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  1. 1. Trevor Shaw Project proposal Spend on health now to save on health costs later. A project proposal by Trevor Shaw K0953840Date submitted: - 21st of November 2001Word count: - 4298K0953840 Page 1 Cohort 5
  2. 2. Trevor Shaw Project proposal Spend on health now to save on health costs later by Trevor Shaw K0953840Aims and objectivesAn ever increasing number of patients each year attend sleep apnoea clinics within thisTrust; sleep apnoea is defined as a temporary cessation of breathing during periods ofsleep, in obstructive sleep apnoea syndrome the frequent pauses in breathing sleep due tothe closure of the air passage in the pharynx.The signs and symptoms of obstructive sleep apnoea are many and may include some ofthe following at night; heavy snoring, apnoea, restless sleep, insomnia, nocturnal choking,sweating and reduced libido.This range of symptoms then leads on to the day time symptoms of excess sleepiness,impaired performance, morning headaches, intellectual deterioration, impaired memory,impaired concentration, depressive symptoms and even heart burn.These symptoms can be distressing and debilitating to the patient having a direct impact onboth their social as well as their working lives, leading to a reduced quality of life and insome cases depression.Patients who are identified by their own general practitioner as having the condition andassociated symptoms, would at first be referred to an apnoea specialist for confirmation andthen be referred on from there to a CPAP clinic for treatment.The purpose of the clinic is to assess the patient for this condition, and then to prescribe acontinuous positive air pressure (CPAP) device to be used by the patient at night, the CPAPdevice supplies positive air pressure to the patient via a face mask to keep the airways openand so help to aid restful sleep and elevate some if not most of the day and nightsymptoms..It is suggested by Apnex medical (2011) that worldwide 2% of women and 4% of men havesleep apnoea that causes problems. Certain groups, however, have a much higher chance.So if we surmise that just 6% of the population could be potentially suffering from thisdebilitating condition that is 6% of the 62,435,709 population of the United Kingdom, giving atotal of 3,746,142 people each needing the resources of the NHS.K0953840 Page 2 Cohort 5
  3. 3. Trevor Shaw Project proposalThis staggering figure is only the tip of the ice berg it would be hard to assess the potentialcost implications this condition may be exerting on industry through lost production due tosickness or to the economy as a whole, not to mention the impact on the sufferer of such adebilitating condition.The cause of sleep apnoea are many and may include such things as Obesity, the naturalshape and size of the pharynx, nasal obstruction, alcohol and hypnotic drugs, this list is notexhaustive but it gives an indication of the probable causes of sleep apnoea.As the main cause of obstructive sleep apnoea seems to be related to obesity, anymeasures aimed at reducing excess weight and improving fitness may help to prevent it oralleviate some of the symptoms.In addition to sleep apnoea, it is suggested by the Endocrine society (2011) that obesepatients may also suffer from a whole host of other debilitating conditions associated withobesity, this could potentially include:- Type one or two diabetes. High blood pressure. Coronary heart conditions. Poor blood circulation. Increased risk of some cancers. Bone joint damage.So potentially an obese patient could represent a massive financial drain for the NHS over alife span.This project will become the basis of a community based partnership in which the patient willbe paid for losing weight over a specified period of time, this could be a nominal figure of£100 per stone of weight loss, but the patient is also given a specific time frame which theweight loss must occur, say for the figures, number of stones in weight loss in two year X£100 would be the patients goal, the money would be paid to the patient on completion ofparticipation in the project for 2 full years.To further help and encourage the patient on their road to recovery, the hospital Trust wouldbe required with the help of existing hospital staff, to provide specialist help and advice forthe patient on diet, nutrition and fitness and as part of the recovery plan the patient wouldalso be given some form of exercise plan tailored to their requirements.K0953840 Page 3 Cohort 5
  4. 4. Trevor Shaw Project proposalIf for the sake of figures each patient lost an average of approximately 10 stone this wouldgive the patient the sum of £1000, on these figures for the Trust’s initial outlay of £50,000 itcould make an immense difference to the lives of 50 people, over the 2 year that the projectwould run. This would bring about immeasurable changes to the lives health and wellbeingof the participants in this project.The remaining £50,000 investment could then be used to set up the infrastructure needed torun this project and provide any additional equipment and manpower needed for the project.AimsThe aim of this project is to:- Reduce the number of people requiring CPAP devices by 1% per year, by introducing a program of monitory bonuses for weight loss and food awareness classes. Raise the Trust’s profile as progressive forward thinking Trust that treats not just the patient’s symptoms but also the causes of the symptoms. Reduce obesity in the target population. Help 50 patients per year increase their quality of life and give them an improvement in the quality of their health.ObjectivesThe objective of this project would be to Reduce the financial burden on the NHS, by reducing obesity in the target group. Promote the fitness and wellbeing for the patients, to a level that will produce a positive effect on their health. Promote the general health for the participating patients and hope this has some effect on their families and friends health. Reduce the burden on the NHS and industry for the patients in the target group, within 2 years.Deliverables A reduction in the amount of hospital support needed annually for each member of the target group participating in this project.K0953840 Page 4 Cohort 5
  5. 5. Trevor Shaw Project proposal Increases quality of life for each member of the target group. Substantial weight loss for each member of the target group. A reduction of burden on the NHS due to obesity in the target group.AssumptionThis plan assumes that the targeted patients have the will to lose weight and that themonitory incentive will also help them in this quest. It is also assumed that the provision ofspecialised help and advice on health and nutrition will spur the patients on to a healthierfitter and brighter future, free form the majority of health problems that are associated withobesity.It is also assumed that this project would have the help and support of the dieteticsdepartment, the physiotherapy department and the patient’s own doctor would also need toassist in this project.Measurement of successThe success of this project could be measured in a variety of different ways. The patient’s own doctor could be asked to draft a report on the patient’s health before and after their participation to assess any change in the health of the patient. Annual review of the number patients attending the CPAP clinic could also be an indicator of the success of the project. A patient questionnaire could be generated to gauge what the patient thinks he has gained for participation on the project. A review Trust wide could be generated annually to gauge the project’s impact on other obesity related illnesses such as dubieties and coronary heart complaints.Requirements and project scopeThis project is in essence a support and reward scheme aimed at the clinically obese; its aimis to reduce the overall costs to the NHS imposed by an ever increasing obese populationand the medical and social problems that this condition is associated with, over time byempowering the clinically obese patients to bring about changes in their own life style anddiet and reward them for taking part in this project.K0953840 Page 5 Cohort 5
  6. 6. Trevor Shaw Project proposalThis project will have to in the first instance identify 50 people from the target group thathave the will and the need to lose weight for medical, social or personal reasons and sobring about a substantial change in their lives. Then put in place a system of support andreward to help them achieve this goal, this will in turn enable them to live life free from thesymptoms of obesity, prolonging their life span, helping them become fit and healthyproductive members of society and in so doing reducing their impact on the NHS. This willalso have impact on their working lives cutting time off for sickness.To enable this to happen this project has to give support and guidance to the patients on dietto help educate them into a healthy eating life style.The project must also support the patient by providing them with help and advice on thesuitable fitness regimes, available to them and also help them to map out a personal fitnessplan, this could be a simple thing like walk a half mile a day for the first week and then rampup the distance for subsequent weeks.Provide monitory insensitive to the patient as a reward for taking part in the project.In addition to this there will be the following requirements for this project to proceed:- To enable this project to precede it is expected that the existing CPAP clinic staff would weigh the patients in the first instance and then monitor the weight loss at subsequent visits. A new post for a member of staff would be created to co-ordinate resources and assist CPAP staff. A new hospital database would have to be set up to track patient’s progress. New precise scales would be brought into service to measure the weight and body mass index of the patients. Existing staff from the physiotherapy and dietetics departments would have to be available to provide advice on nutrition and fitness. An infrastructure would have to be set up utilising existing NHS staff to verify weight loss and pay the reward. The patient’s own NHS doctor could be used to review patients past notes and give feed back to the Trust on the health benefits the patient has experienced as a direct result of the weight loss.K0953840 Page 6 Cohort 5
  7. 7. Trevor Shaw Project proposalKey Stake holdersThe key stake holders on this project would be as follows:-The patient would be one of the major stake holders as with out there full commitment andparticipation this project would certainly fail. The patient must at the beginning setthemselves goals and be focused on the task in hand, with help and support they will go onto a longer, healthy, fitter life, free from many of the problems associated with obesity.The NHS stands to gain the most from this project as it is suggested by our own primeminister David Cameron, that obesity costs the NHS a staggering 4 billion pounds per yearand this figure is set to rise to over 6 billion, full (2011) if this project was a success itcould be seen as a future model that could be duplicated across the country. Thisinformation is available at and the BBC News (2007) suggest that costs to the Britisheconomy is set to rise to £22 billion patient’s own family and friends could be considered as stake holders as thesuccess or failure could rest with them, for the patient to lose the substantial amountof weight necessary, the friends and family would have to offer support and guidanceto the patient, after all they could give them the push to change their life style inorder to lead a longer healthy life.Another group that stands to gain from the success of this project could be the government,getting people fit and healthy and back into work could be seen as a way of reducing thenumber of people dependant on the benefit system. Finally industry could be a potentialstake holder in this project getting people fit and healthy should have a ongoing effect on thesickness figures.Strategies and outcomesThe strategic analysis of this project can be Brocken down for this trust, to enable this totake place the strengths weaknesses opportunities and threats must first be examined.The main strengths of this project would be the fact that the hospital already has theresources to make this project a reality, the highly trained specialist medical staff, thepremises’ to conduct the project and the most to gain from a healthier population. Add to thisK0953840 Page 7 Cohort 5
  8. 8. Trevor Shaw Project proposalthe resources to employ an additional member of staff part time for the duration of the 2 yearproject.The main weaknesses’ with this project could be, the patients themselves, do the patientshave the resolve to lose weight? even with the right incentives and support, the patient stillmay not have the will to stay on this project for 2 years and achieve the weight lossexpected, the need for a new hospital database is not a real weakness just a small part ofthe puzzle to be completed in the project.The opportunities this project present are potentially life changing and perhaps life saving forthe patients in the project, getting them fit and well would be the 2 year goal, and gettingthem back into a healthy lifestyle, were they could go on to be less of a drain on theresources of the NHS and also society, would then follow. This scheme could then go on tobring good PR for the hospital, as a forward thinking Trust, treating the causes not just thesymptoms.The main threats this project could potentially face, are many, funding may get cut due toeconomic climate, as the NHS is coming under the spot light for cuts in governmentspending, or the hospital management may change, forcing the premature closure of thisproject but one of the main concerns could be public opinion, there could be public outrageby some at the thought of giving away public money to the obese to lose weight causingpossible bad publicity for the Trust.Strengths Weaknesses 1. Existing hospital staff and resources 1. The weight loss would solely be could be utilised. controlled by the patient. 2. The clinics could be conducted in 2. Incentive may be too small to be hospital provided venues. taken up 3. A temporary staff post would be 3. Staff may not want to take on extra created. responsibilities. 4. Existing medical expertise could be 4. There would be a need for utilised. investment in a new hospital data 5. Less expenditure on bariatric base. equipmentOpportunities ThreatsK0953840 Page 8 Cohort 5
  9. 9. Trevor Shaw Project proposal 1. Get obese patients fit and well. 1. Funding may get cut due to economic 2. Get some obese patients back into climate. work. 2. There may not be enough patients 3. Long term the patient would put less willing to change there lifestyle to pressure on the NHS make this project work. 4. Good PR for the hospital. 3. Change of hospital management may cut service. 4. Back lash from the general public. 5. Possible bad publicity.Political Economic 1. The patient’s dependence on the 1. Present economic climate is driven NHS funds would be lower. by cut backs and administration 2. Dependence on benefits would be changes cut. 3. Hospital profile will rise.Social Technological 1. It would give some patients back self 1. There are other faster ways to esteem. achieve the same result such as 2. It would give some patients back slimming pills and gastric surgery. mobility and a sense of self worth. 3. It would allow some patients to fend for themselves again.Legal Environmental 1. Would it be legal to give away money 1. This could become part of the NHS to promote weight loss treat the symptom not the cause. 2. There could be legal challenges to public money being used in this way.K0953840 Page 9 Cohort 5
  10. 10. Trevor Shaw Project proposalTotal budget requestThe total budget requested for this project would be £100,000 this figure could be brokendown as follows:- 1. A new excel database needs to be set up and made available to all the departments involved with this project, through the hospital intranet. It is envisaged that this task will only take a few hours of in house development, by the Trusts information technology department at a cost of £40 per hour, the total cost for this work to be completed is expected to be no more than £100 to the project. 2. A temporary 2 year post will be created for a ward Clark’s position to assist, co- ordinate and act as a liaison, between the patients and the various departments that will form this project. This will cost the project approximately £15,000 per year and will equate to £ 30,000 over the 2 years of the project. 3. It is hard to fully estimate the cost of the patient reward aspect of the project as it contains many variables but as a general guideline it is expected that 50 patients will be selected for this project and it is hoped they will lose around 10 stones per patient. So at £100 per stone that would equate to £1000 per patient over the 2 years of the project giving a total expenditure of £50,000. 4. There will be a requirement for new patient weighing scales to be procured it expected that the total cost for the scales will not exceed £200 5. The project will require contact with the patients though the domestic mail system and literature to be sent to the patients periodically it is expected that over the 2 years of the project this will not amount to more than £10,000This brings the projected total cost for this project to the total of £90,300 of course there willbe sundry’s to pay out that is why the full £100,000 is to be requested.How the results will be achievedThis project is in essence a support and reward scheme aimed at the clinically obese; itsaim is to reduce the overall costs to the NHS imposed by an ever increasing obesepopulation and the medical and social problems that this condition is associated with, overtime by empowering the clinically obese patients to bring about changes in their own lifestyle and diet and reward them for taking part in this project.K0953840 Page 10 Cohort 5
  11. 11. Trevor Shaw Project proposalAfter identifying the patients they will be interviewed and assessed by their own GP, who willlook at their suitability for the project and assess the possible health benefits to be gainedfrom substantial weight loss for each individual.The patient will then be invited to attend a series of clinics with the hospital dietetics andphysiotherapy departments to work out a personalised diet and fitness regime for eachindividual.The patient will at this time have their weight and body mass index taken to derive to startingpoint for the weight loss.The patient will then be invited back to the clinic periodically over the span of the 2 yearproject to assess their progress.At the end of the 2 year project the patient will be expected to revisit their own GP who willassess the patient and give feedback on the possible health gains the patient may haveachieved.The choice to run this project along the lines of a “diet club” instead of opting for the surgicalapproach of gastric surgery are many, but the main benefits are as follows:- 1. The patient will have to change their diet and lifestyle instead of opting for the quick fix that gastric surgery would produce; setting the patient up for a health fit life style. 2. It is hoped that the patient will be less likely to put the weight back on if it took a lot of effort and time to lose the weight. 3. The patient will gain in self esteem knowing they have achieved goals. 4. “Gastric surgery also caries long term health risks for the patient” Smith-Squire (2011). 5. The cost of gastric surgery is high in the rejoin of £7000 to £8000 clinic (2009).Work breakdown structureThe main deliverables for this project are:- 1. A reduction in the amount of hospital support needed annually for each member of the target group participating in this project. 2. Increases quality of life for each member of the target group. 3. Substantial weight loss for each member of the target group.K0953840 Page 11 Cohort 5
  12. 12. Trevor Shaw Project proposal 4. A reduction of burden on the NHS due to obesity in the target group.Bringing about each deliverable will be achieved as followsA reduction in the amount of hospital support needed annually for each member of the targetgroup participating in this project, will be achieved by the target group simply by losing asubstantial amount of weight each, it is widely accepted by most clinical staff that obesity isthe trigger for a whole host of medical complaints and by reducing that element the patientshould go on to have less medical problems in the future and so reduce the burden on theNHS.Increases quality of life for each member of the target group, again by losing weight thepatient should gain mobility, health and self esteem leading to a better healthy active life.Substantial weight loss for each member of the target group, each patient will be given allthe help and support needed to achieve this goal. They will be advised on diet health andfitness by trained health professionals in a controlled monitored environment.A reduction of burden on the NHS due to obesity in the target group, the NHS is stretched atthis time though cut backs and budgetary restraints, by reducing the number of obesepatients attending surgeries for routine as well as emergency care, the NHS would havemore money to spend on other projects, the burden of obesity on the NHS is set to rise to anall time high of £6 billion in the near future. Act on obesity now to save in the future, eachpatient attending hospital though obesity related illness adds to the NHS burden, table oneshows a sample of the costs compared with the costs of this projectCosts to the NHS and British economy from Costs to run weight loss program for 50obesity peopleCosts of equipment 50 people each loosing an £50,000 1. Cost of bariatric From £250 average of 10 stones @ £100 per wheel chair stone 2. Cost of bariatric £4000 aprox Cost of 1 co-ordinator secretary for £30,000 hospital bed 2 years of the project. 3. Cost CPAP device £400 Cost of new hospital data base set £0.00 per patient. up in excel.Hospital costs Cost of new weight scales £120 1. 1 I.T.U bed for 1 £1000 per set day Existing staff to be used on this 2. Gastric surgery £7,500 project and so the new costs to the 3. Cost of heart £5,000 to hospital will be £0.00K0953840 Page 12 Cohort 5
  13. 13. Trevor Shaw Project proposal arterial bypass £20,000 surgery dependant on number of bypasses required 4. Cost to the NHS as £4 billion rising a whole for obesity to £6 billion related illness per year. 5. Costs to the economy from obesity £22 billion Table 1Break down of tasksThe project manager will be in place for the full 2 years of the project, to oversee theproject and act as a buffer between Sponsor and the project workers. He will also direct staffon the overall workings and budget requirements for the project. The project manager wouldalso act as a liaison for the interdepartmental management structure and also act as a pointof contact should problems arise.The information technology’s department will have little input to the project apart fromsetting up a database and making it available to all the departments involved, this databaseis to track the patient’s progress, but they may need to be called upon to help with anyproblems with the data base.The Clark coordinators responsibilities would include booking patients appointments, withthe various departments, helping out in the CPAP clinic when necessary and keeping thedatabase up to date with accurate patient information.The CPAP clinic staff will be tasked with firstly Identifying suitable patients for this project,they will report to the Clark coordinator and they will also meet with the patients periodicallyto take weight and take body mass index readings, to assess the patients progress andidentified any potential problems that may arrise.The dietetics department will assess the patient at the start of the project and work out asuitable diet to attain weight loss in a safe controlled manner and also to be available onrequest to give further help and guidance to the patient, though out the 2 year period.The physiotherapy department will assess the patient at the start of the project for fitnessand ability and from this work out a fitness plan for the patient that will help them consistentlylose weight over the 2 year project in a controlled safe manner.K0953840 Page 13 Cohort 5
  14. 14. Trevor Shaw Project proposal AppendixApnex medical (2011) Obstructive Sleep Apnea FAQs [on line] Apnex medical availablefrom: (accessed9th November 2011)BBC News (2007) Cost of obesity over-estimated [on line] BBC home available from (accessed 3rd November 2011)Clinic (2009). How Much does Gastric Band Surgery Cost? [ on line], available from (accessed 3rd November 2011)Endocrine society (2011) Obesity-Related Diseases [on line] available from (Accessed 1stNovember 2011)Full (2011) Promoting accuracy in public debate [on line] full fact available from: (Accessed 29th October 2011) SMITH-SQUIRE (2011) The drastic weight-loss surgery that is quite literally wreckingpeoples lives [on line] Mail online available from (accessed 1st November2011)K0953840 Page 14 Cohort 5