduction to this programmeOrganised and run by the Community Nutrition Service in order to offer overweight patients more support to lose weight.Your Choice provides practical support, dietary advice, activities and health checks. Self motivation is also a key factor andthe regular health checks encourage this as well as the opportunity for more help with other professionals in this area.What to expect from this programmeThere are 3 key areas;1. Nutrition - Delivered by Dietitians and Nutrition Assistants. Practical help. Group sessions. Further 1-1 help to makechanges to diet that will reduce calorie intake. As well as providing a regular 3 monthly health check for patients toreview their progress.2. Activity - Delivered by P.A.R.S. (Physical Activity Referral Scheme for those with co-morbidities) and the Active lifestyleservice (for those without co-morbidities). Patients can be referred to either of these services as part of their weightloss programme.3. Motivation - Patients are involved in breaking down barriers and developing their own goals to achieve weight loss.Sometimes there are behavioural or psychological issues which prevent people from achieving their aims. We workclosely with the Mental Health Team to help patients that need this extra support.‘Your Choice’ was started in South Manchester where it is currently provided by experienced dietitians and nutrition assistants.Changes to NHS Manchester mean that a citywide weight management programme will be developed to provide a servicefor all Manchester residents. The program will include elements of the following;• Education Morning – A group session to discuss food, eating and energy intake we also look at activity and motivationto make these lifestyle changes to lose weight.• Activity - with help from P.A.R.S. (Physical Activity Referral Scheme) and the Active lifestyles service qualified instructorscan work on helping the patient increase their activity. Activities to suit all levels of ability are available.• Health checks - The patient will be offered health checks to monitor their weight, BMI, body fat, blood pressure andwaist circumference.• Drop-in – The patient can come along anytime during the half hour to have a chat and get weighed if they wish.Mondays – 12:00 to 12:30 upstairs at the Forum Health Centre• 1 to 1 – An appointment with a Registered DietitianReferral criteriaThe service accepts self referrals from people aged 16+ with a BMI of 30+. Please see appendix 4. The service will contactthe patient directly following referral and provide them with an appointment that is closest to their home address.Contact detailsFor more information about the programme or to send referrals please contact:Ray Green (Community Dietitian)Wythenshawe OfficesStancliffe RoadSharstonM22 4PJTel: 0161 946 8210Fax: 0161 946 8209Email: ray.green@uhsm.nhs.uk19

Weight management service - Community nutrition assistants(South Manchester)Introduction to this serviceThe role of the Community Nutrition Assistant (CNA) is to support the dietetic service delivery to clients. CommunityNutrition Service CNAs have recognised nutrition qualifications and specific skills such as communication and community orgroup work skills, which provide motivational and practical support to clients.What to expect from this serviceCurrently CNAs participate in regular weight management sessions in South localities only, for example they complete:• Twice monthly group sessions in different venues• Follow up and health check one to one sessions weekly in different venues• Drop in weight monitoring sessions face to face, and telephone support• Exercise programme on referralReferral criteriaAny adult (>16 years) with a BMI over 30 or over 28 with co-morbidities can self refer to the ‘Your choice’ program usingthe referral form. GPs or health care professional can also refer patients to this service, using the referral form. Please seeappendix 2.Contact detailsFor further details about the CNA role or the ‘Your Choice Programme’ please contactRay Green (Community Dietitian)Wythenshawe OfficesStancliffe RoadSharstonM22 4PJTel: 0161 946 8210Fax: 0161 946 8209Email: ray.green@uhsm.nhs.uk20

Weight No More, Active LifestylesIntroduction to this serviceDeveloped and run by Active Lifestyles, Weight No More is a city-wide weight management programme for adult residentswho are overweight and obese.The sessions are arranged to provide support including confidential weigh-ins, physical activity sessions, goal-setting,nutritional advice and lots of support and encouragement.What to expect from this programme• Fun physical activity sessions• Nutritional advice (if required). This can be omitted if a client is receiving nutritional advice from another weightmanagement programme.• Ongoing support, guidance and advice.• Regular health checks• Encouragement and motivation and personal development workshops• Sessions run at various times in the daytime and evening, there are always two sessions at the same venue per week.Referral criteriaTo join Weight No More, residents can turn up to the advertised sessions, alternatively if you feel a resident needs moresupport then please refer them and we will contact them and go through the options available to them.• Suitable for ages 16 – 65 years approx.• No co-morbidities• Sessions are suitable for those with a BMI over 25.00• Everyone referred to WNM will be contacted.Please see appendix 5.Contact detailsFor more information or to refer a patient to this programme please contactAngela Matthews or Ross McGuiganActive Lifestyles Centre,Denmark RoadHulmeManchesterM15 6FGTel: 0161 232 3114/ 3117 or 07852 569 181/ 07760 328 273Email: a.matthews@manchester.gov.uk OR r.mcguigan@manchester.gov.ukWebsite: www.manchester.gov.uk/activelifestyles21

Community Health Trainer ProgrammeIntroduction to this serviceHealth Trainers are drawn from local communities and aim to reach people who want to adopt healthier lifestyles. Theprogramme aims to:• Improve public and patient access to information and services• Target vulnerable and marginalised individuals• Address the major lifestyle determinants of health• Support clients to achieve and maintain positive lifestyle changesHealth Trainers are based within different settings across the city. They encourage increased levels of physical activity andimprove access to information and one-to-one support around food, diet and nutrition. The introduction of a more holistichealth and well being assessment means Health Trainers work more broadly. They can now therefore offer assistance aroundalcohol consumption, smoking, stress and anxiety.The Health Trainers role is not to give advice, it is to structure a series of discussions to empower the client to develop anduse skills to regulate their own behaviour. This brief intervention aims to assist clients in moving towards specific goals.What to expect from this serviceA Health Trainer will usually see a client on a maximum of 6 separate occasions. The first session includes a health and wellbeing assessment in order to assess the person’s opinion of their current general health, well-being and health goals.Referral criteriaAny adult (>18 years) can access the Health Trainer service by self referral or referral from a third party, using the referralform. Please see appendix 6.Contact detailsFor further information about the service or to make a referral please contactAurora Robb,Manchester Public Health Development Service,Manchester Mental Health and Social Care Trust,Victoria Mill,Lower Vickers St,Miles Platting,Manchester,M40 7LJTel: 0161 861 2548Fax: 0161 203 5817Email: aurora.robb@mhsc.nhs.uk22

Healthy Living Network -South ManchesterIntroduction to this serviceSMHLN is a service which works with people and local organisations to bring them together to improve health and wellbeing.What to expect from this serviceSMHLN consists of the following projects:Volunteer project - supports local involvement in the NHS, volunteers are trained in smoking cessation, chair based exerciseand outreach work. They support local focus groups, map gaps in existing health provision and act as sign posters for localNHS services.Partnership health project - supports local organisations and groups to improve health and wellbeing. The project buildscapacity and helps towards sustainable community work.Community Food Project - Supports local individuals and community groups in weight management courses, healthyeating and food growing projects (see community food co-ordinators page for more details).Referral criteriaMost sessions are open to all, and are free or very low cost. Some sessions are for specific target groups and ages. This serviceaccepts self referral by contacting the SMHLN directly.Contact detailsFor more information or to obtain a full list of healthy activities contactHealth Improvement ManagerWithington Community HospitalNell LaneManchesterM20 2LRTel: 0161 217 366723

Healthy Living Network -ZestIntroduction to this serviceZest is an established healthy living network in North and East Manchester. Zest works in partnership with local people,communities and organisations from all sectors to increase choices and opportunities to improve health and well-being. Zestlinks in to the public health agendas of Manchester City Council and the NHS.What to expect from this serviceThe service currently delivers over 40 regular healthy living activities in local, accessible venues, which are free or low costand are mainly open to everyone. Zest works closely with individual communities and residents to ensure these activitiesreflect local need. Examples of the range of activities include: Yoga, Tai Chi, massage and relaxation, craft, dance, chair-basedexercise, walking, Fun and Games.Food related activities include: cook and taste, cooking skills and weight management classes. (These are provided by theZest Community Food Co-ordinator – see their page for more details)Other wellbeing programmes / workshops are delivered throughout the year in response to identified needs and in partnershipwith local groups and organisations.There is a Zest Co-ordinator for each of the following areas:• Charlestown / Higher Blackley• Cheetham / Crumpsall• Harpurhey / Moston• MPAC ( Miles Platting, Ancoats and Collyhurst) / Newton Heath• Beacons (Beswick, Clayton and Openshaw)Health Forums are supported in each area, where local health and well-being issues and solutions can be discussed, andinformation shared. These are open to all residents, partners and organisations.Referral criteriaMost sessions are open to all and anyone can be directed to these. Some sessions are for specific target groups and ages.Contact Zest directly for further details.Contact detailsFor more information or to obtain a full list of activities contactDebra Pearson,Zest Project Manager,North Manchester Regeneration,7th Floor, Hexagon Tower,Delaunays Road,Blackley Village,M9 8GQ.Tel: 0161 655 7889Fax: 0161 655 780124

Healthy Schools ProgrammeIntroduction to this programmeThe National Healthy Schools Programme (NHSP) is a joint initiative between the Department for Children, Schools andFamilies (DCSF) and the Department of Health (DH). The programme promotes a whole school/whole child approach tohealth. It is recognised as a key delivery mechanism in the Children’s Plan (DCSF 2007) and in Healthy Weight, HealthyLives (DH 2008).Healthy Schools is intended to deliver real benefits in respect of:• Improvement in health and reduced health inequalities;• Raised pupil achievement;• More social inclusion; and,• Closer working between health promotion providers and education establishmentsHow do schools achieve National Healthy School Status?National Healthy School Status (NHSS) is achieved within a rigorous quality assurance framework. All schools achievingNHSS must meet national criteria in four core themes including: Personal Social Health Education, Healthy Eating, PhysicalActivity and Emotional Health and Well Being.The NHSS healthy eating outcomes:• contributes significantly to the being healthy national outcome for children and young people• ensures healthy Children and young people have the confidence, skills, knowledge and understanding to makehealthy food choices• ensures healthy and nutritious food and drink is available across the school dayThe NHSS physical activity outcomes:• contributes significantly to the being healthy national outcome for children• ensures children/young people are provided with a range of opportunities to be physically active• ensures children understand how physical activity can help them to be more healthy, and how physical activity canimprove and be a part of their every day lifeMany of the schools in Manchester in addition to the curriculum offer children the opportunity to participate in physicalactivity and cooking and growing clubs after school.Contact detailsFor more information about the programme please contactHealthy Schools,Children’s Community Services,Central Manchester University Hospital NHS Foundation Trust,Wythenshawe Health Care Centre,Stancliffe Road,Manchester.M22 4PJTel: 0161 946 8270Fax: 0161 946 9427website: www.healthyschools.gov.uk25

Health Visiting ServiceIntroduction to this serviceHealth Visitors are qualified registered nurses with specialist qualifications in community health which includes child health,health promotion and education. They lead teams comprised of community staff nurses and nursery nurses. They providea universal service to all families with children under four and a half years of age in a number of settings including in thehome, at baby clinics, in Children’s Centres and can also give telephone advice. Their focus is on the prevention of ill-healthand on the early identification of health problems.What to expect from this serviceAdvice and support for parents around:• Breast feeding• Infant feeding and healthy weaning for babies• Healthy eating for children and families• Weight and growth monitoring• Children’s development and behaviour• Sign-posting/referral to local services such as healthy eating/cooking groups and exercise activities for toddlersReferral criteriaClients can access the health visiting service by self-referral or can be referred by any agency by phone or letter.Contact detailsClients can find their Health Visitors contact details in their Personal Child Health Record (red book).Health Visitors can becontacted by phone, by calling in at their base/health centre or at the community baby clinic.You can access all children’s community health services via our website www.younghealthymanchester.nhs.ukAlternatively clients can locate their Health Visitor through their GP or local Children’s Centre who all have link HealthVisitors. They will ensure a clients referral/request for Health Visitor contact is passed onto the Health Visitor for the family.26

School Nursing ServiceIntroduction to this serviceSchool Nursing is based on child centred public health principles with a strong preventative emphasis. The School Nursingteams provide a range of health improvement activities.What to expect from this serviceWith specific reference to addressing healthy weight, the School Nursing Service can:• Provide targeted 1:1 intervention – offering advice and support to enable the child and family to adopt healthier eating/lifestyle approaches• Deliver group health promotion sessions about healthy eating/healthy lifestyle• Refer to Specialist Services if deemed appropriate by the School Health Advisor/NurseSchool Health Nurses/Advisors use a partnership framework in their work, operating in collaboration with other colleaguesand agencies in order to address the wider threats to health eg: housing, transport, crime reduction, social exclusion etc...School Health Nurses/Advisors also provide advice and help on a one to one basis with children and young people on areassuch as personal relationships, managing stress and risk taking behaviours. They compliment Primary Care Services byproviding a safety net for children and young people particularly the most disadvantaged.Referral criteriaContact from any agency with concerns, or self referral by client or parent /carerContact DetailsFor more information please contactNorth DistrictCharlestown Road Health CentreTel: 0161 741 2000Cheetham Primary Care CentreTel: 0161 202 8775Clayton Health CentreTel: 0161 231 1151Harpurhey Health CentreTel: 0161 861 2400/ 861 2433/4Newton Heath Health CentreTel: 0161 684 9696Plant Hill ClinicTel: 0161 740 8004CentralLevenshulme Health CentreTel: 0161 861 2300Alexandra Park Health CentreTel: 0161 226 0101The VallanceTel: 0161 274 1550SouthNorthenden Health CentreTel: 0161 945 3624Wythenshawe Offices1 Stancliffe RoadTel: 0161 946 006527

Sure StartIntroduction to this serviceSure Start is a national government programme which aims to achieve better outcomes for children under 5 years old,parents and communities by:• increasing the availability of childcare for all children• improving health and emotional development of young children• supporting parents through parenting programmes and in their aspirations towards employment.There are 40 Children’s Centers in the City of Manchester.What to expect from this serviceFor more information contact the local Children’s Centre or go online at:www.manchester.gov.uk/info/200016/childcare/3109/childrens_centres/1Referral criteriaGroups have differing referral criteria dependent on the focus of the activity. Referral criteria is always included in publicity.Contact detailsWebsites:www.surestart.gov.ukwww.manchester.gov.uk/info/200016/childcare/3109/childrens_centres/128

Services which support a healthy weightSupport for people drinking at higher risk or dependent levelsIntroduction to this serviceManchester Community Alcohol Team provides specialist alcohol assessments and structured treatment for anyone over theage of 16 drinking at higher risk or dependent levels.What to expect from this serviceAppointments are held with an Alcohol Linkworker and take place on a one-to-one basis in doctor’s surgeries or nearbyhealth centres. Following initial assessment, the Alcohol Linkworker agrees a care plan with the patient aiming to enhancemotivation, support reduction, stabilisation or abstinence from alcohol. If there is a level of alcohol-dependence requiring“planned withdrawal” with detoxification, the Alcohol Linkworker will advise the safest location to do this (e.g. at home orin a residential environment) and ensure a recovery plan is in place prior to treatment.Referral criteriaThis service is aimed at patients who have been identified as possibly alcohol dependent (AUDIT scores 20-40) or higherrisk drinkers who have not responded to a brief intervention (AUDIT scores 16-19). Referrals can be made by telephoningthe number below or by completing the referral form and faxing to the CAT on the details below. Please see appendix 7.Contact detailsFor more information about this service please contactManchester Community Alcohol TeamLongsight District Office523 Stockport RoadManchesterM12 4LLTel: 0161 225 9293Fax: 0161 882 1344Website: www.manchestercat.org29

Expert Patients ProgrammeIntroduction to this serviceThe Expert Patients Programme is a course for anyone with long-term health conditions, who would like to find ways ofmanaging the impact of living with health problems, in order to improve their quality of life. The programme builds on theprincipal that people who live with long-term health problems or have difficulties in managing the impact of being over orunder weight can affect their over all health and well being, It has been nationally recognised that people who live withhealth problems know best how their condition affects the way they feel on a day to day basis, how it affects their lifestyleand their ability to accomplish activities important to them. The course also looks at ways to positively manage symptoms,to improve on daily activities and manage the changing emotions that can be brought about by living with long term healthconditions.There is a wealth of evidence to back claims that the Expert Patients Programme has significant benefits for the individualswho participate.What to expect from this serviceThe course is free and consists of 6 weekly sessions – each lasting 2 ½ hours. It is delivered by two nationally trainedvolunteer tutors who themselves have long-term health problems and have previously attended an Expert Patient Courseprior to becoming a tutor. This means they understand the challenges people face in having health problems and comingon the course.Weekly sessions provide information on specific topics such as managing symptoms, relaxation techniques, healthy eatingand physical activity; how and why this can help reduce symptoms and learn how to communicate effectively with healthcare practitioners. On each course there are between 8 and 10 participants. The venues are checked to ensure they arefully accessible.Referral criteriaThis programme is open to anyone with long term health problems. Any one can refer into the programme and the patientmay also self refer if they wish to. To refer into the programme please complete the patient registration form – please seeappendix 8.Contact detailsFor more information about this service please contactExpert Patients Programme Referral Team,EPP Manager NHS Manchester,University Hospital of South Manchester NHS Foundation Trust,Newton House, Newton Silk Mill,Holyoak Street,Newton Heath,Manchester,M40 1HA.Tel: 0161 219 9424Fax: 0161 219 9477Email: man-pct.epp@nhs.net30

Paediatric physiotherapy for children with weight managementissues and associated musculoskeletal conditionsIntroduction to this serviceIf a child aged between 0 and 16 has weight issues and also a musculoskeletal condition ie. back pain then the physiotherapyteam could see the child and incorporate healthy exercise into their management plan.What to expect from the serviceThe physiotherapy team would see the child until their pain had resolved or other services needed to be involved egorthopaedics.Referral criteriaWhen to refer• Children/young people who are 16 and under• Identification of weight issues using IOTF BMI centile cut offs• Associated joint pain e.g. In knees or back which is impacting on the child’s ability to take part in physical activity orincrease their activity levelsWhen not to refer• When a child and their family are not in agreement with the referralPlease see appendix 10 and 11.Contact detailsFor more information about this service please contactPaediatric Physiotherapy & Occupational Therapy DepartmentChildren’s Community ServicesCentral Manchester University Hospitals NHS Foundation TrustCornerstones Centre2 Graham StreetBeswickManchesterM11 3AATel: 0161 220 7110Fax: 0161 220 399132

Partnership for Older People Project (POPP)Introduction to this servicePOPP is an 8 week programme of health promotion and supported exercise for people who have survived a stroke and/or aTransient Ischaemic Attack (TIA)- “mini-stroke”- and their carers. This is an ongoing project, which aims to give people affectedby stroke an opportunity to improve strength, mobility and confidence, by trying physical exercise in a safe environment.The project will run in the form of an 8 week session based at a venue in Gorton and, if needed, transport can be provided.What to expect from this serviceParticipants will have an increased awareness of the health benefits of taking regular exercise and be able to make otherhealthier lifestyle choices. They will be able to access other facilities and services in their community where they can take partin physical exercise after the programme has finished.Carer’s will either have the opportunity for respite or to relax with other carers during the sessions. It is hoped that thiswill improve carer’s confidence and emotional well being by helping them to feel less isolated. They will also be able toparticipate in the healthy living education programme, which will help carer’s to make healthier lifestyle choices.Referral criteriaThe following must apply to the referred person:• Have had a stroke or TIA at any time in the past• Any age can attend• Be a resident in the Central, South or North Manchester areaTo refer a participant please use the referral form in appendix 12. The referral form can be faxed or sent to the service oncegaining permission of the referred person. This form may be copied if needed and completed with as much information aspossible.Contact detailsFor more information or to make a referral please contactHelen GilbertsonThe Stroke Association1st FloorStamford HouseNorthenden RoadSaleM33 2DHTel: 0161 972 0559Fax: 0161 962 3323Email: helen.gilbertson@stroke.org.uk33

Stop Smoking ServiceIntroduction to this serviceManchester Stop Smoking Service is a free NHS service, dedicated to providing non-judgmental advice and support to helppeople give up smoking.What to expect from this serviceTrained specialist advisors offer one-to-one support on a drop-in or appointment basis. Anyone going to a drop-in orappointment can get help to plan their quit attempt as well as receive free or discounted nicotine replacement therapy(NRT). Advisors provide support from a number of venues around the city, including pharmacies, hospitals, health centres,GP practices, community centre’s, Childrens Centres, workplaces and local markets.Referral criteriaManchester Stop Smoking Service is open to people who live, work or are registered with a GP in Manchester. People cancontact the service directly or be referred by a health professional.Contact detailsFor more information about this service or to quit smoking please contactTel: 0161 205 5998.If an interpreter is required Text ‘LANG’ plus the language the client would like to be called back in to 81025.Website: www.stopsmokingmanchester.co.uk34

Supporting Health ProgrammeIntroduction to this serviceThe Manchester Supporting Health Programme is in two parts, one part is focussed on improving physical health of peoplewith severe mental illness and the other part is focussed on improving physical health of people with dementia and theircarers.The programme team to develop the work includes Supporting Health Nurses and Public Health Development Advisors,based within Manchester Mental Health and Social Care Trust.To view reports, please look in the reports section of the mental health pages of the Public Health Development website atwww.mphds.org.What to expect from this serviceThe Supporting Health Nurses have built experience in providing detailed physical health checks to the client groups. Thisexperience is now going to be utilised to support and guide others who have roles to offer health checks, both withinprimary and secondary care. They also work closely with specialist mental health services so that supporting improvedphysical health can become a part of care planning for the service user.Some of the key areas being developed are:• Appropriate support for people who want to improve their health• Improving access to information about health improvement• Improving pathways to healthcare and health promotion services in the community• Increasing the public health skills of mental health specialists• Offering mental health awareness and dementia awareness training for staff/volunteers of services engaged in health andcommunity workContact detailsSupporting Health Nurses - Severe Mental IllnessSue BlakeleyMobile: 07949765541Email: sue.blakeley@mhsc.nhs.ukMargaret MuldownMobile: 07553365349Email: margaret.muldown@mhsc.nhs.ukSupporting Health Nurse – DementiaPam KehoeMobile: 07553377135Email: pam.kehoe@mhsc.nhs.ukTo discuss access to health improvement opportunities for people with severe mental illness, resources and trainingShamin MalikTel: 0161 861 2539Email: shamin.malik@mhsc.nhs.ukTo discuss access to health improvement opportunities for people with dementia and associated resources and trainingAlpa RajaTel: 0161 861 2545Email: alpa.raja@mhsc.nhs.uk35

Support for people with mental health problems -Services for adults:Introduction to this serviceNHS services are divided into those that offer support and treatment for common mental health problems and those thatoffer support and treatment for serious mental illnesses.Primary care servicesManchester Primary Care Mental Health Services offer short term support to residents, aged 16 and older, who are registeredwith a GP and have common mental health problems and/or associated social problems such as anxiety and panic, phobias,depression, bereavement difficulties, obsessions, compulsions and stress related problems.The service provides brief psychological interventions based on Cognitive Behavioural Therapy, and includes problem solving,guided self help, help with physical health, advice and information and signposting to other services. North and South teamsprovide counselling services and the Central team can sign post to counselling.There are three Primary Care Mental Health Teams in Manchester, who can accept referrals from GPs, professionals and self referrals.These services can be contacted by frontline staff if you need advice and guidance about someone experiencing mental distress.Primary Care Mental Health Team (North Districts) 0161 231 0017Primary Care Mental Health Team (Central District) 0161 861 2236Primary Care Mental Health Team (South Districts) 0161 946 8260Secondary care servicesSecondary Care services help people who are diagnosed with a severe or enduring mental illness under a care plan, includingpeople with dementia. Conditions such as psychosis, schizophrenia, bipolar disorder and severe depression are considered tobe the more serious mental health problems.In Manchester, most of the secondary care services provided for adults and older people are by the Manchester MentalHealth & Social Care Trust (MMHSCT). This can be contacted on 0161 882 1000 or visit www.mhsc.nhs.uk for a servicedirectory which holds details on the Trust’s services, including descriptions, contact details and referral methods.Services on offer include hospital and specialist services that support people during a mental health crisis and offer continuingtreatment when the crisis has stabilised and a wide range of services to support the recovery and social inclusion of individualsin the community.It is very important for individuals to seek help early; identifying that there is a problem and getting treatment early leads tobetter recovery and longer term outcome.How to get support for clients or make a referralIf you are concerned that someone is suffering from a severe mental health problem:• They should see their GP. They will consider whether to make a referral to a specialist mental health service where anassessment can be made by a psychiatrist, a psychologist or other specialist; this is usually through the Single Point ofAccess (SPA).• You or they can telephone the Manchester Contact Service for Social Care (see below).• Alternatively as a professional you can make a referral into the SPA or get advice from them (see below).Manchester Contact Service for Social CareIf there is a concern that someone may have a mental health problem, referral to NHS secondary care mental healthservices would in most cases be through the Manchester Contact Service for Social Care on 0161 255 8250 in the firstinstance. Anybody can contact this number including self, friends, family and neighbours. This number can be used if you areconcerned about someone’s mental health, about the mistreatment of a child or vulnerable adult or to report a hate crime.36

Single Point of AccessReferral to individual services provided by the MMHSCT Trust for people who have mental health problems, can be madethrough the Single Point of Access (SPA): contact 0161 276 6155. Any professional can make a referral; most referrals comefrom GPs and the Manchester Contact Service for Social Care.Crisis Resolution and Home Treatment TeamThey support clients who are in crisis (risk to self or others). Referrals are only accepted from medical staff and mental healthprofessionals who must have seen the individual within 12 hours. Referrals need to be made by phone. They will do theirbest to see someone within 48 hours.• CRISIS Central: Tel: 0161 901 7380/0161-276-5368 Fax: 0161-276-4730• CRISIS North: Tel: 0161-720-2045 Fax: 0161-720-4200• CRISIS South: Tel: 0161-882-1029 Fax: 0161-882-1035Early Intervention ServiceMany people will experience their first ‘psychotic episode’ between the ages of 14 and 35. If you notice that someone isexperiencing persistent changes in mood and behaviour, is becoming isolated and not getting on with people, has strangethoughts, ideas or odd behaviour, or is using drugs or alcohol more, then these could be just some of the signs that they areexperiencing difficulties. It is vital to act early. The Manchester Early Intervention Service offers assessment and treatment toyoung people in Manchester aged between 14 and 35. They can be contacted on 0161 277 6830.Voluntary and community sector organisationsIn Manchester there are a large number of voluntary and community sector organisations (e.g., charities) that provide a widerange of services. Some of these are mental health specialists providing services like counselling and self-help groups. Othersoffer a wider range of services that can support good mental health, e.g., housing advice or social support and volunteering.There are a few organisations that provide services specifically for black and minority ethnic communities.37

Support for people with mental health problems -Services for children and young peopleChild and Adolescent Mental Health Services (CAMHS)Child and adolescent mental health services in Manchester offer a range of services including psychiatry and psychology for0-16 year olds. Contacts are: Central Manchester - The Winnicott Centre, 0161 248 9494), North Manchester - The Bridge,0161 203 3250/3251) and South Manchester - The Carol Kendrick Centre, 0161 902 3400).CAMHS services accept referrals from GPs, Community Paediatricians, School Doctors, Educational Psychology, HealthVisitors, School Nurses, Social Services and Youth Offending Teams. Most CAMHS services do not accept self referrals.Emerge 16/17 Community Mental Health Team is part of CAMHS. Emerge offers confidential support for 16 and 17year olds around mental health issues; this is one to one and group support. The service will accept referrals from youngpeople, family members, carers and professionals; contact 0161 226 7457.Voluntary sector services for young peopleThere is a range including:• 42nd Street offers individual support for anyone aged 13 to 25 and under stress. Services include counselling, groups andindividual support.Contact: 0161 832 0170Swan Buildings, 20 Swan Street, Manchester, M4 5JW• Young Adult Advice and Support Project (YASP) is a community based Young Mental Health Project providing practicaladvice and support for 15-25 year olds around issues such as housing, benefits, money, health, education, relationshipsand sexual healthContact: 0161 221 3054832 Stockport Road, Levenshulme, Manchester, M19 3AWEmergency and crisis for young peopleOptions to deal with emergencies are:• Contact GP• Go to the nearest Accident & Emergency hospital department• Call 999 and ask for an ambulance• PoliceCurrent users of Manchester Mental Health & Social Care Trust services who are in crisis should contact the 24 hour crisisline on 0161 901 1477.Website for further information and directory of servicesFor more information about the range of services for adults and young people, visit www.mhim.org.uk. A directory ofmental health services across Manchester and a list of counselling services can be downloaded from the site.38

The Common Assessment FrameworkIntroduction to this serviceThe Common Assessment Framework (CAF) is a key component in the Every Child Matters: Change for Children programme.The aim is to identify, at the earliest opportunity, a child or young person’s additional needs and provide timely and coordinatedsupport to meet those needs. This can include children who are overweight and obese.What is the CAF?It has three elements:• A simple pre-assessment checklist to help practitioners identify children or young people who would benefit from acommon assessment;• A process for undertaking a common assessment to help practitioners gather and understand information about the needsand strengths of the child – based on discussions with the child, their family and other practitioners as appropriate;• A standard form to help practitioners record and, where appropriate, share with others the findings from the assessmentin terms that are helpful in working with the family to find a response to unmet needs; agreeing with the child and familywhat support is needed.CAF benefitsThe CAF provides an assessment that is common across services. It will help embed a shared language, support betterunderstanding amongst practitioners, reduce the number of different assessments, facilitate early intervention and speedup service delivery.The lead professional is the one practitioner who takes a ‘lead role’ to ensure that front-line services are coordinated,coherent and achieving intended outcomes. This way all children and young people who require integrated support frommore than one practitioner should experience a seamless and effective service.What is the role of a lead professional?The lead professional is not a new role. Instead s/he delivers three core functions as part of their work:• Act as a single point of contact for the child or family;• Coordinate the delivery of the actions agreed;• Reduce overlap and inconsistency in the services received.A lead professional is accountable to their home agency for their delivery of the lead professional functions. They are notresponsible or accountable for the actions of others.ImplementationCAF and the lead professional role are being implemented in Manchester.Practitioners, children and families are already seeing the benefits.Contact detailsFor more information please contactEmail: cafit@manchester.gov.uk39

Health Exercise Nutrition for the Really YoungIntroduction to this trainingHENRY is a health promotion, prevention and early intervention scheme that aims to tackle child obesity by enhancing theskills of practitioners working with parents of babies, toddlers and preschoolers.Henry aims• to make professional training widely available for all those working on the promotion of a healthy lifestyle with youngfamilies (health visitors, community nursery nurses, Children’s Centre staff, nutritionists, etc.)• to work with Children’s Centres to optimise their efforts in developing community resilience to an obesogenic environment• to offer parent groups with a particular focus on intervening to arrest the development of obesity in babies and youngchildren (0–5 years) within a framework of emotionally healthy parenting• to provide informative, entertaining resources for professionals and parentsHENRY training courses include• 2-day Core Training for community practitioners and Children’s Centre teams• e-learning courseLets get healthy with HENRYLets get healthy with HENRY is a course for groups of parents/carers. This course offers 8 weekly 2½-hour sessions aimed atdeveloping the parent/carers knowledge about and skills in adopting a healthier lifestyle for themselves and their families,and helps them find the motivation and confidence to give their children a healthy start in life.Contact detailsFor more information about this training please contactJane BrophyGreater Manchester Sub-Regional Programme Manager - HENRY ProgrammeTel: 07929 465251Email: janebrophy@nhs.netFor local information and to identify trained staff please contactAmy Ashton, Public Health Manager - Healthy Weight (NHS Manchester)Tel: 0161 765 4468Email: amy.ashton@manchester.nhs.uk40

Physical activity, healthy eating and weight managementtraining coursesIntroduction to these coursesManchester Public Health Development Service provides a number of training courses, relating to healthy weight. Thecourses delivered include:• Getting Manchester Moving• Turning people on to Active Transport• Cook and Taste Groups: a practical guide• Healthy Weight Manchester – Be Aware• Healthy Weight Manchester• Food Safety RSPH level 2 (Royal society of Public Health)• Healthy Eating for All Level 1, 2 and 3 (RIPH accredited)• Active travel - walk, cycle or take the bus• Food and Mood• Supporting Healthy Weight - A Practical Approach• Motivating Behaviour ChangeReferral criteria to these coursesAll courses are free of charge. Applicants can book onto a course by self-referral.Contact detailsFor further information about the courses or to enquire about the date/s of each course please contactRuhana MiahManchester Public Health Development Service,1st FloorFallowfield LibraryPlatt LaneFallowfieldM14 7FBTel: 0161 248 176641

X-PERT – Structured Diabetes Education ProgrammeIntroduction to this programmeThe aim of the X-pert programme is to empower people with diabetes to develop the knowledge, skills and confidence tomake informed decisions regarding their lifestyle and diabetes self –management.What to expect from this programmeThe programme is aimed at adults with diabetes and is free to attend. The courses run across Manchester at a variety of venues.The programme is run over six weeks and participants are encouraged to attend all 2 ½ hour sessions. The sessions include:Week 1. What is DiabetesWeek 2. Weight ManagementWeek 3. Carbohydrate AwarenessWeek 4. Supermarket TourWeek 5. Possible ComplicationsWeek 6. Questions and EvaluationClients are welcome to take along a family member or friend, however the session are not suitable for children.Referral CriteriaAny adult with diabetes can self refer to the programme using the referral form. Health care professionals can also referpatients to this programme. The referral form can be faxed or posted to the detail below. Please see appendix 13.Contact detailsAmy GriffithsCommunity Dietitian – Long Term Conditions,Wythenshawe Offices,Stancliffe RoadSharston,Manchester,M22 4PJ.Tel: 0161 946 8210Fax: 0161 946 8209Email: amy.griffiths@uhsm.nhs.uk42

Mental Health training coursesIntroduction to these coursesManchester’s Public Health Development (MPHD) – Public Mental Health team aim to support all organisations in the cityto be able to promote better mental health for the people they work with and to be able to respond helpfully to peopleexperiencing emotional distress and mental health problems.As part of this work, a range of training opportunities are available for people working in Manchester, including:Interventions for Mental Health in Everyday Practice (IMHEP)This is a two day course for frontline staff working with people who are vulnerable to poor mental health (for example,because of poverty, unemployment, poor physical health, insecure housing, discrimination). Participants will learn how bestto help their clients manage their mental health. The course develops practical skills in identifying and responding to distresseffectively, using a structured model of support.Understanding Mental HealthThis is a half-day introduction to mental health and the Manchester context and also an optional basis for further training. Itis for staff working with people who are vulnerable to poor mental health (for example, because of poverty, unemployment,poor physical health, insecure housing, discrimination).Emotional Aspects of Your ConsultationsThis training is for clinical staff working in Primary Care (GP practices) and Community Health Services (in the AcuteHospital Trusts) in Manchester who work with patients and suspect that their emotional health is a barrier to managingtheir physical health conditions and achieving better health. These brief workshops will provide simple tools to help movepatients forward who have been experiencing difficulty in coming to terms with and managing their condition. This will notadd to your current workload, but will provide you with some simple skills that you can use everyday.The training comprises two x 2 hour sessions - attendance at both parts of the workshop is required. For further informationcontact: Teresa Czajka, Wythenshawe Offices, 1 Stancliffe Rd, M22 4PJ. Tel: 0161 946 9446, Email: teresa.czajka@mhsc.nhs.ukSpecialised Mental Health Topics and / or Specific training for your organisationFrom time to time we organise courses on specialised mental health topics. These are normally advertised through ourwebsite. We are happy to discuss the provision of our training courses adapted for your organisation’s needs, if you have agroup of staff you want to train together.If you have specialised topics on which you would like us to consider offering training or would like us to run a coursespecifically for your organisation please contact Caroline Bedale.Referral criteria to these coursesAll courses are free of charge. Applicants can book onto a course by self-referral.Contact detailsFor more information about the courses, contact:Caroline Bedale, Tel: 0161 861 2540, Email: caroline.bedale@mhsc.nhs.ukFor further information, dates of open courses, and evaluations of previous courses, see the MPHDS website:www.mphds.org/mphds/mental-health/mental-health-training.htmlFor further information about Child and Adolescent Mental Health Training Programme (for those who workwith children and young people up to 18 years old) contact:Kevin Buchanan, Tel: 07890 076 183, Email: kevin.buchanan@cmft.nhs.ukFor applications for mental health courses, contact:Madge Strong, Tel: 0161 861 2547, Email: madge.strong@mhsc.nhs.uk43

The Common Assessment Framework (CAF) Training ProgrammeIntroduction to these coursesThe CAF training programme has been devised following feedback from practitioners, local and national evaluations and hasbeen developed in collaboration with The Workforce Development Group.CAF is a vital tool in ensuring that children’s needs are identified and met at the earliest opportunity, and relies on us allworking together to help children reach the five Every Child Matters outcomes. The aim of the CAF training is to equippractitioners with the skills and knowledge to initiate a common assessment, complete a common assessment and act asthe lead professional. In addition we aim to develop and foster the following:• A shared understanding of principles, processes, tasks, roles and responsibilities as outlined in national and local guidance• Improved communication between professionals, including a common language to describe children’s needs, and basedon best practice in information sharing• Effective working relationships built on mutual trust and respect• More effective and integrated services• A commitment to helping all children achieve the best and fulfil their potentialWherever possible we aim to deliver the training in the districts in order to promote networking and knowledge of local resources.Which Common Assessment Framework (CAF) Training is for you?Level 1: AwarenessAnyone who works with children and young people will need an awareness of what the Common Assessment Framework is.This short briefing gives an overview of what the Common Assessment Framework is and how it fits in with integrated workingin Manchester. It also gives an overview of the lead professional role and information sharing - key elements of the CAF.This course is a pre-requisite for the Level 2 training.Level 2: Practitioner – for practitioners working closely with children and young peopleThis is a practical one day training session which enables practitioners to:• Identify when a CAF should be initiated• Complete a CAF assessment• Undertake the lead professional role• Know when and how to share information with other servicesLevel 2: Practitioner for Managers/Supervisors – for those who supervise other practitioners.This is a one day training session which provides an overview of the Common Assessment Framework from a managementperspective. Managers/supervisors will look at:• How to complete a common assessment• How CAF fits with their existing assessments• What skills their teams will need to complete a CAF assessment• What skills their teams will need to take on the lead professional role• What implications CAF has for their organisation and how it can be implemented.Refresher training is also availableContact detailsFor more information please contactEmail: cafit@manchester.gov.uk44

Alcohol identification and brief advice trainingIntroduction to these coursesProviding more help to encourage people to drink lessPublic Health Development Service provides training for frontline staff working in targeted settings where alcohol should bediscussed routinely as part of a larger role within adult services (such as services that support people to maintain a healthyweight) .Various training options are available which aim to:• Raise confidence in identifying those at risk of harm from the amount of alcohol they drink as an integral part of practice• Equip staff to provide brief interventions that encourage people to drink less• Standardise knowledge and skills in using AUDIT-C/AUDIT as a validated identification tool and providing brief interventions• Contribute to the achievement of multi-agency targets to reduce alcohol related harm• Enable organisations and services to implement NICE guidelinesWe are also available to support you with setting up internal systems or protocols as well as on-going development throughskills practice and staff updates.Contact detailsAlcohol Team, Manchester Public Health Development ServiceTel: 0161 248 1750Website: www.mphds.org45

Health Information and Resource LibraryNHS Manchester Library has merged with MPHDS Resource and Information Service to create a combined service, theManchester Health Information and Resources Library (HIRL).Where We AreThe service is located at:Fallowfield Library1st Floor,Platt Lane,Fallowfield, Manchester M14 7FBWho can Use the Health Information and Resources Library?NHS Staff, students and contractors and also to health promoters working in Manchester. For full details of our services andterms & conditions of membership, please ask a member of staff.Library Services• Multidisciplinary collection of books, reports, journals and multimedia resources such as DVDs and CD ROMs• Health promotion models and teaching resources• Enquiry service• Literature searching service• Training on searching for information on the Healthcare Databases• Current awareness: email bulletins of new information• Wide range of electronic resources, available through NHS Athens• Access to documents through our inter-library loan service• Free leaflets and posters to order on a range of health promotion topicsHow can you find us?1st Floor, Fallowfield Library,Platt Lane,Fallowfield, Manchester M14 7FBTel: 0161 248 1769Fax: 0161 248 1751Email: HIRL@mhsc.nhs.ukOpen: Monday to Friday 9.00am to 4.30pmEmily Hopkins – Library ManagerEmail: Emily.Hopkins@mhsc.nhs.ukKathy Atkinson - LibrarianEmail: Kathy.Atkinson@mhsc.nhs.ukCarnell Bell-Smith – Resource & Information AdvisorEmail: Carnell.Bell-Smith@mhsc.nhs.ukSarah Race – Resource & Information AdvisorEmail: Sarah.Race@mhsc.nhs.uk46

Mental health information and self help guidesThere are a number of mental health resources available in the City, including:Self help guides to help mental health problems e.g. depression and low mood, panic, stress and anxiety, sleepproblems, bereavement, post traumatic stress, obsessions and compulsions, living with long term conditions, understandingvoices and disturbing beliefs, dementia, depression and older people, mental well-being in pregnancy.All these guides can be downloaded from www.mhim.org.ukPhysical activity and moodTaking part in physical activity on a regular basis can have a positive impact on mental health and the symptoms that areassociated with poor mental health. This guide will help people to think about the type and amount of physical activity theycan do to improve their health. It gives practical guidance about how to include more physical activity in their life, how to doit safely and how to overcome the issues that may make it difficult to start or stick to a more active lifestyle.This guide can be downloaded fromhttp://www.mhim.org.uk/document_uploads/stayingwell/Physical_Activity_&_Mood.pdfFood and moodWhat we eat and drink can affect our mental health and experiencing emotional distress and mental health problems canaffect how a person feels about eating. Eating regularly and eating more of certain foods can have a positive impact on ourmental health and the symptoms associated with poor mental health. This guide provides information on:• The benefits of certain foods and water to our mental health• Ideas and tips to make changes, including a food and mood diaryThis guide can be downloaded fromhttp://www.mhim.org.uk/document_uploads/stayingwell/Food_and_Mood_Booklet.pdfGet creative; it’s good for your mental health”-guide one: visual artCreative activities are used as a therapeutic tool to support people’s recovery from mental ill health. This guide is focussedon visual arts; it gives information on the benefits of visual art for mental wellbeing, tips to get started and some practicalquick start activities in relation to both making art or looking at art.This guide can be downloaded fromhttp://www.mhim.org.uk/document_uploads/stayingwell/Visual_Arts_booklet_web_version.pdfAll the above guides can be used as a one to one tool to assist someone to help themselves or be given to clients to workthrough on their own.Hard copies can be obtained from the Health Information and Resource Library (see library information).Further information and contacts about work to improve mental health in Manchester can be found onwww.mphds.org/mphds/mental-health/mental-health.html47

Getting Manchester Moving WebsiteIntroduction to this serviceGetting Manchester Moving is a website designed to encourage and support Manchester people to get more physicallyactive, eat more healthily and in some cases to lose weight.What to expect from this servicewww.gettingmanchestermoving.org provides a one stop shop of information regarding physical activity, healthy eatingand weight management provisions across Manchester.Contact DetailsTo submit or amend information on the website please contactSarah RaceResource and Information AdvisorPublic Health Development Service1st FloorFallowfield LibraryPlatt LaneFallowfieldM14 7FBTel: 0161 248 1753Website: www.gettingmanchestermoving.org48

Alcohol resources availableIntroductionPublic Health Development Service has a number of resources available to support alcohol identification and brief advice aswell as general alcohol awareness campaigns:• Unit calculators / kcal estimates for popular alcoholic products• Measuring tumblers to support smaller home measures• Copies of AUDIT questionnaires (Alcohol Self-Test)• Brief advice and extended brief intervention tools• Drink Smart self-help guides• Posters for display in reception areas, clinics and interview rooms• Standardised text and information for websitesContact detailsContact Us - Alcohol Team, Public Health Development ServiceTel: 0161 248 1750Website: www.mphds.org49

50Manchester’s care pathway for child and familyhealthy weight

Manchester’s care pathway for overweight andobese adults51

Guidelines for the use of pharmacotherapy in themanagement of adult obesityThese guidelines are intended for use in conjunction with NHS Manchester’s care pathway for overweightand obese adults. Anti-obesity drugs are to be used to support healthy lifestyle and behaviour changesand not in isolation.Scope of the guidelineThese guidelines relate to the use of orlistat in adults over 18 years, in line with NICE (2006) guidance. It is anticipatedthat for most patients, the General Practitioner (GP) is the most appropriate prescriber; however anti-obesity drugsmay be commenced by hospital specialists, as long as appropriate support is arranged.When should pharmacological management for obesity be considered?• Drug therapy for obesity should only be considered after dietary, exercise and behavioural approaches have beenstarted and evaluated• Drug therapy may be considered for patients who have not reached their target weight loss or have reached aplateau on dietary, exercise and behavioural changes alone• Orlistat drug therapy should be prescribed only as part of an overall plan for managing obesity in adults who meetone of the following criteria:• a BMI of 28.0kg/m2 or more with associated risk factors• a BMI of 30.0kg/m2 or greater (NICE, 2006)Which drug?Orlistat may be used as first line therapy after discussing with the patient the mode of action, adverse effectsand monitoring requirements. In a meta-analysis of randomised trials, orlistat reduced weight by 2.9kg more thanplacebo (Rucker, Padwal & Li et al, 2007).Anti-obesity drug sibutramine has had its license suspended and GPs are not to issue any new prescriptions for thedrug. The suspension follows a review of the drug’s safety by the European Medicines Agency (EMEA) on the basisof data from the Sibutramine Cardiovascular Outcomes Trial (SCOUT). This review concluded there was an increasedrisk of non-fatal cardiovascular events, such as heart attacks or strokes, with sibutramine, compared with placebo(http://www.ema.europa.eu/pdfs/human/referral/sibutramine/3940810en.pdf).Prescribers are being advised not to issue any new prescriptions for sibutramine and to review the treatment ofpatients taking the drug. Pharmacists are asked to cease dispensing the medicine(http://www.ema.europa.eu/pdfs/human/referral/sibutramine/3940810en.pdf).Points to consider:• Many drug treatments cause weight gain. These include antipsychotics, antidepressants, corticosteroids, COC,beta blockers, oral hypoglycaemics and anticonvulsants• BMI may be less accurate in highly muscular people. These people may have an artificially high BMI becausemuscle is three times denser than fat (HSE, 2007). BMI results should therefore be interpreted with caution andused alongside other measures such as waist circumference• Patients following a very low fat diet may respond less well to orlistat due to its affect on fat absorption.Similarly, if a person has a very high fat diet and has difficulty knowing which foods/meals in their diet containtoo much fat, the side effects of orlistat can help them develop a better understanding of their diet. This shouldprompt swift changes in the diet to reduce the fat content (with the aid of healthy eating advice from a healthprofessional)52

• Drugs should not be substituted or alternated with healthy eating and activity habits to provide ‘breaks’or a ‘way out’ of making the necessary changes. The individual should be motivated to continue diet and exercisechanges once they start on anti-obesity drugs• Realistic targets for weight loss are a maximum weekly weight loss of 0.5-1kg and an overall aim to lose 5-10%of original weight. These should be modified in the light of other factors (see following points)• Weight loss may be slower for some people than others i.e. less than 1-2lb/week or less than 5% of theirweight over 3 months. This may be due to medical conditions (e.g. diabetes, hypothyroidism), medication (e.g.beta blockers), physical disabilities, very little mean muscle mass or changes to metabolism due to a long history ofdieting. Anti-obesity drugs may be complementary treatment to increase their average weight loss• Regular review is recommended to monitor the effect of drug treatment and to reinforce lifestyle advice andadherence• Consider less strict goals for patients with type 2 diabetes, because they may lose weight more slowly. Agreegoals with the patient and review regularly• Be aware of the potential for hypoglycaemia in diabetic patients who have managed to reduce calorie intakewithout appropriate adjustment of oral antidiabetic drugs (and possibly insulin)• Anti-obesity drugs are not appropriate for patients with any evidence of an eating disorder, such ascompulsive over-eating or binge eating. These patients should be referred to an eating disorders or local psychologyservice• Anti-obesity drugs should not be available on repeat prescriptions without consultation with an appropriatehealth professional. Reinforce lifestyle advice throughout treatment• Combination therapy involving more than one antiobesity drug should not be used• Drug treatment may be used to help patients maintain weight loss, as well as to continue to lose weight.This should be limited to certain patients, e.g. diabetics• Consider micronutrient intake whilst on a low calorie diet. A supplement providing vitamins and traceelements (e.g. Forceval capsules) can be prescribed, particularly for vulnerable groups who may be at risk ofmalnutrition• Orilstst improves total cholesterol and LDL cholesterol profiles• If withdrawing drug treatment, offer support to help maintain weight loss because the patient’s self-confidenceand belief in their ability to make changes may be low• Use the British National Formulary (http://bnf.org/bnf/) or Summary of Product Characteristics (SPC)(www.medicines.org.uk) for full prescribing information53

Drug interactionsThe following table should be used in conjunction with the overview of drug therapy table and the appropriateflowchart (See following pages)Acarbose: Avoid concomitant use.Amiodarone: Clinical and ECG monitoring is recommended as orlistat may decreaseamiodarone plasma levels.OrlistatCiclosporin: Orlistat may decrease ciclosporin levels. If concomitant use is unavoidable,ciclosporin levels should be monitored more frequently, particularly after both addition anddiscontinuation of orlistat until stabilised.Fat-soluble vitamins: If a supplement is prescribed, it should be taken at least 2 hours afterorlistat or at bedtime.Oral contraceptives: Additional precautions are recommended if severe diarrhoea occurs.Warfarin: Monitor INR.54

Prescribing Orlistat55

OrlistatMCH Medicines Management (2009)56

8 tips for eating wellThe two keys to a healthy diet are:• eating the right amount of food for how active you are and• eating a range of foods to make sure you’re getting a balanced diet.A healthy balanced diet contains a variety of types of food, including lots of fruit, vegetables and starchy foods such as wholemealbread and wholegrain cereals; some protein-rich foods such as meat, fish, eggs and lentils; and some milk and dairy foods.8 tips for eating well:1. Base your meals on starchy foodsStarchy foods such as bread, cereals, rice, pasta and potatoes are a really important part of a healthy diet. Try to choosewholegrain varieties of starchy foods whenever you can.Starchy foods should make up about a third of the food we eat. They are a good source of energy and the main source of arange of nutrients in our diet. As well as starch, these foods contain fibre, calcium, iron and B vitamins.Most of us should eat more starchy foods - try to include at least one starchy food with each of your main meals. So youcould start the day with a wholegrain breakfast cereal, have a sandwich for lunch, and potatoes, pasta or rice with yourevening meal.Some people think starchy foods are fattening, but gram for gram they contain less than half the calories of fat. You justneed to watch the fats you add when cooking and serving these foods, because this is what increases the calorie content.Wholegrain foods contain more fibre and other nutrients than white or refined starchy foods.2. Eat lots of fruit and vegetablesMost people know we should be eating more fruit and vegetables. But most of us still aren’t eating enough.Try to eat at least 5 portions of a variety of fruit and vegetables every day. It might be easier than you think.You can choose from fresh, frozen, tinned, dried or juiced, but remember potatoes count as a starchy food, not as portionsof fruit and veg.3. Eat more fishMost of us should be eating more fish - Aim for at least two portions of fish a week, including a portion of oily fish. You canchoose from fresh, frozen or canned - but remember that canned and smoked fish can be high in salt.Fish is an excellent source of protein and contains many vitamins and minerals.Some fish are called oily fish because they are rich in certain types of fats, called omega 3 fatty acids, which can help keepour hearts healthy. For children, women who are pregnant, breastfeeding or trying for a baby, see the Food StandardsAgency – Eatwell website for advice www.eatwell.gov.uk.Don’t have more than one portion a week of shark, swordfish and marlin because these fish contain high levels of mercury.4. Cut down on saturated fat and sugarFatsTo stay healthy we need some fat in our diets. What is important is the kind of fat we are eating. There are two main types of fat:• saturated fat - having too much can increase the amount of cholesterol in the blood, which increases the chance ofdeveloping heart disease• unsaturated fat - having unsaturated fat instead of saturated fat lowers blood cholesterol57

Try to cut down on food that are high in saturated fat e.g. meat pies, sausages, hard cheese, butter, cakes, cream and havefoods that are rich in unsaturated fat instead, such as vegetable oils (including sunflower, rapeseed and olive oil), oily fish,avocados, nuts and seeds.For a healthy choice, use just a small amount of vegetable oil or a reduced-fat spread instead of butter, lard or ghee. Andwhen you are having meat, try to choose lean cuts and cut off any visible fat.Look at the label to see how much fat a food contains. Generally the label will say how many grams (g) of fat there are in100g of the food.High is more than 20g fat per 100gLow is 3g fat or less per 100gSaturated fat - what’s high and what’s low?High is more than 5g saturates per 100gLow is 1.5g saturates or less per 100gSugarMost people in the UK are eating too much sugar. We should all be trying to eat fewer foods containing added sugar, suchas sweets, cakes and biscuits, and drinking fewer sugary soft and fizzy drinks.Having sugary foods and drinks too often can cause tooth decay, especially if you have them between meals. Many foodsthat contain added sugar can also be high in calories so cutting down could help you control your weight.How do I know if a food is high in added sugar?Take a look at the label. The ingredients list always starts with the biggest ingredient first. But watch out for other wordsused to describe added sugars, such as sucrose, glucose, fructose, maltose, hydrolysed starch and invert sugar, corn syrupand honey. If you see one of these near the top of the list, you know the food is likely to be high in added sugars.Another way to get an idea of how much sugar is in a food is to have a look for the ‘Carbohydrates (of which sugars)’ figureon the label. But this figure can’t tell you how much is from added sugars, which is the type we should try to cut down on.High is more than 15g sugars per 100gLow is 5g sugars or less per 100g5. Try to eat less salt - no more than 6g a dayLots of people think they don’t eat much salt, especially if they don’t add it to their food. However every day in the UK, 85%men and 69% women eat too much salt. Adults - and children over 11 - should have no more than 6g salt a day. Youngerchildren should have even less.Three-quarters (75%) of the salt we eat is already in the food we buy, such as breakfast cereals, soups, sauces and readymeals. So you could easily be eating too much salt without realising it.Eating too much salt can raise your blood pressure. And people with high blood pressure are three times more likely todevelop heart disease or have a stroke than people with normal blood pressure.How do I know if a food is high in salt?Check the label to find out the figure for salt per 100g.High is more than 1.5g salt per 100g (or 0.6g sodium)Low is 0.3g salt or less per 100g (or 0.1g sodium)6. Get active and try to be a healthy weightPhysical activity is a good way of using up extra calories, and helps control our weight. But this doesn’t mean you need tojoin a gym.58Just try to get active every day and build up the amount you do. For example, you could try to fit in as much walking as youcan into your daily routine. Try to walk at a good pace.

Children and young people should achieve a total of at least 60 minutes of at least moderate intensity physical activityeach day. At least twice a week this should include activities to improve bone health, muscle strength and flexibilityFor general health benefit, adults should achieve a total of at least 30 minutes a day of at least moderate intensity physicalactivity on five or more days of the week.Whenever we eat more than our body needs, we put on weight. This is because we store any energy we don’t use up -usually as fat. Even small amounts of extra energy each day can lead to weight gain.7. Drink plenty of waterWe should be drinking about 6 to 8 glasses (1.2 litres) of water, or other fluids, every day to stop us getting dehydrated.When the weather is warm or when we get active, our bodies need more than this. But avoid drinking soft and fizzy drinksthat are high in added sugar.AlcoholThere is nothing wrong with the occasional drink. But drinking too much can cause problems. Alcohol is also high in calories,so cutting down could help you control your weight.Women can drink up to 2 to 3 units of alcohol a day and men up to 3 to 4 units a day, without significant risk to their health.For good health, it’s a good idea to spread your drinking throughout the week and avoid binge drinking. Drinking heavilyover a long period of time can damage the liver.8. Don’t skip breakfastBreakfast can help give us the energy we need to face the day, as well as some of the vitamins and minerals we need forgood health.Some people skip breakfast because they think it will help them lose weight. There is some evidence to suggest that eatingbreakfast can help people control their weight.Please photocopy this and the subsequent food standards agency information for use with patients/clients.59

The eatwell plateIf you want to get the balance of your diet right, use the eatwell plate. The eatwell plate makes healthy eating easier tounderstand by showing the types and proportions of foods we need to have a healthy and well balanced diet. Look at theeatwell plate to see how much of your food should come from each food group. You don’t need to get the balance rightat every meal. But try to get it right over time such as a whole day or week.Try to choose options that are lower in fat, salt and sugar when you can.(To see a larger version of the eatwell plate, see the following page).The eatwell plate shows how much of what you eat should come from each food group. This includes everything you eatduring the day, including snacks.So, try to eat:plenty of fruit and vegetablesplenty of bread, rice, potatoes, pasta and other starchy foods – choose wholegrain varieties whenever you cansome milk and dairy foodssome meat, fish, eggs, beans and other non-dairy sources of proteinjust a small amount of foods and drinks high in fat and/or sugar60

Physical activity recommendationsThe chief medical officer’s report Start Active, Stay Active: A report on physical activity from the four homecountries (2011) updates existing physical activity guidelines for children, young people and adults andincludes new guidelines for early years and older people for the first time in the UK.Early years (under 5s):• Physical activity should be encouraged from birth, particularly through floor based play and water based activities in safeenvironments.• Children of pre-school age who are capable of walking unaided should be physically active daily for at least 180 minutes(3 hours), spread throughout the day.• All under 5’s should minimise the amount of time spend being sedentary (being restrained or sitting) for extendedperiods (except time spent sleeping).Children and young people (5-18 years):• All children and young people should engage in moderate to vigorous intensity physical activity for at least 60 minutesand up to several hours every day.• Vigorous intensity activities, including those that strengthen muscle and bone, should be incorporated at least three days a week.• All children and young people should minimise the amount of time spent being sedentary (sitting) for extended periods of time.Adults (19-64 years):• Adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes (2 ½ hours) ofmoderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least 5days a week.• Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across theweek or a combination of moderate and vigorous intensity activity.• Adults should also undertake physical activity to improve muscle strength on at least two days a week.• All adults should minimise the amount of time spent being sedentary (sitting) for extended periods.Older adults (65+ years):• Older adults who participate in any amount of physical activity gain some health benefits, including maintenance ofgood physical and cognitive function. Some physical activity is better than none, and more physical activity providesgreater health benefits.• Older adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes (2 ½ hours) ofmoderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least 5days a week.• For those who are already regularly active at moderate intensity, comparable benefits can be achieved through 75minutes of vigorous intensity activity spread across the week or a combination of moderate and vigorous activity.• Older adults should also undertake physical activity to improve muscle strength on at least two days a week.• Older adults at risk of falls should incorporate physical activity to improve balance and co-ordination on at least two days a week.• All older adults should minimise the amount of time spent being sedentary (sitting) for extended periods.62

The definition of overweight and obesityOverweight and obesity are terms which refer to an excess accumulation of body fat, to the extent that health may beimpaired. Overweight and obesity in adults is most commonly measured using Body Mass index (BMI), which is defined as thebody mass in kilograms divided by the height in meters squared (World Health Organization (WHO) 2004). The calculationproduces a figure that can be compared to various thresholds that define the weight status of an individual (see table 1).Table 1. WHO (2004) classification of ‘healthy’ and ‘unhealthy’ weight in adults:ClassificationBMI (kg/m2)Underweight Less than 18.5Healthy weight 18.5-24.99Overweight 25.0-29.99Obese I 30.0-34.99Obese II 35.0-39.99Obese III (Morbidly obese) 40.0 or moreBMI is a widely accepted method used to define overweight and obesity, however it is not a direct measure of adiposity (fattissue) and it fails to distinguish between mass due to body fat and mass due to muscle (North West regional public healthgroup, 2008). Therefore people who are muscular may not appear to be overweight or obese but may have an artificiallyhigh BMI because muscle is three times denser than fat (HSE, 2007). BMI results should therefore be interpreted with cautionand used alongside other measures such as waist circumference (National Institute of Clinical Excellence (NICE), 2006). NICE(2006) recommends the use of BMI in conjunction with waist circumference to measure weight status and determine healthrisks for those with a BMI less than 35kg/m2 (see table 2) (NICE, 2006). For adults with a BMI of 35kg/m2 or over, healthrisks are assumed to be very high with any waist circumference (NICE, 2006).Table 2. NICE (2006) waist circumference thresholds and risk categories for adults:BMIclassificationHealthy weight18.5-24.99Overweight25.0-29.99Obese I30.0-34.99Waist circumferenceLow High Very HighMale 102cmFemale 88cmNo increased Risk No increased Risk No increasedNo increased Risk Increased Rrisk High riskIncreased Rrisk High risk Very high riskSource: NICE (2006)Measuring overweight and obesity in children and young people is more complex than adults. This is because the relationshipbetween BMI and being overweight and obese in childhood is subject to variation by age, height and gender (NICE, 2006).To overcome these problems BMI reference charts are used. NICE (2006) recommends the use of the UK 1990 BMI growthreference standards to give age and gender specific information (NICE, 2006). A child above the 91st centile is consideredoverweight and above the 98th centile obese (Cole, Freeman & Preece, 1995. Cole et al, 2000. NICE, 2006).Among children aged from birth to 4 years of age new UK-WHO Growth Charts developed for the Department of Health bythe Royal College of Paediatrics and Child Health were launched in May 2009. These growth charts replace UK 1990 chartsfor this age group, which were based on predominately formula fed babies. The new charts are based on the World HealthOrganization (WHO) children growth standards which describe the optimal growth of healthy breast fed children. The newUK-WHO growth charts will provide more accurate measurements for infant growth of breastfed babies and will also helphealthcare professionals and parents to identify early signs of overweight or obesity and provide support (DoH. 2009).63

NHS Manchester -How to access dietary advice for children (June 2010)• The present Community Nutrition Service specification details the following; one off dietary assessments for childrenwhere there is a safeguarding concern. This will consist of an experienced Registered Dietitian discussing the case withthe referring health professional and using clinical judgement to arrange a visit to the family with the HCP and thenreport back.• MEND programmes for children who are overweight /obese in the age range 7-13 years. (PHDS will also be providingMEND programmes for this age group, see page 17)• A specialist dietitian (0.6wte), as part of Manchester’s Community Nutrition Service, provides limited dietary advice toindividual families whose children are obese (very overweight). See page 18.There is no routine service for other childhood dietary advice as this has not yet been specifically commissioned.64

NHS Manchester’s checklist before using commercialweight management organisations (CWMO)At present [June 2010] NHS Manchester has not entered into any agreements with CWMO, it is not possible therefore torecommend or endorse any schemes specifically. However the following principles should be checked before consideringusing any CWMO;NICE compliant; this means that they include;• Information and encouragement on activity sessions tailored to the requirements /needs of individuals.• Use behaviour management techniques to support new healthier lifestyle habits and long term maintenance of weightloss.• Recommend evidence based dietary changes i.e. food choices based on the Eat Well plate and portion control advice.• That expected weight loss is no more than 0.5-1kg per week.Extract from NICE guideline 43: Management of weight Commercial, self-help and community organisations• Discuss the range of weight management options and help people decide what is best for them in the long term.• If recommending commercial, community and/or self-help weight management programmes, continue to monitor patientsand provide support and care.• Check that any you recommend to patients meet best-practice standards by:• helping people decide on a realistic healthy target weight (usually to lose 5–10% of their weight)• aiming for a maximum weekly weight loss of 0.5–1 kg• focusing on long-term lifestyle changes• addressing both diet and activity, and offering a variety of approaches• using a balanced, healthy-eating approach• offering practical, safe advice about being more active• including some behaviour-change techniques, such as keeping a diary and advice on how to cope with ‘lapses’ and ‘highrisk’situations recommending and/or providing ongoing support.65

NHS Manchester - Referral criteria for bariatric surgerySince 1st April 2009 a Greater Manchester contract has been in place for bariatric surgery, this sets out the NICE criteria forbariatric surgery but also identifies priority categories, agreed by all Greater Manchester PCT’s, which NHS Manchester hasdecided to adopt. Therefore referrals for bariatric surgery from GPs contracted to NHS Manchester must meet thefollowing criteria;• BMI above 50 with no co-morbidities• BMI 45 and above with significant co-morbidities [i.e. Diabetes , CVD … And people needing obesity surgery to enableother surgery to be successfully performed e.g. knee replacement,]The bariatric review panel of NHS Manchester require full information, including dates and weights and the non surgicaltreatment completed by people seeking obesity surgery, in these priority categories.NICE guideline 43: Management of weight:States that bariatric surgery should be considered for people with severe obesity if:• they have a BMI of 40 kg/m2 or more, or between 35 kg/m2 and 40 kg/m2 and other significant disease (for example,type 2 diabetes, high blood pressure) that could be improved if they lost weight• all appropriate non-surgical measures have failed to achieve or maintain adequate clinically• beneficial weight loss for at least 6 months• they are receiving or will receive intensive specialist management• they are generally fit for anaesthesia and surgery• they commit to the need for long-term follow-upNICE guideline 43: Management of weight:States that bariatric surgery should be considered as a first-line option for adults with a BMI of more than 50 kg/m2in whom• surgical intervention is considered appropriate; consider orlistat before surgery if waiting time is long.66

Evidence based advice to protect dental health• Breast feeding should be promoted as it provides the best nutrition for babies. There is no clear evidence that breastfeedingcan cause dental decay• From six months infants should be drinking from a cup and from the age of one the use of bottles should be discouraged,especially at night• Sugar should never be added to drinks or weaning foods• Sugary foods and drinks should not be consumed more than 4 times daily and never close to bedtime• If a child requires medication it should be sugar free whenever possible and especially when it is required regularly• Teeth should be brushed as soon as they erupt with a smear (for under 3s) or a pea size amount (for over 3s) of afamily fluoride toothpaste (contains 1350 -1450 parts per million fluoride) for maximum protection and parents shouldsupervise the brushing of teethSmear for under 3sPea-sized blob for 3-6 s• Children’s toothpastes containing less than 1000 parts per million of fluoride do not give adequate protectionagainst decay and should not be used• Everyone should brush their teeth with fluoride toothpaste at least twice daily – last thing at night and on one otheroccasion• Everyone should be encouraged to spit out after brushing and not rinse with cups of water• Adults and children should attend dental services regularly for examination and preventive interventions67

National Institute forHealth and Clinical ExcellencePromoting physical activity –Brief Intervention in primary care recommendationsNICE public health guidance (2006) - Four Commonly Used Methods to Promote Physical Activity: endorses the delivery ofbrief interventions for physical activity in primary care as both clinically and cost effective in the long termBrief interventions involve opportunistic advice, discussion, negotiation or encouragement. They are commonly usedin many areas of health promotion, and are delivered by a range of primary and community care professionals. Theinterventions vary from basic advice to more extended, individually focused attempts to identify and change factors thatinfluence activity levels.Recommendation 1Primary care practitioners should take the opportunity, whenever possible, to identify inactive adults and advise them toaim for 30 minutes of moderate activity on 5 days of the week (or more). They should use their judgement to determinewhen this would be inappropriate (for example, because of medical conditions or personal circumstances). They should usea validated tool, such as the Department of Health’s general practitioner physical activity questionnaire (GPPAQ), to identifyinactive individuals.Recommendation 2When providing physical activity advice, primary care practitioners should take into account the individual’s needs,preferences and circumstances. They should agree goals with them. They should also provide written information aboutthe benefits of activity and the local opportunities to be active. (See Physical Activity section of this resource pack) Theyshould follow them up at appropriate intervals over a 3 to 6 month period.68

Raising the Issue of Weight in Children and Young People1 WHEN TO INITIATE A DISCUSSION ABOUT WEIGHT• If the family expresses concern about the child’s weight.• If the child has weight-related co-morbidities.• If the child is visibly overweight.2 RAISE THE ISSUE OF OVERWEIGHTDiscuss the child’s weight in a sensitive manner because parents may be unaware that their child is overweight. Use theterm ‘overweight’ rather than ‘obese’. Let the maturity of the child and the child’s and parents’ wishes determine the levelof child involvement.If a parent is concerned about the child’s weight:‘We have [child’s] measurements so we can see if he/she is overweight for his/her age.If the child is visibly overweight:‘I see more children nowadays who are a little overweight. Could we check [child’s] weight?’If the child presents with co-morbidities:‘Sometimes [co-morbidity] is related to weight. I think that we should check [child’s] weight.’3 ASSESS THE CHILD’S WEIGHT STATUSRefer to UK Child Growth Charts and plot BMI centile. Explain BMI to parent: eg ‘We use a measure called BMI to look atchildren’s weight. Looking at [child’s] measurements, his/her BMI does seem to be somewhat higher than we would like it to be.’If the child’s weight status is in dispute, consider plotting their BMI on the centile chart in front of them. In some cases thisapproach may be inappropriate and upsetting for the family.OverweightBMI centile>91st centileSeverely overweightBMI centile>98th centile4 ASSESS SERIOUSNESS OF OVERWEIGHT PROBLEM AND DISCUSS WITH PARENTIf child is severely overweight with co-morbidities, consider raising the possibility that their weight may affect their healthnow or in the future. This could be left for follow-up discussions or raised without the child present as some parents mayfeel it is distressing for their child to hear.‘If their overweight continues into adult life, it could affect their health. Have either you [or child] been concerned about his/her weight?’Consider discussing these points with the parent at follow-up:• Age and pubertal stage: the older the child and the further advanced into puberty, the more likely overweight will persistinto adulthood.• Parental weight status: if parents are obese, child’s overweight is more likely to persist into adulthood.• Co-morbidities: (see overleaf) increase the seriousness of the weight problem5 REASSURE THE PARENT/CHILDIf this is the first time that weight has been raised with the family, it is important to make the interaction as supportive as possible:Together, if you would like to, we can do something about your child’s weight. By taking action now, we have the chanceto improve [child’s] health in the future.’69

6 AGREE NEXT STEPSProvide patient information literature, discuss as appropriate and:• If overweight and no immediate action necessary: arrange follow-up appointment to monitor weight in three to sixmonths: ‘It might be useful for us to keep an eye on [child’s] weight for the next year and refer to available services aslisted in the resource pack’• If overweight and family want to take action: offer appointment for discussion with GP, nurse or other health professional;arrange three-to six-month follow-up to monitor weight and refer to available services as listed in the resource pack.• If overweight and family do not wish to take action now: monitor child’s weight and raise again in six months to a year.• If overweight with co-morbidities: consider referral to appropraite services in this resource pack or to secondary care:‘It might be useful for you and [child] to talk to someone about it.’BACKGROUND INFORMATIONIdentifying the problemAscertaining a child’s weight status is an important first step in childhood weight management. Parents who do not recognisethe weight status of their overweight children may be less likely to provide them with support to achieve a healthy weight. Ina British survey of parental perception of their child’s weight, the overwhelming majority (94%) of parents with overweightor obese children misclassified their child’s weight status. 1 Given this low level of parental awareness, health professionalsshould take care to establish a child’s weight status in a sensitive manner.Assessing weight status in childrenThe child growth charts for the UK allow easy calculation of BMI based on a child’s known weight and height. 2 Measuresof body fat in children can also be a useful way of assessing a child’s weight status. Details of body fat reference curves forchildren are now available, 3 although, in practice, body fat cannot be assessed without the necessary equipment.Assessing the severity of the problemA number of factors are known to increase the risk of childhood obesity and the likelihood that a weight problem will persistinto adult life. Considering these factors will help you to make an informed decision about the most appropriate mode ofaction.• The older the child, the more likely it is that their weight problem will continue into later life and the less time they haveto ‘grow into’ their excess weight.• A child is 20–40% more likely to become obese if one parent is obese. The figure rises to around 80% if both parents areobese.• While weight problems can lead to psychosocial issues such as depression and low self-esteem, weight loss may notnecessarily resolve these problems, so don’t rule out referral to CAMHS.Health risks of excess weight in childhood 4,5Being obese in childhood or adolescence increases the risk of obesity in adult life. Childhood obesity will also increase thechances of developing chronic diseases typically associated with adult obesity:• insulin resistance and type 2 diabetes;• breathing problems such as sleep apnoea and asthma;• psychosocial morbidity;• impaired fertility;• cardiovascular disease;• dyslipidaemia;• hypertension;• some cancers;• orthopaedic complications.70

Importance of weight controlFor many overweight children, prevention of further weight gain is the main goal because as long as they gain no moreweight, they can ‘grow into’ their weight over time. This goal can be achieved through lifestyle changes:• improving the diet, eg by increasing fruit and vegetable consumption, reducing fat intake and portion sizes, consideringintake of sugary drinks, and planning meals;• increasing activity, eg playing football, walking the dog;• reducing sedentary behaviours such as time spent watching TV or playing computer games. If the child is more severelyoverweight, or has already reached adolescence, ‘growing into’ weight is more difficult and weight loss has to be considered.Need to offer solutionsUnless the child is severely overweight with comorbidities, be led by the parents’ and/or child’s wishes. Encourage action ifappropriate. Health professionals should be ready to offer referral support so that they are seen as taking the issue seriously.If the child is very overweight and has co-morbidities, the child (and family) may require on-going support despite referrals,eg through continued weight monitoring, additional specialist referrals, or help with family-based lifestyle modification.1Carnell S et al (2005) Parental perceptions of overweight in 3–5 year olds. Int J Obes 29: 353–5.2Cole T et al (2002) A chart to link child centiles of body mass index, weight and height. Eur J Clin Nutr 56: 1194–9.3Jebb S et al (2004) New body fat reference curves for children. Obes Rev (NAASO Suppl) A156.4McCallum Z and Gerner B (2005) Weighty matters: An approach to childhood overweight in general practice. Aus FamPhys 34(9): 745–8.5British Medical Association Board of Science (2005) Preventing Childhood Obesity. BMA.© Crown Copyright 2006 274544 1p 60k Apr06 (BEL)Produced by COI for the Department of Health. First published April 200671

Raising the Issue of Weight in Adults1. RAISE THE ISSUE OF WEIGHTIf BMI is >25 and there are no contraindications to raising the issue of weight, initiate a dialogue:‘We have your weight and height measurements here. We can look at whether you are overweight. Can we have a chatabout this?’2 IS THE PATIENT OVERWEIGHT/OBESE?BMI (kg/m2) Weight classification25–29.9 Overweight>30 ObeseUsing the patient’s current weight and height measurements, plot their BMI with them and use this to tell them whatcategory of weight status they are.‘We use a measure called BMI to assess whether people are the right weight for their height. Using your measurements,we can see that your BMI is in the [overweight or obese] category [show the patient where they lie on a BMI chart]. Whenweight goes into the [overweight or obese] category, this can seriously affect your health.’WAIST CIRCUMFERENCEIncreased disease riskMenWomen>40 inches (>102cm) >35 inches (>88cm)Asian menAsian women>90 cm >80 cmWaist circumference can be used in cases where BMI, in isolation, may be inappropriate and to give feedback on centraladiposity. In Asians, it is estimated that there is increased disease risk at >90cm for males and >80cm for females.Measure midway between the lowest rib and the top of the right iliac crest. The tape measure should sit snugly around thewaist but not compress the skin.3 EXPLAIN WHY EXCESS WEIGHT COULD BE A PROBLEMIf patient has a BMI >25 and obesity-related condition(s):‘Your weight is likely to be affecting your [co-morbidity/condition]. The extra weight is also putting you at greater risk ofdiabetes, heart disease and cancer.’If patient has BMI >30 and no co-morbidities:‘Your weight is likely to affect your health in the future. You will be at greater risk of developing diabetes, heart disease andcancer.’If patient has BMI >25 and no co-morbidities:‘Any increase in weight is likely to affect your health in the future.’4 EXPLAIN THAT FURTHER WEIGHT GAIN IS UNDESIRABLE72‘It will be good for your health if you do not put on any more weight. Gaining more weight will put your health at greater risk.’

5 MAKE PATIENT AWARE OF THE BENEFITS OF MODEST WEIGHT/WAIST LOSS‘Losing 5–10% of weight [calculate this for the patient in kilos or pounds] at a rate of around 1–2lb (0.5–1kg) per weekshould improve your health. This could be your initial goal.’If patient has co-morbidities:‘Losing weight will also improve your [co-morbidity].’Note that reductions in waist circumference can lower disease risk. This may be a more sensitive measure of lifestyle changethan BMI.6 AGREE NEXT STEPSProvide patient literature and:• If overweight without co-morbidities: agree to monitor weight and refer to services available.• If obese or overweight with co-morbidities: arrange follow-up consultation and refer to services available.• If severely obese with co-morbidities: consider referral to appropraite services in this resource pack and to secondary care.• If patient is not ready to lose weight: agree to raise the issue again (eg in six months).BACKGROUND INFORMATIONRaising the issue of weightMany people are unaware of the extent of their weight problem. Around 30% of men and 10% of women who areoverweight believe themselves to be a healthy weight. 1 There is evidence that people become more motivated to lose weightif advised to do so 2 by a health professional. 2Health consequences of excess weightThe table below summarises the health risks of being overweight or obese. 3 In addition, obesity is estimated to reduce lifeexpectancy by between 3 and 14 years. Many patients will be unaware of the impact of weight on health.Greatly increased risk Moderately increased risk Slightly increased risk• type 2 diabetes• gall bladder disease• dyslipidaemia• insulin resistance• breathlessness• sleep apnoea• cardiovascular disease• hypertension• osteoarthritis (knees)• hyperuricaemia and gout• some cancers (colon, prostate, postmenopausalbreast and endometrial)• reproductive hormone abnormalities• polycystic ovary syndrome• impaired fertility• low back pain• anaesthetic complicationsBenefits of modest weight loss 4Patients may be unaware that a small amount of weight loss can improve their health.Condition Health benefits of modest (10%) weight lossMortality • 20–25% fall in overall mortality• 30–40% fall in diabetes-related deaths• 40–50% fall in obesityrelated cancer deathsDiabetes • up to a 50% fall in fasting blood glucose• over 50% reduction in risk of developing diabetesLipids• 10% fall in total cholesterol, 15% in LDL, and 30% in TG, 8% increase in HDLBlood pressure • 10 mmHg fall in diastolic and systolic pressures73

Realistic goals for modest weight/waist loss (adapted from Australian guidelines) 5Duration Weight change Waist circumference changeShort term 2–4kg a month 1–2cm a monthMedium term 5–10% of initial weight 5% after six weeksLong term10–20% of initial weightPatients may have unrealistic weight loss goals.aim to be

Useful websiteswww.apho.org.uk - Association of Public Health Observatorieswww.babyfriendly.org.uk - There is lots of information on this site that can help services go Baby Friendly, as well as acomprehensive research archive and a section for parentswww.bbc.co.uk/health - BBC Health Topics and Health Newswww.bhf.org.uk/keeping_your_heart_healthy/staying_active.aspx - Ways to get more active and information on thebenefits of activitywww.bmj.com - The BMJ is an international peer reviewed medical journal and a fully “online first” publication. NHS staffand students have full online access to the British Medical Journal using their NHS Athens detailswww.britishcycling.org.uk - Go to Skyride for information on led rides and mass participation events. Have a look at theTravel and Recreation sections for online cycling support, cycling routes and eventswww.cks.nhs.uk/obesity - The NHS Clinical Knowledge Summaries (formerly PRODIGY) are a reliable source of evidencebasedinformation and practical ‘know how’ about the common conditions managed in primarycare e.g. overweight and obesity. They are aimed at healthcare professionals working in primaryand first-contact carewww.counterweight.org - Weight management in primary carewww.cwt.org.uk – Caroline Walker Trust, nutritional and practical guidelines for both young and oldwww.dancechampions.org.uk - Developed to support and encourage more people to be more activewww.dh.gov.uk – Contains Your Weight Your Health (2006) which is a comprehensive package that comprises materialsfor health professionals as well as information to be given to patientswww.dietaryadvicedirect.co.uk/ - Dietary advice direct is an online guide that helps people through the process of settingrealistic and achievable goals to lose weight for lifewww.eatwell.gov.uk – Information from the Food Standards Agencywww.evidence.nhs.uk - NHS Evidencewww.food.gov.uk – Information from the Food Standards Agencywww.foodfutures.info - Food Futures is a partnership that embraces a wide range of individuals and organisations with aninterest in improving food in the citywww.fph.org.uk - Faculty of Public healthwww.gettingmanchestermoving.org - Getting Manchester Moving is a project designed to encourage and supportManchester people to get more physically active, eat more healthily and in somecases to lose weightwww.gmphnetwork.org.uk - Greater Manchester Public Health Networkwww.greatersport.co.uk – This website lists many physical activity opportunities for children and young peoplewww.hpa.org.uk - Health Protection Agencywww.ic.nhs.uk - The Information Centrewww.library.nhs.uk - Health Information Resources75

www.manchester.gov.uk/health/jhu - The Joint Health Unit is a key part of the public health system in Manchester. Itis a team that focuses on strategic planning and partnership working for healthimprovement and tackling health inequalitieswww.manchester.gov.uk/jsna - Manchester Joint Strategic Needs Assessment 2008 – 2013www.manchester.nhs.uk – NHS Manchester Public Healthhttp://manchester.plings.net/index.php - Places to go, things to do. This website includes a list of sporting/physical activityopportunities for children in Manchesterwww.map-project.org.uk - Manchester’s Multi Agency Partnership for Disabled Children and Young People (includes a listof physical activities/clubs in Manchester)www.mendprogramme.org – Mind exercise nutrition do it - Fitter, healthier, happier families. MEND is an organisationdedicated to reducing global overweight and obesity levels among children and youngpeoplewww.mhim.org.uk - Information about mental healthwww.mphds.org/ - Manchester Public Health Development Servicewww.mymanchester.net - My Manchester is a community portal, from Manchester Community Information Networkwhich provides links to Manchester related informationwww.myschoollunch.co.uk/manchester - Making school lunch times the ninth lessonwww.ncmp.ic.nhs.uk –National Child Measurement Programme resultswww.netmums.com - Netmums is a unique local network for Mums (or Dads), offering a wealth of information on both anational and local level e.g. local physical activity opportunities for parents and children.www.nhsdirect.nhs.uk – NHS Directwww.nhs.uk/lifecheck - NHS LifeCheck is an online health service for babies, teens and middle-aged adultswww.nhs.uk/5aday - Top tips for eating more fruit and vegetableswww.nhs.uk/Change4Life - Change for Life: Tops for healthy kids and familieswww.nhs.uk/livewell/alcohol - How drinking can affect health, with alcohol units and recommended limits explainedwww.nhs.uk/LiveWell/Loseweight - Articles to help with all aspects of attaining a healthy weightwww.nhs.uk/ServiceDirectories/Pages/ServiceSearchAdditional.aspx?ServiceType=SportAndFitness&WT.mc_id=090905 – Find local physical activity/sporting opportunities close to home/workwww.nhs.uk/livewell/fitness - Information on becoming more activewww.nhs.uk/News/Pages/NewsIndex.aspx - NHS Choices (Behind the Headlines)www.nhs.uk/planners/nhshealthcheck/Pages/NHSHealthCheck.aspx - The new NHS Health Check is for adults inEngland between the ages of 40 and 74. In thissite you can learn more about what the checkis, what it involves, and when and how you canget itwww.nice.org.uk – National Institute for Healthcare and Clinical Excellence76

www.nks.nhs.uk - National Knowledge Servicewww.nwpho.org.uk - North West Public Health Observatorywww.promotingactivitytoolkit.com - The Promoting Activity toolkit helps bring the Change4Life campaign to life inlocal areas. It has photos, an online design tool to help create Change4Life posters,calendars of campaigns to help plan when to do marketing and an activity searchtool to help make it easier for the public to find their local activitywww.ramblers.org.uk - Details of many locally organised walking groups, catering for all levels of fitnesswww.smokefree.nhs.uk - Quit smoking information and advicewww.sustrans.com - Information on starting off cycling and national cycle network mapswww.walkengland.org.uk/walknowgettingstarted.aspx - A comprehensive website, with information on how to getactive through walking, linking to lots of different localopportunitieswww.walkit.com - Walkit.com is an urban walking map and route planner that helps you get around town on footwww.whatisseries.co.uk - The “What is…?” series on Healthcarewww.whi.org.uk - ‘Walking the way to health’ aims to encourage people, particularly those who take little exercise, to doregular short walks in their local communitywww.who.int - World Health Organisationhttp://www.yougo4it.co.uk/manchester - Advice about food and exercise for young people in ManchesterIf you would like also to receive a daily media digest of health news called presswatch, just send your email address to:cuttings@presswatch.comAccess to websites is available at every public library77

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Appendix 2FAMILY CLUBFamily Weight Management – Active LifestylesReferral to the programmePreliminary child suitability assessment (please circle where appropriate)Is the child age between 5 – 16 yearsIs the child, together with a parent/ carer, able to commit to weekly sessions?If YES is answered to both of these questions please proceed with the referralChild’s DetailsFirst Name:Parent/ Carer’s Name:Yes/ NoYes/ NoSurname:Sex: (Please circle)Male/ FemaleRelationship to child:Address:Date of Birth:Postcode:NHS Number:Telephone Number:Height & Weight (Please enter)Height (cm) Weight (kg) Date Taken:Medical HistoryRelevant medical history:Current Medications:Additional social information, learning and/ or behavioural difficulties if relevant:Medically is the child able to participate in physical activity sessions? Please circleYes/ NoIf NO please state the reasons for this:Referrers DetailsReferred by (print name):Address:Job Title/ Profession:Signature:Date:PostcodeTelephone Number:Email:Referral Return Address – please send this completed form to:Active LifestylesTel 0161 232 3114/ 3117/ 3100Denmark Road, Hulme, Manchester, M15 6FG Fax 0161 276 7483Office Use Only79

80Appendix 3

Appendix 4‘Your Choice’ -Weight Management ProgrammeThank you for requesting information from us to try to help you to control your weight. Losing weight isnot easy and we do not claim to be able to prescribe any miracle potions. We certainly cannot do it foryou – the hard work and effort must come from you.One thing we will promise to do is to work with to provide the advice and support you require in order toachieve long term successful weight loss. You need to be a Manchester resident or have a ManchesterGP (This does not include Trafford, Stockport, Tameside or Salford).What we do to help you;Education Morning – A group session to discuss food, eating and energy intake wealso look at activity and motivation to make these lifestyle changes to lose weight.Activity - with help from P.A.R.S.* and qualified instructors if you wish you can workon increasing your activity. Activities to suit all levels of ability are available.Health checks – You will be offered health checks to monitor your weight, body fat,blood pressure and heart rate to check if you are losing weight and getting fitter. Wewill help you set goals to achieve this.Drop-in - You can come along anytime during the half hour to have a chat and getweighed if you wish.Mondays – 12:00 to 12:30 upstairs at the Forum Health Centre1 to 1 – An appointment with a Registered Dietitian Initial Appointment with a Health Trainer if your Body Mass Index is less than 30*Physical Activity Referral SchemeWhat do you need to do?If you are ready to make a start and want to lose weight, you need to fill in the referral form and return tous at the address at the foot of this letter. We will then get in touch and invite you to an educationmorning (usually 10am – 12.30pm)Yours sincerely,Ray Green, Suzanne Paul and Jen Bramley – Dietitian and Nutrition Assistants‘Your Choice’ (Community Nutrition Service)Wythenshawe Offices, 1, Stancliffe Road, Sharston, Manchester, M22 4PJTel: 0161 946 8210 Fax 0161 946 8209,81YC/Ed Day/ YC Letters/ YC-1 Pat Interest

Appendix 4Referred by:Self ReferralDate:Health Care Professional (Name and Designation)* Your patient will only be seen if they agree to the referralPlease tick if your patient has agreed‘Your Choice’Weight Management ProgrammeApplication FormPlease complete all sections of this form. We may otherwise need to return it to you for completion.If you need any help, contact our team or ask the person who handed you this form.First Name:Date of Birth:Surname:Telephone number:Address:Postcode:Doctors Name:Doctors Address:Current Weight:Height:Do you have any medical conditions (please state)?Do you take any medicine or tablets (please list)?Weight history over the past 2 years?Do you do require an interpreter?Referral Reason:82Please return to:YC/Ed Day/ YC Letters/ YC-1 Pat Interest“Your Choice” Community Nutrition ServiceWythenshawe Offices, 1, Stancliffe Road, Sharston, M22 4PJTel: 0161 946 8210 Fax 0161 946 8209

Appendix 5Weight No More - Referral FormIs the client currently on any other weight management programme?(Please list/ describe)Please complete this referral form if you know of a resident who would benefitfrom the Weight No More programme. Here’s a quick guide to show what isoffered on the programme.Current Weight (if known)………………………………………………….Height (if known)…………………………………………………………….BMI (if known)………………………………..…Date taken…..................Blood Pressure (if known)…….......................Date taken……………….How mobile or active is the resident? (Please describe if possible)Programmes: Daytime and evening sessions on various days of the week; there willalways be two sessions per week at the same venue. Nutrition/ Support advice workshops run for the first half-hour ofsessions (these can be excluded if the resident is already receivingnutritional advice from another weight management programme). Additional Personal Development workshops will run as part of theprogramme. Sessions are at venues across the city. Health checks/ measurements recorded. Sessions are only suitable for residents with no co-morbidities andthat have a BMI over 25.00Medical HistoryPlease list any relevant medical conditions and / or any medication that mayaffect participation:…………………………………… ………………………………………………………………………… ………………………………………………………………………… ……………………………………Referred by:(Name)……………………………………………………………….(Date)…………………………………………………………………(Position)……………………………………………………………..(Tel/ Email)…………………..……………………………………….…………………………………………………………………………Client DetailsName………………………………………………………………….Address……………………………………………………………….Thank you for completing this referral form. Once youhave sent this to us we will contact the resident.Postcode………………………………………………………………Tel/ Mobile……………………………………………………………Date of Birth…………………………………….……………………Please send this form either by post:-Active Lifestyles, Denmark Road, Hulme, Manchester, M15 6FG orFax: 0161 276 7483Email: a.matthews@manchester.gov.uk ORr.mcguigan@manchester.gov.ukWeight management historyIs the client currently on the Counterweight or the Your Choice programme?(please tick which programme if yes)Please address for the attention of Angela Matthews OR RossMcGuigan.For any enquiries please contact us on Tel: 0161 232 3114 / 3117.CounterWeight [ ] Your Choice [ ]83

Appendix 6HEALTH TRAINER REFERRAL FORMTel: 0161 861 2548Fax: 0161 203 5817Client number:(Health Trainer use only)HT initials Year Client noName of client referred:Client’s address:Client’s full postcode:Telephone no:Referrer’s name and position:Referrer’s contact details:Address:Tel:Date: / /D D M M Y Y Y YThank you for your interest in the Manchester Community Health Trainers service. ManchesterCommunity Health Trainers aim to support people to adopt health promoting behaviour. HealthTrainers do this by helping people to identify their own goals and stick to them. They will alsogive some practical support, particularly around losing weight, eating more healthily and doingmore physical activity. Health Trainers can also provide information on other services that canhelp individuals to achieve their goals.What do you want to focus on?(tick all that apply) food (healthy eating) physical activity (exercise) smoking drinking other what? …………………………………………….You can send the completed form or make further enquiries to this freepost address:Manchester Community Health Trainers, Business Reply Licence No RRBL-ASHX-YYCB, ManchesterPublic Health Development Service, Victoria Mill, Lower Vickers Street, Miles Platting, Manchester M407LJ Tel: 0161-861-2548; Fax: 0161-203-5817Official use only Outcome: couldn’t make contact didn’t want service at this time booked in for first visit didn’t meet service criteria84

Appendix 7Manchester Community Alcohol TeamAlcohol Linkworker Referral FormDate of referral:Details of person wanting advice / supportDOB:Name:Address:Post code:Tel No:GP details (if known):Name:Practice Address:Tel No:Details of person making referral if different from aboveName:Organisation / relationship to personrequesting help:Address:Tel No:Brief reason for referral:CAT Referral Form 2011-07-0185

Appendix 7How to send your referral to Manchester Community Alcohol TeamBY SECURE FAX:0161 882 1344BY POST:Manchester Community Alcohol TeamLongsight District Office523 Stockport RoadManchesterM12 4LLWhen we receive referrals by post or by fax, we will telephone the person wantingadvice / support so they have a chance to ask any questions about our service.86CAT Referral Form 2011-07-01

Appendix 887

88Appendix 8

Appendix 9Manchester Science Park1 st Floor, Unit 21Enterprise HouseLloyd Street NorthM15 6SETel: 0161 227 0600Fax: 0161 227 0605Family Nurse PartnershipReferral form for Family Nurse Partnership Project Wave 1 & Wave 2Supervisors Vanda Wellock & Lesley LambYoung women under 20yrs who are pregnant for the 1 st time?Date:Name:NHS Number:DoB:EDD:Address:Postcode:Home Number:Mobile Number:Weeks Gestation:GPs name:Telephone number:Referrers name:Contact Details:Is it O.K for Family Nurse to contact client: Yes/No89

Appendix 10Paediatric Referral Form for Children with Weight ManagementIssues and Associated Musculoskeletal ConditionsPlease fax completed form to 0161 220 5809 then send original in postCriteria For Referral (when to refer)• 17 and under• Identification of weight issues using IOTF BMI centile cut offs• Associated joint pain e.g. In knees or back which is impacting on the child’s ability to take partin physical activity or increase their activity levels(When not to refer)• When child and their family are not in agreement with the referralName: DOB: NHS No.Date of Referral ____/____/____Name of Referrer:Address:Address:Tel No:Postcode:Home Tel:Mob Tel:Name of CarerRelationshipReason for Referral:GP Name:Address:Postcode:Tel No:Relevant Medical Details:Current WeightCurrent BMIBPSummary of previous weight management interventionsAssociated joint painOther services involvedMSK Team – Cornerstone Centre, 2 Graham Street, Beswick, Manchester, M11 3AA. Tel No. 0161 220 7110 Fax: 0161 220 399190

Appendix 11Children and Young People’s Services Referral FormPlease select the service you are referring to by marking “X” in one of the appropriate boxes below:Audiology Children’s CommunityNursing TeamDisabled Children’sTeam Nursing ServiceOccupationalTherapyPaediatrics Physiotherapy Podiatry Speech andLanguage TherapyHealth Visiting ServiceSchool Health / School Nursing ServiceOrthopticsOther – please state* Starred fields are mandatory. If any of these fields are not completed the form will be returned to the referrer.Surname: *Forename: *Previous Surname:Address: *Date of Birth: *NHS Number: *Gender: * Male / FemalePostcode: *Is copy appointment letter required: Yes / NoPlease give details:Appointment Preference (mark with x):Monday Tuesday Wednesday Thursday Fridayam pm am pm am pm am pm am pmHome Telephone: *Mobile Telephone:E-mail Address:Reminder required for appointments (if available):Text: Yes / NoE-mail: Yes / NoLanguage Spoken: *Interpreter Required: * Yes / NoEthnicity: * Religion: *Disability: * Y / N Access Needs:Common Assessment Framework (CAF) Completed: *Yes / NoMulti Agency Case Planning:Lead Professional / Key Worker:Name:Address:Telephone:Other Professionals Involved:Yes / NoDiagnosis / Reason for referral / treatment required: *GP Name: *Practice Name: *Practice Address: *Nursery / School Attended:Manchester Health Record Holder & Base:Additional information (including test results orprovide clinic letter as appropriate):Referrer Name: (PLEASE PRINT) *Designation: *Address: *Telephone: *Date of referral: *Have parents agreed to referral? *Has this child been referred tothis service previously:Yes / NoYes / NoOffice Use OnlyDate referral received …………………….....…............... Demographic details checked on child health system? Yes / NoName……………………………………………….……….. Date……………………………………Date of appointment………………………………………CYPS1v6 November 201091

Appendix 12Stroke Association – Healthy Living Referral Form to 8 week programmeName:Name of NoK:Male/Female:Address:Relationship:Address:Ethnicity:Telephone:Discharge Address if different:Telephone:GP Name:GP Address:Discharge Telephone if different:Date of Stroke:DoB: Age: Ward/Consultant:Marital Status:Married Single Widowed Div/SepLives Alone: Yes/NoStroke/TIA:Home Stroke/Neuro Outreach:(if applicable)Referrers Name:Details of carer if different from NoKName:Relationship:Transferred to:Date of Transfer:Date of Discharge:Discharged to:Referrers Job Title:Does the carer wish to attend thesession?Transport required or not:Address:Telephone:921

Appendix 12Brief Medical History:Comments with regard to current medication and medical status:Communication:Dysphasia Dysarthria Dyspraxia Receptive:No Problem |____|____|____|____|____|____|____|____|____| SevereExpressive: No Problem |____|____|____|____|____|____|____|____|____| SevereComments:Exercise experience prior to stroke:Present Mobility:Additional support needed:Flexibility:Other health problems:Comments with regards to suitability to programme:93

Appendix 13A STRUCTURED PATIENT EDUCATION PROGRAMME FORPEOPLE WITH DIABETESDo you want to increase your skills, knowledge andconfidence in managing your diabetes?The local X-PERT programme is a six-week group diabetes education programme. You will learnall about the up-to-date treatments and management of diabetes and will have the opportunityto explore and address problems/issues that you may have with your diabetes.The programme has been shown to improvediabetes control, increase self-management skills,improve lifestyle and quality of life.You are invited to attend the X-PERTprogramme. It is important to attend all theweeks to get the most out of the course. Youare welcome to bring along a family memberor friend, however the session are notsuitable for children to attend.Week 1. What is DiabetesWeek 2. Weight ManagementWeek 3. Carbohydrate awarenessWeek 4. Supermarket TourWeek 5. Possible ComplicationsWeek 6. Questions and EvaluationThe sessions will last for 3 hours except onWeek 4 that’s 2 hours and at your nearestSupermarket.Comments from patients:‘This is the first time in 10 years of being a diabetic thatanybody has told me these things’‘Very glad to be offered the course, much appreciated(Thank you NHS!). Feel much encouraged in dealing withmyself and more understanding with latest knowledge’‘I am more at ease with diabetes from what I have learntand able to control it better’‘I was very impressed – the sessions have been deliveredin a manner that had obviously gone beyond thatrequired to make them understandable’‘Don’t feel as frightened as I did.....feel more confident inmyself…things explained so that anybody & everybodycan understand’‘This course was really helpful in helping me understanddiabetes as all demonstrations were in laymen’s language- programme should have been implemented years ago’94

Appendix 13Ifyou would like to attend, please complete the reply slip below.Reply Slip (Please Complete as much as possible)I would like to attend the X-PERT Programme. (Please circle) Yes NoYour Name:Home Address:PostCode:Telephone Number:Date of Birth:GP Practice:Date of Diagnosis of Diabetes:Treatment for Diabetes (please circle) Diet Tablets InsulinWould like to bring a friend/carer/ family member? (please circle) YesNoPlease return the reply slip to one of the diabetes team or post to:‘X-PERT Diabetes’, Community Nutrition Service, Wythenshawe Offices, Stancliffe Road,Sharston, Manchester, M22 4PJ.If you would like any further information please contact:Amy Griffiths - Dietitian: 0161 946 8210Helen Tyrer – Podiatrist: 07970 650787Jackie Price – Diabetes Specialist Nurse: 0161 945 8203.95