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Right Decision Service newsletter: April 2024

Welcome to the Right Decision Service (RDS) newsletter for April 2024. 

Issues with RDS and Umbraco access

Tactuum has been working hard to address the issues experienced during the last week. They have identified a series of three mitigation measures and put the first of these in place on Friday 3rd May.  If this does not resolve the problems, the second mitigation will be actioned, and then the third if necessary.

Please keep a lookout for any slowing down of the system or getting locked out. Please email myself, mbuchner@tactuum.com and onivarova@tactuum.com if you experience any problems, and also please raise an urgent support ticket via the Support Portal.

Thank you for your patience and understanding while we achieve a full resolution.

Promotion and communication resources

A rotating carousel presenting some of the key RDS tools and capabilities, and an editable slideset, are now available in the Resources for RDS providers section of the Learning and Support toolkit.

Redesign and improvements to RDS

The redesign of RDS Search and Browse is still on-track for delivery by mid-June 2024. We then plan to have a 3-week user acceptance testing phase before release to live. All editors and toolkit owners on this mailing list will be invited to participate in the UAT.

The archiving and version control functionality is also progressing well and we will advise on timescales for user acceptance testing shortly.

Tactuum is also progressing with the deep linking to individual toolkits within the mobile RDS app. There are several unknowns around the time and effort required for this work, which will only become clear as the work progresses. So we need to be careful to protect budget for this purpose.

New feature requests

These have all been compiled and effort estimated. Once the redesign work is complete, these will be prioritised in line with the remaining budget. We expect this to take place around late June.

Evaluation

Many thanks to those of you completed the value and impact survey we distributed in February. Here are some key findings from the 65 responses we received.

Figure 1: Impact of RDS on direct delivery of care

Key figures

  • 93% say that RDS has improved evidence-informed practice (high impact 62%; some impact 31%)
  • 91% report that RDS has improved consistency in practice (high impact 65%, some impact 26%)
  • 85% say that RDS has improved patient safety (high impact 59%, some impact 26%)
  • Although shared decision-making tools are only a recent addition to RDS, and only represent a small proportion of the current toolset, 85% of respondents still said that RDS had delivered impact in this area (53% high impact, 32% some impact.) 92% anticipate that RDS will deliver impact on shared decision-making in future and 85% believe it will improve delivery of personalised care in future.

Figure 2 shows RDS impact to date on delivery of health and care services

 

Key figures

These data show how RDS is already contributing to NHS reform priorities and supporting delivery of more sustainable care.

Saving time and money

  • RDS clearly has a strong impact on saving practitioner time, with 90% of respondents reporting that this is the case. 65% say it has a high impact; 25% say it has some impact on time-saving.
  • It supports devolved decision-making across the multi-professional team (85% of respondents)
  • 76% of respondents confirm that it saves money compared, for example, to investing in commercial apps (54% high impact; 22% some impact.)
  • 72% believe it has impacted already on saving money and reducing waste in the way services are delivered – e.g. reducing costs of referral management, prescribing, admissions.

Quality assurance and governance

  • RDS leads are clear that RDS has improved local governance of guidelines, with 87% confirming that this is the case. (62% high impact; 25% some impact.)

Service innovation and workforce development

  • RDS is a major driver for service innovation and improvement (83% of respondents) and has impacted significantly on workforce knowledge and skills (92% of respondents – 66% high impact; 26% some impact).

New toolkits

A few examples of toolkits published to live in the last month:

Toolkits in development

Some of the toolkits the RDS team is currently working on:

  • SARCS (Sexual Assault Response Coordination Service)
  • Staffing method framework – Care Inspectorate.
  • SIGN 171 - Diabetes in pregnancy
  • SIGN 158 – British Guideline on Management of Asthma. Selected sections will be incorporated into the RDS, and complemented by a new chronic asthma pathway being developed by SIGN, British Thoracic Society and NICE.
  • Clinical pathways from NHS Fife and NHS Lanarkshire

Please contact his.decisionsupport@nhs.scot if you would like to learn more about a toolkit. The RDS team will put you in touch with the relevant toolkit lead.

Quality audit of RDS toolkits

Thanks to all of you who have responded to the retrospective quality audit survey and to the follow up questions.  We still have some following up to do, and to work with owners of a further 23 toolkits to complete responses. An interim report is being presented to the HIS Quality and Performance Committee.

Implementation projects

Eight clinical services and two public library services are undertaking tests of change to implement the Being a partner in my care app. This app aims to support patients and the public to become active participants in Realistic Medicine. It has a strong focus on personalised, person-centred care and a library of shared decision aids, as well as simple explanations and videoclips to help the public to understand the aims of Realistic Medicine.  The tests of change will inform guidance and an implementation model around wider adoption and spread of the app.

With kind regards

Right Decision Service team

Healthcare Improvement Scotland

Managing my weight

Your weight plays a large role in  your risk of developing  type 2 diabetes, especially if your extra weight is around your waist. 

Bathroom scales    tape measure

What is a healthy weight to aim for?

This is about working out your Body Mass Index (BMI).  BMI uses your height and weight to work out if you're a healthy weight.  You can work your BMI out for yourself using this NHS tool  – it will show you your target range.

For many people living with obesity, aiming for a healthy BMI may not be realistic. Research shows that  even losing just 5% of extra weight will improve your health. The more weight you lose, the greater the health benefits.

What is a healthy waist size?

BMI  doesn’t look at how much fat you have around the middle. That is why you need to measure your waist too.

Healthy weight size all depends on your gender and ethnicity. For a healthy measurement you need to aim to be less than:

  • 80cm (31.5in) for all women
  • 94cm (37in) for most men
  • 90cm (35in) for South Asian men.

This video from Diabetes UK shows you how to measure your waist size.

 

Diet plan options to lose weight

There are a lot of different ways to lose weight – but there’s no one-size-fits-all diet.

It starts with finding a way to eat fewer calories than you use. A calorie (or kcal) is a unit of energy, which is in the food and drink we consume. Your body uses energy for everything we do – from breathing and sleeping to exercising. When you eat, you’re replacing the energy you’ve used, which helps you to maintain a healthy weight.

As a general guide, government recommendations are that men need around 2,500kcal a day to maintain a healthy weight, and women need around 2,000kcal a day. But most people need different amounts of calories based on how their bodies work, how active they are and any weight management goals.

A range of diet options is listed below, with links to menu plans from Diabetes UK. Research suggests that the best type of diet is one that you can maintain in the long term, so it's important to talk to your healthcare professional about what will work for you. 

With any weight loss diet it is important to speak to your healthcare team first as it may impact on your health conditions or medication.

What is the evidence for different types of diet?

Researchers have examined all the evidence on which diets help people with type 2 diabetes to lose weight. They found that low-calorie meal replacement diets helped people to lose more weight than other types of diets and gave people with type 2 diabetes the best chance of going into remission. 

The research showed that people with type 2 diabetes who went on a very low-calorie diet of around 400-500 calories a day for 8-12 weeks  lost the most weight. This type of diet involves swapping your usual meals for a short period with total diet replacement products, often soups, bars and shakes, that are carefully designed to provide the vital nutrients your body needs. Normal foods are then gradually introduced

This type of diet on average helped people lose 6.6kg more weight compared to food-based low-calorie diets of around 1000-1500 calories a day. This is because very low-calorie meal replacement diets provide fewer calories. 

The evidence also showed that low carbohydrate diets did not lead to greater weight loss than higher carbohydrate, low-fat diets.

High-protein and Mediterranean, diets all led to only a small amount (between 0.3-2 kg) or no weight loss compared to other diets tested, but the researchers found the evidence on these diets was of poor quality.

Support from healthcare professionals

The people who took part in the study were supported through their behaviour change and to stay on the trial diet. If you want to follow a similar diet, it's very important to get support from your healthcare team to make sure it's safe and suitable for you.

You can read this research online.

A healthy balanced diet

A healthy diet is all about variety and choosing different foods from each of the main food groups every day. This variety is essential, as no single food contains all the essential nutrients your body needs.

The main food groups are listed below, with links to more information from Diabetes UK:

Low carb diet

Eating a low-carb diet means cutting down on the amount of carbohydrates (carbs) you eat to less than 130g a day.

But low-carb eating shouldn’t be no-carb eating. Some carbohydrate foods contain essential vitamins, minerals and fibre, which form an important part of a healthy diet. 

It’s really important to first reduce your carb intake from unhealthy sources such as sugary drinks, pizzas, cakes, biscuits, chips, white bread, fruit juices and smoothies.

And it is a good idea to get your limited carbs from healthy high-fibre carb foods, such as pulses, nuts, vegetables, whole fruits and whole grains.

Benefits and risks

One of the main benefits of following a low-carb diet is weight loss. This helps to reduce HbA1c and blood fats such as cholesterol. For people with prediabetes, losing weight can reduce your risk of developing type 2 diabetes, and a low-carb diet is one option to help you do this.

However, there’s no evidence that following a low-carb diet is any more beneficial in managing diabetes than other approaches in the long term, including a healthy, balanced diet.

Depending on the approach, following a low-carb diet may also lead to  side effects, such as constipation or bad breath. Although these can be unpleasant, they are usually temporary and shouldn’t be harmful in the long term. Speak to your healthcare professional if you’re concerned about any of these.

You can help make sure you're getting the calcium you need by including unsweetened milk and yoghurt in your diet too. 

Meal plan 

Diabetes UK provides a 7-day low-carb meal plan that you can try.

Mediterranean diet

Mediterranean diets have been associated with reduced risk of high blood pressure and cholesterol which are risk factors for heart disease. A Mediterranean style diet can therefore provide a great option for people at risk of diabetes, as it could help reduce the risk of heart-related diabetes complications.

There’s also evidence to show that the Mediterranean-style diet can promote weight loss and improve blood glucose management.

A Mediterranean diet includes a lot of fruits and vegetables, beans and pulses, nuts and seeds, wholegrains and olive oil. It also includes some dairy (milk and yogurts), lean protein like chicken, eggs and fish, in moderation. Red meat and processed foods are included in much smaller amounts, and wine is included in moderation.

Diabetes UK provide a 7-day Mediterranean diet meal plan that you can try.

Lower calorie diet plans - e.g. 1200 or 1500 kcal per day

Diabetes UK provide a range of low calorie meal plans for men and women, Including vegetarian options.

 

Low calorie and very low calorie diets

A low-calorie diet is made up of between 800 to 1200 calories a day. A very low-calorie diet means having less than 800 calories a day. 

Most people who follow these diets use special meal replacement products, likes soups and shakes, which are nutritionally complete. If you chose to try a low-calorie diet, speak to your GP, nurse or dietitian first.

These are short-term diets. You would usually have the soups or shakes for about 12 weeks, then gradually reintroduce normal, healthy food again.

This type of diet isn't right for everyone. You need to talk to your doctor before starting a low-calorie diet, so you can be sure that it's safe and could work for you.

It may sound obvious, but this diet isn’t easy. You'll need a lot of support from your doctor and other healthcare professionals, as well as the people around you.

Benefits and risks of a low-calorie diet

Your doctor can talk to you about the benefits and risks of a low-calorie diet.

A low-calorie diet can have side effects, including:

  • constipation
  • dizziness
  • headaches.

These side effects often go away after a while, but it's important to talk to your doctor if you have any of these, so they can keep a close eye on you.

Portion sizes

Information on portion sizes from British Nutrition Foundation

Information on portion sizes from the British Dietetics Association

Carbohydrates

The British Dietetics Association provides useful information on carbohydrates and the glycaemic index - a rating system for foods containing carbohydrates.

Weight loss planners

By putting a weight loss plan in place and noting down your progress, you'll be able to see the positive changes you're making. 

NHS Weight Loss Plan

This is a free NHS weight loss app for IOS and Android. The plan is broken down into 12 weeks, and helps you to:

    • set weight loss goals, plan your meals
    • make healthier food choices
    • get more active and burn more calories
    • record your activity and progress.

 

Diabetes UK: My weight-loss planner

If you don't want to use a mobile app, you can download this PDF document from Diabetes UK to help you set weight loss goals, track your progress, and keep motivated (PDF download).

 

Weight loss programmes

Healthy Helpings

  • An online weight management programme for NHS Grampian, designed to be done as 12 weekly sessions. Please note that this program is not appropriate for people who are under 18 years of age, pregnant, or in a healthy weight range.

 

 

Information and learning resources

Healthy Weight Grampian

  • This website aims to provide a range of information which will be useful to anyone who is looking to adopt or promote a healthier lifestyle with the aim of achieving better health and a healthier weight. Resources cover physical activity, eating and drinking, healthy habits and routines, and psychological support.

Diabetes UK Healthy Eating

  • Advice and tips on a healthy, balanced diet. Includes  healthy swaps, understanding food labels, how to cook healthier meals, meal planning and shopping on a budget and a recipe finder.

Diabetes UK Learning Zone

  • The Learning Zone includes various diabetes resources, including a course on losing weight. This online course is designed to be completed over 6 weekly 10-minute sessions. You will need to give some personal information to register for the learning zone, including your name, email, and postcode.