1. Lifestyle Management Programme Pam Lewis Deputy to the Clinical Director of Therapies BCUHB 09/06/20161

2. Outcome statement To reduce the total number of TKR/ THR surgery performed in BCUHB thus aiming towards a sustainable service model for Orthopaedics. Ensure that individuals are in optimal condition to undergo surgery if needed Improve strength, mobility, coordination and balance Improve health and well being Reduction in the risk of post operative complications Links into a healthier lifestyle (impact on Diabetes, depression or cardiac factors not measures) 09/06/20162

3. Cost Savings Estimated that 1000 people will be eligible for the LMP Research suggests 20- 25% will be successfully discharged and not convert to surgery Equates to 200 patients not requiring surgical intervention. Cost THR = £8000 Cost of a TKR = £6,800 100 x THR + 100 x TKR COST SAVING of almost £1.5 million (additional cost saving from a ↓LOS / post operative complications following surgery)

4. Joint partnership between BCUHB and the National Exercise Referral Scheme (NERS) Aimed at adults with a BMI of 35 and over at risk of needing hip / knee joint arthroplasty. Designed to support and deliver a weight management and exercise programme to this cohort of patients.. Overview

5. BMI <35 * CMATS High Pain & joint destruction High Pain and moderate destruction Low pain moderate joint destruction Orthopaedics Injection 8 weeks Weight and Dietetics Evaluation Public Awareness Link to Literature search Severe Pain score & severe Functional limitations Lifestyle Programme 16 weeks (L4) Condition specific. Physio 1;1. Aqua-cise. Group exercises 16 weeks (L3) NERS / (L4) Condition Specific Pain Score - Classification of pain level and functional limitations tables. BMI >35 * Or artificial BMI affected by large muscle bulk i.e. sportsmen / women Discharge / Active Monitoring GP Patient Low Pain score low function limitation Lifestyle programme Physiotherapy Triage Lifestyle Hip and Knee pathway +

6. Evaluation Number of patients entering the lifestyle programme/ diverted away from Orthopaedics Number of patients going onto have surgery Height (baseline) Weight/ BMI ( baseline, 8 weeks, 16 weeks & 32 weeks) OKS/OHS/ EQ5D (baseline), 8 weeks, 16 weeks & 32 weeks) Post operative complication rates following THR/TKR Length of stay following THR/TKR Drop out rates Patient Satisfaction 09/06/20166

7. Summary Position of Patients Reaching;8 weeks16 weeks24 Weeks32 Weeks Change between weeks 1 and 8 Change between weeks 1 and 16 Change between weeks 1 and 24 Change between weeks 1 and 32 Patient Records with weight at week161753815 Number of patients with weight loss recorded104623112 Greatest Weight Loss-9.5kg-14.6kg-22.8kg-24.6kg Average Weight Loss-2.9kg-4.2kg-6.1kg-7.7kg Number of patient with no weight change43520 Number of patients with weight gain recorded14853 Greatest Weight Gain3kg4.4kg3.3kg1.6kg Average Weight Gain1.4kg1.6kg 1.2kg Average Weight change-1.7kg-3.3kg-4.9kg-5.9kg Results 09/06/20167

8. Results Cont. 522 patients entered the LMP (38%hips / 62% knees) 2.1% drop out rate 6.9% DNA 1 st Appt 14.3% DNA FU 1% Self Funded Outcomes at 32 weeks D/C – exclusion criteria met17 (39%) D/C – Proceed to surgery2 (5%) D/C – Programme Complete (weight loss not met) 5 (12%) D/C – Programme not completed ( Pt choice) 10 (23%) D/C – Self Management9 (21%) (DNA’s not included)

9. Lessons Learnt Main lessons learnt were that Health and Local Authorities can work well together to improve the health and lifestyle of the population of North Wales. Determination for improvement was a key element in the programs set up. Patients are keen to lose weight (more than anticipated) and are very pleased to be supported by a professional team. To develop a patient contract at the initial assessment demonstrating clearly what is expected of the patient.

10. Partnership Communication has been the key to success– within BCUHB and external agencies resulting in a coordinated team achievement Establishing firm links within the BCUHB – Surgical CPG, Physiotherapist’s, Dieticians, Administration, IT and Senior Management Establishing firm links external to BCUHB – Local Authorities in North Wales, NERS Team, Public Health Wales, Welsh Government. 09/06/201610

11. Future Developments As an essential element of health and wellbeing in the future we need to address the obesity problem that is facing us. This weight reduction programme not only supports weight loss and improved mobility but also supports the individual to be healthier physically and mentally. The majority of patients really value this support. Possible Future developments Reducing the BMI from 35 to 30 to target a greater proportion of the population. Psychology Input Possibility of opening up the lifestyle management programme to other patient groups. Research Opportunities. 09/06/201611

12. Success Stories Extract from a patient letter “I wish to thank you all for a job well done on helping me loose weight to enable me to have a knee replacement operation. I was asked by my surgeon to loose 2 stone 9lb before he would considered operation on my knee…………………I could not have lost the weight without your help, also I feel a lot fitter and healthier (but it has cost me to have smaller fitting clothes) Former Welsh health minister Lesley Griffiths backed the scheme after visiting a class at Prestatyn leisure centre. ‘It is an example of how health boards across Wales are developing exciting community-based schemes to improve the health of their populations and cut down on the need for unnecessary hospital stays.’

13. Thank you Any Questions