Measuring and Improving Vitamin D awareness and promotion for prenatal and postnatal women across Greater Manchester 2013
was held at the Midland Hotel, Manchester on Tuesday 17th September 2013.

Web site

GENERAL INFORMATION
Agenda 170913
Delegate List (downloads an Excel spreadsheet)

PRESENTATIONS
(many of which are at the bottom of this page - some in PDF format)
Presentation 2 – Magda Sachs – Vitamin D – Pregnancy, Breastfeeding, Babyhood
Presentation 3 – Katy Gardner – Vitamin D Deficiency in Liverpool – where are we now
Presentation 4 – Elaine Burfitt & Amy Wilson – CQUIN E-learning Package
Presentation 5 – James Bunn – Vitamin D deficiency presenting in children – a growing concern
Presentation 6 – Chris Jordan – Improving Vitamin D uptake in Bolton
Presentation 7 – Claire Candelier – Vitamin D and maternal health – studies linking vitamin D with maternal complications PDF format is at bottom of this page
Presentation 8 – Deb Lee & Lucy Wilcoxon – Measuring and Improving vitamin D Audit Results PDF format is at bottom of this page

EVALUATION
Evaluation

CONFERENCE FEEDBACK REPORT
2013 Conference Feedback Report

OTHER INFORMATION / PAPERS
2010 Vitamin D Birmingham BMJ letter
2012 Vitamin D Birmingham
Samsam published paper
North Mersey Guidance for Vitamin D Deficiency FINAL VERSION feb12
May Moonan 12th Sept 2012
UoB Healthy Start Vouchers Study Exec Summary with logos
Somali Abstract NWest PH Conference rtf
Somali Abstract NWest PH Conference rtf
Healthy start booklet final

The following are extracted from the Conference summary, attached at the bottom of this page

What was the conference about?

The main purpose of the conference was to feedback the findings from the regional supra-district funded audit into the awareness amongst health professionals and promotion of vitamin D to pre- and postnatal women amongst a number of NHS service providers across Greater Manchester.
The conference also created an opportunity for various healthcare professionals and researchers to present their work relating to vitamin D to other professionals within the field. Dissemination of such work involved the outline of the importance of vitamin D by some speakers, the current issues faced with vitamin D deficiency within Greater Manchester and surrounding areas and overviews of current research surrounding the topic. The conference allowed professionals to discuss their current policies in place, personal experiences of the effects of vitamin D deficiency on the public and aims for future research projects.
Presentations were of a wide variety covering the political, medical, and public issues relating to vitamin D. Presenters were also from a wide area of the North West of England, and some talks were specifically related to work at various Trusts such as Liverpool, Bolton and Salford.
The conference also provided an opportunity for healthcare professionals to openly discuss their frustrations, views and ideas regarding current vitamin D practice, and future directions for change. It allowed individuals to network and to develop strong ideas which could be put forward to higher governing bodies in the hope to promote awareness of the importance of vitamin D deficiency, the seriousness of its effect and subsequently encourage changes to both policy and pracitce.

Open Floor Discussion: Recommendations for future research

The final session involved an open floor discussion around recommendations for future work and ideas by delegates in the room. This was led by Deborah Lee who also offered her own views/suggestions on the topics raised.

General Information:

• 1. 2014 - Release of the Scientific Advisory Committee on Nutrition (see: http:// www.sacn.gov.uk/meetings/workinggroups/vitamin/04122013.html for papers of group meeings)
• 2. There are currently no clear NICE guidelines surrounding vitamin D supplementation which needs to be addressed. Deborah Lee advised that NICE is looking into vitamin D guidelines but these will not be available unil 2014.
• 3. There is a general problem, which has been raised before, with the knowledge of midwives, health visitors and GPs around vitamin D. Mothers are asking for information, but due to a lack of standardized training at University level, mothers are receiving mixed messages. This needs to be addressed at a University level to incorporate vitamin D into student training programs.
• 4. Elaine Burfitt advised that there is a final meeting in October to discuss the universal roll out of Vitamin D supplementation to all under 4's within the Salford area.
• 5. Salford's Vitamin D CQUIN may be useful for other Trusts to use in staff training. Once it has been finalized there is talk of offering this to other trusts at a price.
• 6. Vitamin D deficiency is supposedly worse in areas above 520 latitude as these areas do not receive enough UVB sunrays between October and April; the North West falls into this category therefore it is important that supplements are taken. However, it was mentioned that the cut off latitude should actually be 350 which would mean everyone in the UK is at risk of deficiency.
• 7. Current information regarding Vitamin D and sun cream use is contradictory. It is unclear as to when people should be applying sun cream, and how much we should be applying in order to maximize our vitamin D uptake but reduce the risk of skin cancer. All sunscreen above Factor 8 eliminates all vitamin D absorpion.
• 8. Changing culture in dress wear also a factor and the Asian community also suffer due to cultural dress.
• 9. We are too hung up on risk groups, like with policies surrounding folic acid, vitamin D should be UNIVERSAL.
• 10. The worrying factor is what do we actually know for sure? 4-5,000 units per day for a woman who is breastfeeding which would mean the recommended 10u. too low (10u. = 400 international units)
• 11. Healthy Start is not quality assured- - this seemed to surprise many of the professionals in the room.

Recommendations:

• 1. Advocates should be using their North West Clinical networks to encourage further work and recognition.
• 2. Suggestions were made by some members of the floor to provide all pregnant mothers and young children with free supplementation as it is so cheap. This would reduce stigmaization amongst social classes, reduce levels of deficiency and be more cost effective than testing and treatment of deficiency. Problems relating to this idea are mainly Trust instigated.
• 3. Elaine Burfitt emphasized that all training / guidelines should be the same across Greater Manchester and surrounding areas, as currently, individual Trusts are performing differently to one another. Greater Manchester Public Health Network and Greater Manchester Healthy Start teams should be working together to ensure standardized guidelines across the area.
• 4. General thought was that we need to aim higher to get vitamin D recognized nationally. However it was asked who is best to go to. One floor member suggested we use Kate Green, due to her interest in vitamin D, and as our MP to drive this further.
• 5. Magda Sachs recognized there were no University representatives here today. She highlighted the necessity of including the importance of vitamin D within current medical, midwifery and health visitor training at University
• 6. Magda has also mentioned a report by The University of Bristol which we will add to our website page.
• 7. One delegate spoke of looking at vitamin D in men as well but the general forum was that we need to concentrate of pregnant/breastfeeding mothers and children under the age of 4 in the first instance
• 8. It was highlighted that Healthy Start - not fit for purpose
  • has Vitamin A which is not good for some babies
  • it is a licensed medicine so can't be purchased over the counter
  • take vitamin D off the healthy start agenda altogether

Final Key points made by delegates:

Oliver Gillie mentioned there was an all-party parliamentarian group on Maternal Health which might be a way of breaking down barriers.
Oliver advised that you could organize a political meeting in a FOC room at Westminster. He felt Stockport were ahead with progress on vitamin D and it should be taken to London. He suggested we could discuss this with Kate Green, MP and the CMO (chief medical officer) Professor Dame Sally Davies has to be involved as a result of her recent letter regarding vitamin D.
James Bunn advised Kate Green had a meeting last week regarding vitamin D but with industry and not parliament
Katy Gardner went to Parliament with Kate Green, Ann Hoskins (PH England, Children) we need to keep pursuing. If we can arrange a meeting with the CMO it might make us feel less powerless
Magda Sachs suggested a Conference Feedback Report was compiled and she would be happy to proof read.

What else, if anything, would you like to have covered?

• What other Trusts have put in place re: training for their midwives
• It would be beneficial to produce a universal document from a brainstorming session which may benefit health professionals of the north west, health visitors and midwives
• More information on the CQUIN E-learning package
• Due to over-running of one presentation the Bolton presentation was very short and it would have been useful to have had more information
• More specific guidance on dosage for pregnant women - what is normal blood levels which women when pregnant should be tested for vitamin D levels
• What other areas are puffing in places towards universal supplementation of vitamin D
• More emphasis on pre-natal vitamin D supplementation
• Good update but disappointed supply of vitamin D in the community is still a problem
• How to influence the CCG to provide free vitamin D to all
• More information regarding exposure to sunlight, best times, length of time
• So little evidence on outcomes of vitamin D to justify so many recommendations and large scale promotion
• Solid studies required / papers for back up
• Information on cost vs. savings of giving universal vitamin D
• Round table discussion to share ideas and local practice from other areas
• A representative from DH to try and justify their position on Healthy Start
• More political discussion, involve parents and women

What did you find particularly useful about the day and did you find it of use to your role?

• To provide universal provision of vitamin D
• Possibility of e-learning package for midwives
• Link between L.B.W. and vitamin D uptake
• Audit report particularly useful; implications for trust in which I work
• Political perspective on vitamin D
• Effect on low vitamin D, effect on children / fetus
• Thought provoking
• That our trust is achieving high uptake of vitamin D with easy access to repeat supplements at Lancashire Teaching Hospitals
• Discussion around protecting breastfeeding - importance of explaining that breast milk was never meant to transfer vitamin D
• Interesting links of low birth weight that I was unaware of

General comments

• Very useful and informative, an excellent day
• Excellent for networking
• Knowledge increased, food for thought re: future work with my midwifery colleagues
• Excellent conference have more knowledge to take back into practice to ensure vitamin D is high on everyone's agenda
• This should be a regular conference, keeping vitamin D high on the agenda
• It would have been useful if at the end each individual table came up with action plans for things they were going to take from the conference
• I feel in 2013 it is sad that health professionals are battling to ensure awareness of offering free vitamin D to the population, there should be government provision and education available
• Emphasized the importance of women commencing vitamin D early
• Guidelines definitely required locally and algorithm / plan of care required
• Please do conference report to put online
• More events should be held like this even if there is a minimal charge
• It would have been useful to have had leaflets / information available on the day
• A roaming mic would have been very useful
• Would have been useful to have identified an outcome for the day
• Suggestion of holding a meeting at house of commons very positive, get Sally Davies (SMO) and Kate Green involved

Summary of the Presentations

Presentation 1

Kate Green MP - Political Perspective on vitamin D and the link to poverty.
Kate Green gave a very captivating opening speech highlighting the general issues surrounding vitamin D deficiency. A recent event in Parliament, occurring just two weeks prior to the conference, resulted in a general consensus that all at risk groups should receive vitamin D supplementation. Parliament recognises the needs in engagement and understanding of the importance of vitamin D across all professionals who are in contact with at risk groups and a holisic education programme is seen as paramount to this success. However, there are currently no clear NICE guidelines which provide health care providers with little certainty on what recommendations should be made and what dosage is considered optimum. Kate claimed that a universal approach to supplementation is what is needed, as this will reduce stigmatisation amongst high risk groups and those from lower income backgrounds and will increase uptake overall. In order for this to be achieved, improving the supply and distribution of the necessary vitamins is key. However funding remains a major issue. Kate closed her speech by emphasising everyone campaigning for universal vitamin D supplementation to "bore bore bore on!!!"
Kate could not attend the whole conference and therefore registered her interest in receiving feedback on the general outcomes of the day.

Presentation 2

Magda Sachs: Vitamin D - Pregnancy, breastfeeding, babyhood
Magda's presentation highlighted that the current recommendations for vitamin D are not very clear and vary amongst countries; in the UK, guidelines for vitamin D supplementation do not begin from birth unlike in the USA and Canada. Generally, views suggest that both healthcare professionals and mothers are skeptical about the current vitamin D guidelines. Many mothers feel they are receiving mixed messages, and many healthcare professional do not have the correct level of knowledge to inform their clients. The general concern surrounds the view that recommending vitamin D will undermine both the confidence in the adequacy of breast milk and/or breastfeeding, and the importance of maintaining a balanced diet. The main reason we struggle with vitamin D deficiency is due to a change in our lifestyles where we have less exposure to sunlight due to working indoors and wearing layers of clothing. Infant formula companies have taken the effects of vitamin D deficiency, such as rickets in children, on board and began adding vitamin D to infant formula milk in the 20th century. However the level of vitamin D in different batches of formula milk may contain variations in the amount of ingredients (and vitamin D) than stated on the label. Studies have found formula-fed infants who still have a deficiency and claim formula level is a 'maintenance dose' and may not reduce deficiency levels. Overall, vitamin D deficiency is wide-spread and there are long-standing issues that need to be addressed with universal information and guidelines that encourage supplementation (before, during and after pregnancy) and the intake of foods that can help with vitamin D requirements. In order to improve, issues with staff knowledge, general awareness in society and issues with the eligibility, administration, access and availability of healthy start vitamins must be addressed.

Presentation 3:

Katy Gardner - Vitamin D deficiency in Liverpool, where are we now?
Katy outlined how vitamin D research in Liverpool began with a large increase in deficiency and cases of osteomalacia in Somali patients within GP surgeries. A community study found that 82% of Somali patients were vitamin D deficient due to eating a poor diet, having limited skin exposure to sunlight and having family history of deficiency.
The clinical team at Liverpool aimed to increase knowledge by rolling out guidelines to neighbouring practices and holding community education events which helped to educate the people of Liverpool on the importance of vitamin D. In 2012, the department issued a North Mersey Guideline and local leaflet which subsequently resulted in an increase in testing for vitamin D deficiency. However, testing and treatment is very expensive, so they encourage prevention and making educated decisions about who to test and when. Similar views towards vitamin D supplementation were found as those mentioned by Magda; Study has shown that the reliable supply of, and access to Healthy Start vitamins is vital for a scheme to be effective. In 2012, the Clinical Commissioning Group agreed to a universal roll out of vitamin D supplements on the basis of working alongside the Public Health Team and City Council, however the reorganisation of the NHS has created further barriers and disruption of the universal scheme.
Katy concluded to highlight that there are still many unanswered questions with regards to vitamin D, such as: what is the optimal vitamin D level needed? And how much sunlight exposure is needed for different skin types?

Presentation 4:

Elaine Burfitt and Amy Wilson - CQUIN e-learning package for Vitamin D
Elaine and Amy discussed the emergence of powerful national guidance in February 2012 from the Chief Medical Officer to all Doctors in England recommending vitamin D supplementation to all pregnant and breastfeeding women and children up to 5 years. These guidelines need to be implemented through ensuring sufficient availability of the vitamins, and ensuring widespread education of both staff and parents. CQUINS are a financial investment for providers to achieve a target, within a given timescale, as agreed by the commissioner and provider service. In Salford, a vitamin D CQUIN has been agreed to create an e-learning package for staff members, to train all staff members and lead to a 10% increase in uptake of the healthy start vitamins for those eligible for the scheme.
The training package has been created and training is currently being implemented for various staff groups within children's and maternity services. Elaine and Amy gave an overview of the E-learning package with three key learning objectives; the role of vitamin D in health which includes symptoms of deficiency; sources of vitamin D, such as food, sunlight and supplementation; and at risk groups. Each of the pages cover the relevant topic to a basic level of detail, however there is a treasure chest icon which users can click to be directed to a page with further information on a particular topic and links to useful references (the presentation provides example slides from the e-learning programme).

Presentation 5

Dr James Bunn - Vitamin D: a growing concern
Dr Bunn began by explaining the background of vitamin D, the process of metabolism and some key facts. Vitamin D deficiency is regarded as a 'a growing problem' due to the increase in its prevalence, increase in conditions associated with deficiency and an increase in the awareness of its effects. Dr Bunn discussed a number of clinical case studies which brought the issue into a more realistic light.
A key aspect of the presentation was highlighting the need for prevention of deficiency rather than cure; all pregnant mothers and all children under 4-5 years should be supplemented. Mapping data show that those who are being tested for deficiency are not those in the high risk areas. Data shows that there is a seasonality of deficiency, with levels being higher in the winter months, however the proportion of people who are deficient has remained unchanged over the past 6years. It is apparent that General Practitioners and community workers are becoming more aware of the issue and testing more children for vitamin D deficiency; however, testing is very expensive!
There are apparent challenges in ensuring universal supplementation, such as determining what products are available, and the supply of these products, the conflicting messages with other policies around breastfeeding and skin cancer, and the focus of guidance on low income backgrounds. It was interesting that Dr Bunn highlighted that the Healthy Start vitamins are not quality assured, as many people within the room did not seem to realise this.
Dr Bunn's main message highlighted that vitamin D deficiency testing should be appropriately directed. If patients are not symptomatic, the focus should be on supplementation rather than testing in order to be more cost effective and efficient. There is an apparent need to increase the awareness of the severity of vitamin D deficiency within the population and therefore needs to be an increase in scientific publication, an increase in public interest and a ensuring a greater awareness of commercial opportunism.

Presentation 6

Chris Jordan - Improving Vitamin D Uptake in Bolton
Chris highlighted that low vitamin D levels are a problem for women of child bearing age and young children within the Bolton area. Despite this deficiency, there are only a small number of children who are taking vitamin D supplements. As a result of this, Bolton launched a protocol in 2008 which claims that supplementaion should be given to all individuals in high risk groups. A local audit revealed that there is inconsistent discussion of vitamin D recorded at the primary visit; health visitors claim they may discuss vitamin D but that it is often covered later by staff at the baby clinics.
The department now aims to ensure that Healthy Start vitamins are easily available to all beneficiaries. This aims to be achieved through ensuring promotion and updates for staff are continued; through gaining the involvement of all pharmacies with a pharmacy campaign and exertion of the vitamin D protocol to include pharmacies; and through a project within the health visiting team aimed to use the eight month check as a discussion point, where giving the child vitamins can trigger a discussion with mothers around the importance of vitamin D and possible risk factors associated.

Presentation 7

Dr Claire Candelier - Vitamin D and Maternal Health: Studies linking vitamin D with maternal complications
Dr Claire Candelier gave an in-depth talk on research studies which have presented evidence both for and against links between vitamin D deficiency and adverse pregnancy outcomes. The studies showed links between vitamin D deficiency and the following maternal complications; gestational diabetes, preeclampsia, infections, caesarean section, pre-term delivery and low birth weight. Details for each of these topics can be found within the presentation; however summaries showed that there is the least evidence with links to caesarean section and pre-term delivery. Despite the extensive research available into the effects of vitamin D deficiency in pregnancy, Claire highlighted that there are still lots of unknowns and thus further research is needed.

Presentation 8

Deborah Lee and Lucy Wilcoxon - Measuring and Improving Vitamin D awareness and promotion for pre and post natal women across Greater Manchester 2013: Regional audit Results.
Deborah and Lucy discussed the findings from the recent regional audit to assess vitamin D knowledge and practice of staff across Trusts within the Greater Manchester area. The current audit was conducted on the back of a previous audit in 2011, which had made recommendations to participating Trusts on the basis of the indings.
The present audit consisted of 3 parts; a provider services audit, a staff survey and a case note audit in which Trusts were assessed on five key standards. The provider services audit showed what services were in place at each Trust and highlighted that each Trust who participated in the 2011 audit had made improvements in some areas of their service, however most improvements were made to staff training. The staff survey had poor response rates from Trusts across Greater Manchester, with an average of around 20%. It highlighted that the knowledge of staff regarding the general facts surrounding vitamin D were relatively poor and training had very little effect on knowledge. However, training did appear to have positive effects on practice and confidence in discussing vitamin D. Comparison analysis between Trusts who paricipated in both 2011 and 2013 showed that significant improvements in both knowledge and practice around vitamin D were evident. The case note audit revealed that there are differences in the performance of Trusts across Greater Manchester, however, across trusts there is evidence that 65% of clients are receiving some form of information around vitamin D. There is evidence of at least one further risk factor of vitamin D deficiency present in 41% of pre and postnatal women, only 62% of whom received some form of information. Again, those Trusts who repeated the audit from 2011 to 2013 appear to have made significant improvements to their practice.
Overall, the audit revealed that none of the audit standards have been achieved in any Trusts. Limitations of the audit and recommendations for change/further study are discussed within the presentation.

Biographies

Julie Estcourt Chair

Julie Estcourt Bsc (Hons), RM, RN Head of Midwifery/Nursing in Women's
& Children's Services, Supervisor of Midwives - Stockport NHS Foundation Trust
Julie qualified as a nurse in 1982, and a midwife in 1984 at Mid Cheshire Hospitals Trust. She has worked as a Ward Manager, Midwifery Team Leader and became a Supervisor of Midwives in 1999. In 2002 Julie took on the role as Practice Development Lead / Matron for Women's Services.
In May 2004 she joined the team at Stockport AHS Foundation Trust as Deputy Head of Midwifery / Head of Gynecology Nursing. Taking the lead for operational issues, working closely with the Consultant Midwife for Public Health, to develop maternity services and support the Normal Birth Campaign.
In February 2007 she became the Acting Head of Midwifery/Nursing, and took up the substantive post in October 2007. She is committed to improving women's health issues and overall experience of maternity services.

Kate Green Presentation 1:

Political perspective on Vitamin D and the link to poverty
Kate Green was elected MP for Stretford and in May 2010. She is currently shadow spokesperson for Equalities. Prior to her election Kate was Chief Executive of the Child Poverty Action Group, and before that Director of the National Council for One Parent Families (now Gingerbread).
She is a long standing campaigner against poverty and inequality, chairs the all-party parliamentary group on poverty, and served as a member of the Greater Manchester Poverty Commission.
Kate was previously a member of the National Employment Panel which advised Ministers on labour market policies, and Chair of the London Child Poverty Commission, reporting to the Mayor of London and local councillors.
Kate also served as a magistrate for 16 years, and takes a particular interest in the experience of women in the penal system, and how best to rehabilitate them to prevent reoffending.

Magda Sachs Presentation 2:

Vitamin D: Pregnancy, Breastfeeding, Babyhood
Magda works for public health in Salford City Council (previously AHS Salford) where she provides strategic leadership for infant feeding, including Healthy Start and Vitamin supplements.
Magda qualified as a volunteer breastfeeding counsellor in 1988, and worked in this role for the National Childbirth Trust and The Breastfeeding Network. She worked as a tutor for these organisations between 1993 and 2000. Magda was awarded her doctorate in 2005.
Magda conducted an ethnographic study of breastfeeding women's experiences of routine baby weighing. In 2008-9 Magda joined the Royal College of Paediatric and Child Health Growth Chart Group, which created the UK-WHO growth charts for children aged 0-4. As part of this work, she was responsible for conducting focus groups with parents and chart workshops with health staff. Magda was a member of the Greater Manchester Health Impact Assessment group which conducted a rapid HIA on vitamin D for children in 2011.

Katy Gardner Presentation 3:

Vitamin D deficiency in Liverpool: Where are we now?
Katy has been a GP in Liverpool for 35 years. Katy is GP lead for Vitamin D in Liverpool and has been involved in Vitamin D since 2003, following the identification of many Somali patients at her practice as vitamin D deficient. Katy helped to develop and launch Merseyside Vitamin D guidelines and is currently involved in rolling out universal supplementation for pregnant women and children under 2 in Liverpool.

Dr Elaine Burfitt and Dr Amy Wilson: Presentation 4:

CQUIN E-Learning Vitamin D package
Dr Burfitt has been a Consultant Community Paediatrician in Salford since 1999. Dr Wilson is a Paediatric Specialist Registrar who is specialising in community paediatrics who worked in Salford for a year in 2012 and is currently training in Manchester.
Community paediatricians see children with a range of neurodevelopmental, behavioural and growth concerns. As well as providing individual care there is a more populaion based aspect to the role in terms of advice to the local authority and working with commissioners on a range of issues that affect children's health and wellbeing. Dr Burfitt has been interested in Vitamin D deficiency and the distribution of vitamin supplements in Salford since meeting a child with rickets in her clinic in 2005.

Dr James Bunn Presentation 5:

Vitamin D: a growing concern
General Paediatric Consultant at Alder Hey Children's NHS Foundaion Trust.
Previously Senior Lecturer at the Liverpool School of Tropical Medicine, and studied vitamin D deficiency in the Liverpool Somali community. We found 82% of those tested had inadequate vitamin D levels, and many were symptomatic from this.
Currently on the RCPCH Nutrition commitee, and editorial boards for Maternal and Child Nutrition, and Paediatrics and International Child Health. A member of the Liverpool Vitamin D group.

Chris Jordan Presentation 6:

Improving Vitamin D uptake in Bolton
Chris is a Specialist Health Visitor for Infant Feeding and lead clinician for Healthy Start within Bolton Foundation Trust. Chris led on the writing of Bolton's Vitamin D Protocol and is a member of the Greater Manchester Vitamin D group. Chris audited Bolton Health Visitor records in December 2012, reviewing documentation of discussion around Vitamin D and promotion of the Healthy Start Vitamins during the mother's pregnancy and baby's infancy.

Dr Claire Candelier, MD, FRCOG Presentation 7:

Vitamin D and Maternal Health - studies linking Vitamin D with maternal complications
Dr Candelier obtained a degree in medicine and surgery at Sheffield University in 1981. Claire trained in the speciality of obstetrics and gynaecology and, during her years in training, worked in Sheffield, Greater Manchester and South Wales. In 1997, Claire was appointed Consultant Obstetrician and Gynaecologist at Stepping Hill Hospital, Stockport. Claire is an experienced clinician committed to the provision of high-quality and safe care. An advocate of new models of care for midwifery and medical workforce, her M.D. thesis enabled her to establish and to study the provision of domiciliary care for women with a high-risk pregnancy (Studies on Antenatal Care in the South Wales Valleys, MD thesis, 1994). In her current post, Claire set up specialist services such as pre-pregnancy counselling and, more recently, bariatric care-pathways for pregnant women with raised BMI. Claire is the obstetric
Within these roles, Deborah has worked and led on a variety of public health research, audit and service development projects, and has had some of this work published in peer review journals. Deborah's current focus of work is on health promotion in hospitals and is currently leading on the Greater Manchester supra-district audit looking into Measuring and Improving Vitamin D awareness and promotion for prenatal and postnatal women across GM, whilst her colleague Sophie Jagatia is on maternity leave.

Deborah Lee Presentation 8: Audit Results

Deborah graduated from The University of Salford in 2005 with a BSc in psychology with irst class honours. Deborah went on to complete post-graduate training (PGDip) in psychological research methods with the Open University in 2007.
Deborah has been working in a public health role within the NHS for over 5 years. Starting out as a Research Assistant in 2007, Deborah went on to become a Project Manager in 2010, and is currently acting up to the role of Research and Projects Lead in the Department of Epidemiology at Stockport NHS Foundation Trust.

Lucy Wilcoxon Presentation 8: Audit Results

Lucy graduated from the University of Manchester in July 2013 with a BSc in Psychology with first class honours. For her third year dissertation, Lucy undertook research which focused on developing a new and innovative individualised measure of people's goals as arranged in a hierarchical framework. This work is to be applied within healthcare settings such as therapy and/or health interventions to facilitate behaviour change.
Lucy recently joined the department of Epidemiology at Stockport NHS Foundation Trust as an Audit Administrator and Data Collector and has been working under the Research and Projects Lead, Deborah Lee, on the Greater Manchester supra-district audit looking into Measuring and Improving Vitamin D awareness and promoion for prenatal and postnatal women. Lucy's main focus of work has been on analysing the results from the staff survey and aiding the write up of the literature review for the inal report.

Pritpal Singh-Jagatia Clinical Audit Coordinator - Vitamin D

Pritpal (Sophie) Singh-Jagaia is a Clinical Audit Coordinator in the Department of Epidemiology; Stock-port NHS FT. Sophie joined the department in 2009 and has successfully orchestrated 3 Greater Manchester public health audits. During her irst audit; Sophie was actively involved in improving fracture neck of femur standards in 13 North West hospitals. In 2010 Sophie transitioned into the role of the Vitamin D Project Coordinator to increase the awareness of vitamin D and to improve vitamin D uptake during pregnancy and postnatally.
The primary audit findings have led to publications in anticipation to enhance clinical practice. Following this audit Sophie proposed to coordinate a second audit (2012/2013) to explore if recommendations from the first audit facilitated better vitamin D practice. Sophie currently is heavily involved in the Vitamin D Project and encounters health professionals on a daily basis who are affected by the constraints hindering their efforts to educate the community on the importance of vitamin D.

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See also VitaminDWiki

• Vitamin D conference in England - April 23-25 2014
• To be reimbursed for supplements in the UK the benefits must now be approved by EU – Aug 2013
• National Osteoporosis Society of UK declares that 12 ng of vitamin D is enough – June 2013
• Draft of UK policy on Vitamin D, keeping 10 ng definition - March 2013
• UK Day-Cares being offered grants to develop vitamin D methods – July 2012
• Huge increase in UK vitamin D prescriptions by July 2012
• A look at inner workings of committee looking at vitamin D for UK - Dec 2012
• Low vitamin D associated with poor regions in the UK, median was 10 ng – Nov 2012
• UK pediatricians have a lot to learn about vitamin D – May 2012
• 5 out of 6 UK dark skinned kids who were vitamin D deficient had no symptoms – May 2012
• All items in category Europe and Vitamin D 234 items
• All items in category Follow-thru Vitamin D 9 items
• 80 percent of South Asian Women in UK had less than 10 ng of vitamin D in winter – April 2012
• UK doctors can now prescribe 800 IU of vitamin D – Dec 2011
• Let the Sun shine on you - Gillie Aug 2011
• Variety of vitamin D loading dose recommendations in the UK - 2011
• Vitamin D insufficiency in UK youths – 37X more likely if dark skin – July 2011
• UK survey of vitamin D knowledge of midwives - 2011
• Immigrants and refugees had lower vitamin D levels – Jan 2013
• Small Australian focus group on getting Vitamin D from the sun – March 2013 an examination of effectivity of vitamin D education
• Vitamin D levels in healthy populations around the globe – Aug 2012 has charts like the following: Note that ALL are under optimal

Low vitamin D associated with poor regions in the UK, median was 10 ng – Nov 2012 has an interesting UK map covering Manchester

Note: This talk was held near to #9 and #10

• Percent of population with less than 20 ng of vitamin D also has an interesting chart

Short url = http://is.gd/UKVITD2013