A Leap Into The Future With The Health and Care Bill

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The Health and Care Bill is a major piece of UK legislation that’s completely changed the picture for SHINE. It’s a complex proposal that’s been on the go for almost ten years and has attracted headlines over concerns it might lead to the privatisation of the NHS. That’s understandable given past governments’ track records. But as The Nuffield Trust has highlighted, “There is nothing in the Bill that would change the NHS from being a publicly funded service, free at the point of use except for existing charges for services like dentistry…” And the bill’s stated aim of addressing the challenges faced by those with complex healthcare needs in particular (The King’s Fund describes this as “a patchwork of organisations that sometimes work together well but sometimes, unfortunately, do not…”) could materially improve things for patients.

That’s where SHINE comes in.

The bill legalises the creation of new partnerships between different health and care organisations – called Integrated Care Systems (ICSs) – that will provide patients with health provision that’s promised to be more local, moving services “out of hospitals and into the community…” As the government’s press release claims.

This means new partnerships between health and social care and education organisations – everyone from voluntary and community sector NGOs and local authorities to Sheffield Children’s Hospital. For years SHINE have been delivering materially successful health programmes from outside the system. We are now in a prime position to share experience with evidence of good practice.

The success of the Government’s bill will be dependent on a large number of factors, but connecting high quality voluntary/community services is central. SHINE’s track record of results and focus on partnerships – with schools most recently (read on for the latest on this) but going back to our work with Chilypep  and our long term funders Children in Need has put us in the spotlight.

That spotlight means our work is being more formally recognised and valued, which is most welcome. But it also means we can develop projects with other organisations, integrate our knowledge into services, and – more important than anything else – help more children and young people who are living with obesity and complex needs.

We’ll be sharing more on this as soon as we can so make sure you’re following us on Twitter if you’re not already doing so. But for the first time, SHINE’s fate is in our hands.

By the way, thank you to MP Paul Blomfield for his long term dedication, enthusiasm and commitment in helping get SHINE recognised in 2021. Paul has been our voice for years at parliamentary level fighting for appropriate services and funding for Tier 3 services for children and young people. Thanks for believing in us and advocating for our work Paul.

Three Tips for 100% Retention on Zoom

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We’re really proud of SHINE’s track record on participant retention – or ‘keeping people engaged’ in normal speak! So what was our reaction when the first Zoom session on our most recent 12-week maintenance course (which coincided with the latest national lockdown) showed us a screen full of empty, muted boxes with not a single camera or mic switched on?

We were overjoyed! Silent and invisible though they’d chosen to be, everyone had turned up….and everyone continued to attend. It took six weeks to go from blank screens to a wall of faces though. How did we do it? We’ve got three tips for you.

1. Build confidence. Our maintenance group were brave. They highlighted how anxious they were feeling. By responding with positive affirmation, humour and an appreciation of how difficult life currently is for them we built their confidence. Face to face is always going to be a richer experience than Zoom but there are basic principles of human contact that apply to both, including showing understanding and empathy.

2. Understand your tools. Everyone knows “I am not a cat” (link here – https://www.theguardian.com/commentisfree/2021/feb/11/lawyer-cat-funny-texas-rod-ponton-judge just in case you don’t). But SHINE’s Kath Sharman dived headlong into Zoom’s filters to take away the fear factor of going on camera. Our new groups were more body conscious than ever but using the moustache and eyebrow filters, for example, helped empower our participants and made us all feel more connected.

3. Listen and respond. We adapted our 12-week programme in record time to meet the priorities of our group. This meant postponing sessions on nutrition to focus on body confidence and emotional literacy – enabling our groups to share their stories and experiences in a safe and supportive way. This showed we were listening and responding to our participants’ needs.

It took us six weeks before everyone in our group was happy to switch their webcams on so ‘Be patient’ is our bonus tip!

Free Zoom Knowledge Builders for Obesity Care Week

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Today is the launch of Obesity Care Week (OCW), an annual public awareness effort supported by more than 60 countries worldwide and more than 75 healthcare-focused organisations.

OCW’s aim is to elevate societal awareness of obesity educate individuals impacted by the disease as well as healthcare professionals, medical societies, policy makers, payers, and other stakeholders – and to advocate for a better world for people living with obesity. They also campaign for fair care and treatment without weight bias. These are all aims we’re squarely behind here at SHINE and we’ll be supporting OCW with a short presentation each day on the topics outlined by the project, as follows:

Each presentation starts at 1300 GMT via Zoom and is presented by SHINE’s Kath Sharman, who’ll draw upon her experiences of working with children and young people living with severe obesity and complex needs.

The link is the same for each session: https://zoom.us/j/92042754753?pwd=elZ4dzhLMGk4ZWk4bEJlRnJjYkl4UT09

Meeting ID: 920 4275 4753

Passcode: 233040

We’d be delighted if you could join us.

For more details please contact:  kath@shinehealthacademy.org.uk

Three ways coronavirus is disrupting weight management programmes – and three ways to fight back

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SHINE’s most recent psychosocial programme has just finished and it was incredibly challenging. Presenting problems weren’t  food-related this term, but stressors of the daily life young people faced; leaving school in Y6 and Y11 with little transition preparation, finding an identity in new environments, losing old friendships and establishing new ones, family conflicts, illnesses, bereavements, and fear of social contacts, all contributed to our participants’ patterns of eating.

Weight losses were minimal (although weight gains were too) and a combination of weariness with lockdown and government restrictions meant we had to come up with new approaches to ensure positive outcomes for the children and young people in our groups. So here’s three ways coronavirus is disrupting weight management programmes – and three ways to fight back…

Three Ways Covid-19 is Disrupting Weight Management Programmes…

1. Constant Change – Part of SHINE’s success has been built on presenting participants on our programme with a structure they can believe in. But it’s hard to build that structure on the shifting sands of 14-day self isolation periods, tiers, lockdowns, bubbles, guidance, instructions and advice.

2. Sport Facilities Shut Down – There’s a buzz to our gym and swimming groups at Springs Leisure Centre and we’re pretty sure missing out on those activities since coronavirus has negatively affected not just our weight loss results but our groups’ wellbeing.

3. Anxiety – For the first time in 17 years, levels of anxiety and depression in our group were higher at the end of the module than at the beginning. Coronavirus has brought illness, bereavements and disrupted education – and taken away social contact with friends and family. SHINE have had to ringfence the emotional wellbeing of our children and young people before even considering weight loss.

…And Three Ways to Fight Back

1. Embrace innovation – It’s always easier to walk down a well-worn track but moving in a new direction can be exciting and fun as we have learnt. For example, developing zoom friendly interactive workbooks gave us a connection where young people could work after their class with their family following simple instructions in there. Staff resilience and endless hours of reshaping how we deliver our interventions has really paid off thanks to a dedicated team of volunteers and workers creating flexible and adapted resources.

2. Go Public – Keeping strictly to government and NHS instructions, we developed ‘bubble sport’ events in the full gaze of Norfolk Park – with outdoor walks, dance, circuits and aerobics. Making the switch from behind closed doors to out and proud in public spaces was a leap in the dark, but the response from the public was inspirational! We even had people joining in – at a distance of course…

3. Be Person Centred – From SHINE’s Young People’s Committee to our multi-family discussion groups, finding out what works best for our young people, keeping them involved and providing support that is really meaningful to them really matters. And it’s succeeding. Our most recent programme run – a 12-week course starting September and finishing earlier this month – had 100% retention. SHINE’s Kath Sharman will be presenting more on this at the Webinar conference run by the Care of Childhood Obesity (CoCO) clinic at Bristol Royal Hospital for Children. Click here to find out more.

Boris’s Blow Out Puts Everyone’s Health On The Line

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You’ve probably seen adverts like the one above. They’re part of Boris Johnson’s new Obesity Plan for a healthier nation. You might have seen them on the way back from an Eat Out To Help Out ‘blow out’ – another government scheme. What a contradiction to release a campaign encouraging us to eat better at the same time as encouraging us to overindulge!

We’re also disappointed in the messages behind the billboards. Johnson’s campaign yet again focuses on the food industry.

The government’s changes – banning TV and online ads for high fat, sugar and salt foods before 9pm; the end of ‘buy one get one free’ deals on unhealthy food; and putting calorie counts on restaurant menus – are simple smart tweaks that no-one can disagree with. And will make very little material difference to people’s lives.

Meanwhile, Obesity Canada release their guidelines; ‘A Patient-Centred Approach to Obesity Care‘ with a 5 step approach that includes recognising obesity as a chronic disease, individual assessments to identify root causes and barriers to obesity treatment, discussion of different treatment options and agreement of goals. And now everyone is raving about this ‘new approach’ when these are exactly the principles SHINE has had in place for the past 17 years!!!

In the UK, there are still no intervention plans for those already living with obesity. The “Better Health” campaign recommends a 12-week weight loss plan based around an app that helps users to set weight loss goals, plan meals, make healthier food choices, to get more active and to burn more calories. But how will that help those living with severe obesity and complex needs? There are no treatment strategies and still no mention of the whole system approach. When will they understand that obesity is not just about ‘eat less and move more’?

What Do SHINE’s 8-18 Year Olds Think About Coronavirus-19?

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You might imagine that putting takeaways, supermarkets and vending machines out of reach would make healthy eating habits easier for SHINE’s children and young people. But a recent interactive survey we conducted with our participants highlighted that these challenges haven’t gone away – they’re simply different. As one participant summarised it, “…there’s more access to food when you’re at home…”

There were lots of surprises in our participants responses but before we dive in, a quick word on the format here. The information from our survey was gathered via group Zoom sessions so they’re not anonymous. Also, this is a group of 20 children and young people so not a huge sample. But there are some fascinating findings anyway…

Question: How’s your diet changed since lockdown?

  • SHINE’s participants reported snacking more at home than they used to but still not as much as they did at school.

  • Secondary school pupils highlighted that food at home was healthier than the sausage rolls, bacon sandwiches, burgers and chips on offer at tuck shops and lunch breaks in school.

  • Primary school pupils unanimously said school meals were healthy and controlled.

  • Generally fewer sweets were eaten as no longer passing shops.

  • Some participants highlighted they’d already started to slide back into pre-CV-19 habits and were visiting shops while going out with friends again.

Question: What takeaways have you had since lockdown?

  • A quarter of our participants said they’d not had a takeaway since lockdown. Nine of our participants said they’d had between one and three takeaways in the 17 weeks of lockdown.

  • Everyone said they’d cut down on takeaways since lockdown. Partly due to lack of access, but several participants also highlighted safety concerns around bringing the virus into their homes.

  • Only four out of the 20 reported having a McDonalds since they opened. All four reported feeling sick afterwards.

>Question: What fears and anxieties do you have about the future?

    • The most common fear and anxiety was ‘Going back to school and confronting bullying again’.

    • Next most common was ‘Gaining back the weight I have lost during lockdown’.

    • Followed by ‘I feel nervous about using public transport’.

    • Several participants highlighted worries about how GCSEs would work and uncertainty about how college would function during CV-19 pandemic.

    • Concerns around lost confidence in going out and being around other people were also highlighted.

    • The older group raised health risk concerns related to their weight.

    • Lots of comments around ‘uncertainty’ – what will the ‘new normal’ be like.

How to beat McDonalds at their own game

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McDonalds Monopoly is a hugely popular fast food promotion that’s terrible for our health and encouraging our children to gamble. Our tip for beating the system? Try out SHINE’s take on MaccyD’s Monopoly – KathyS’s Scra(m)bble! We’ve got a list of great snack and meal ideas – plus prizes that children and young people will love – right here on our worksheet! Click here to read more.

Shocking Bariatric Surgery Figures For Sheffield: What’s Going On?

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A recent article in the Sheffield Star reported that despite 150 children requiring hospital treatment for obesity in Sheffield over the last three years, the number actually undergoing gastric surgery has plummeted (link).

The first thing to say on this story is how sad it is we’re even having discussions around bariatric surgery as a possible treatment pathway for children and young people. UK child obesity statistics support the view that UK child obesity is approaching epidemic levels. This year the National Child Measurement Programme (NCMP) measures have identified children with severe obesity or morbid obesity (>99.6 centile), where previously they only identified the differences between overweight and obese. That revision has revealed some shocking information for Sheffield –

  • 21.2% of the city’s Reception year children are now obese. That’s an increase of 0.5% on last year’s figure and well above the national average of 20%.

  • 35.6% of Year 6 pupils are either overweight or obese. Of those, 4.97% are severely obese – compared with a national average of 4.07 per cent.

Many of these young people with severe obesity would benefit from specialist Tier 3 services like ours but we can only see around 150-200 families with complex needs a year! That’s thanks to our Children in Need grant, of course. Providing services for these children via the NHS would be brilliant – but it would have a major impact on the health budget. Which is perhaps one of the reasons why these services are not currently funded by CCG’s.

So why are the figures for surgery dropping? The Clinical Commissioning Policy document ‘Obesity surgery for children with severe complex obesity’ (link here) identifies children eligible for bariatric surgery as those with BMI > 40 or BMI greater than 35 with a co-morbidity (ie type 2 diabetes, fatty liver, sleep apnoea). It advocates potential need for surgery and sets recommendations to be met before surgery is considered –

  • Children must have completed management treatment within Tier 3 services prior to assessment

  • Children must have undertaken assessments by a multi disciplinary team (including psychological assessments)

  • Surgery must not be offered until all non-surgical avenues have been explored and have been found to be unsuccessful

  • Patients must receive follow up care for five years

This feels like an impossible set of criteria to meet. How can this criteria be achieved when there is no national funding for Tier 3 services for children? And there’s no consistency for obesity treatment for children with severe obesity across the country – we desperately need the government to take this seriously and provide adequate guidelines and funding for children with severe obesity.

Is this lack of funding/services why the number of bariatric surgeries offered are reducing as number of children with severe obesity is increasing? If there were no bariatric surgery procedure undertaken for young people in the last two years is this because there is no statuary Tier 3 obesity service for children to access so the criteria for surgery cannot be met?

We’ve certainly noticed a change in the number and needs of children and young people we work with. When SHINE started in 2003 we saw 30 families a year with Body Mass Index (BMI) between 91st and 98th centile and managed to get most of the children into healthy weight ranges within 6 months – we now see around 200 families a year with complex needs requiring two or three years’ worth of support.

Our new term started January 2019 with 60 young people all with a BMI of higher than 99.6 centile, which means they were all severely obese when they came to us. Of these, more than half have a BMI of over 3.5 Standard Devisation Score (SDS) with co-morbidities or over 4 SDS who are working through our non invasive programmes. The latter fit the criteria for bariatric surgery according to the CCP’s report.

But the point here is that SHINE believe children shouldn’t be being offered surgery as a first line of treatment. SHINE provides demonstrably successful alternatives to the knife.


What the National Child Measurement Programme Missed

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The National Child Measurement Programme (NCMP) is a boring name for what is actually a huge and extremely useful annual survey. It contains measurements taken in schools for Reception and Year 6 children and is published by NHS Digital annually. This year is the first time they’ve identified children with severe obesity (>99.6 centile) and there are some shocking figures for Sheffield.

  • 21.2% of Reception year schoolchildren are now obese. That’s 0.5% higher than the previous year, and above the national average of 20%.
  • 35.6% of Year 6 pupils in the city are either overweight or obese and 4.97% of these children are severely obese – compared with a national average of 4.07 per cent.
  • At the time of the survey there were 40,724 children in Sheffield aged 6-11, which means that 2,023 children on this ratio are severely obese.
  • And there were 36,472 children in Sheffield aged 12-17 so 1,812 of children in this age bracket could be severely obese. What’s even more worrying is that these children are not included in NCMP measures.

Many of these young people would benefit from specialist Tier 3 services like ours but we can only see 200 families a year! Providing services for these children would have a major impact on the health budget, which is perhaps one of the reasons why these services are not currently funded. But that’s a lot of children and young people who are being left behind.

This survey proves there’s a substantial proportion of children who fit the criteria for interventions for ‘severe’ level of obesity. In fact the children we’re seeing at SHINE are above +3 and +4, which is even higher.

But what services will be available for children like those in this report whose weight poses significant health risks?

Alongside services provision, the main thing we’d like to see here is more information. There are no measures as yet for young people once they enter secondary school. NCMP measures stop at Year 6 so after that children are not measured at any other stage of their childhood life. We know obesity increases with age so measuring children again after this age is crucial. We agree with Tam Fry at the National Obesity Forum who is pushing for children to be measured every school year as they used to be in the past – early intervention is paramount to prevent children needing Tier 3 services.

What will the Government’s Obesity Strategy do for children?

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So, have the government finally realised the obesity epidemic is at crisis point after publishing their very first statistics relating to ‘severe’ levels of obesity in children and young people?

Let’s start with the good news. It was hugely heartening, following SHINE’s visit to London to give evidence to Diana Johnson (member of the Health Select Committee) and Sharon Hodgson (Shadow Health Minister) to get a promise that provision for Tier 3 services for severely obese children would be included in chapter two of the Government’s obesity plan.This is important because it’s a pathway to funding treatment. Clinical Commissioning Groups (CCGs) fund at a local level based on money allocated from central government. There is currently no ring- fenced money for Tier 3 services for children. We desperately need the government to set clear performance indicators and targets for multidisciplinary services so that CCGs have to fund these services. SHINE’s track record of delivery means we’re perfectly placed to deliver these services.

Anyway, just before the report came was published last summer, we found out it wouldn’t actually include provision for Tier 3 services. It did include the following passage –

“Signposting to appropriate advice, and where necessary, timely referrals for treatment was inconsistent for children living with childhood obesity. The Government must ensure there are robust systems in place not only to identify children who are overweight or obese, but to ensure that these children are offered effective help through a multidisciplinary, family-centric approach….’”

But there were no further details of how this would be managed.

The release of the report coincided with reports of the tragic death of an obese 13-year old boy from a blood clot whose weight was identified in post mortem as a “significant associated condition” – link.

The need for Tier 3 services is self-evident. We don’t just see it in the news, we see it every day at SHINE. When we started in 2003 we provided 12-week courses for 30 young people a year with ‘mild to moderate’ levels of obesity (BMI lower than 98th centile). We had rapid results and helped young people achieve their goal weight within six months. Today, we’re seeing around 200 families every year and children and young people weighing over 20 stone (BMI’s > 99.6 & 3.5 SDS known as clinical or morbid obesity) with extremely complex needs requiring intense interventions and long term support for up to two years.

So, going back to the question we started with – have the government finally realised the obesity epidemic is at crisis point for ‘severe’ levels of obesity in children and young people? Unfortunately it would appear not. How many more children need to die needlessly before we address this problem?