Department of Health West Midlands

Minutes 01 (Ob WoShop) v3

Department of Health West Midlands

Public Health White Paper Consultation Event on Obesity

and Planning for the Future

Notes of Workshop held on 25 January 2011

at The Welcome Centre, Coventry

1. ATTENDANCE

See Appendix 1.

2. PURPOSE OF THE DAY

·  To understand and consult on the proposed future direction of public health, particularly in relation to healthy weight and obesity priorities and to be updated on progress with Public Health (PH) transition planning

·  To highlight significant issues for local and national consideration and to make recommendations on how these can be taken forward in light of the new arrangements for public health.

The outcomes of the day will be fed back to the DH national team by KarenSaunders as part of the PH White Paper Consultation process.

Delegates were also urged to submit individual and local responses to the consultation and the accompanying documents on regulation, outcomes, commissioning an funding following the event.

The day was facilitated by Lynne Howells, Work Escapades.

3. THE PUBLIC HEALTH WHITE PAPER, THE CONSULTATION AND UPDATE ON PUBLIC HEALTH TRANSITION IN THE WEST MIDLANDS

Janet Baker and Karen Saunders gave an overview of the Public Health White Paper, Healthy Lives, Healthy People and the supporting consultation documents about Public Health Funding & Commissioning and the Public Health Outcomes Framework. A further document on obesity was anticipated and it was hoped that feedback from today’s event would help inform that process.

Discussion

The fast pace of change was welcomed by some whilst others felt it may limit the opportunities for people to understand and comment upon the proposals as well as they might be able to.

In response to a question on identifying current funding on prevention, Janet Baker advised that this was a challenge and an exercise with PCTs was underway.

In response to a question about being updated on the transition process, Karen advised that a Communication Brief is produced following each meeting of the West Midlands Public Health Transition Steering Group. If you would like to receive these please email JulieDavis ().

4. GROUP DISCUSSION ON THE PRESENTATION AND QUESTIONS FOR DH

Resources/Experience

·  How can we ensure knowledge and skills are not lost with the reorganisation and job losses?

·  Temporary contracts can result in loss of knowledge and partnership links.

·  More details was needed on the future direction and agreed outcomes, for the obesity agenda, including the “supplementary” obesity paper announced in the PH White paper consultation

·  We must not lose the good work (and networks) that have gone before us.

·  Sustainable joined up thinking between all partners is required.

·  Long term funding is required and opportunities through the ring fenced budget and Health Premium need to be proactively sought when the time is right.

Opportunities

·  Need to maintain the focus on prevention.

·  Use the life course approach and focus on early intervention to promote more lifestyle changes at a younger age – maternity and pre-school as well as school children

·  Need to ensure the wider determinants of obesity (walking environments, sustainable travel, access to fruit & vegetables, including via Healthy Start) are prioritised.

·  The move of health improvement to LAs is positive – particularly the opportunity to influence planning and transport and to tackle the local environment (through increased physical activity opportunities) as well as the wider determinants of health and obesity issues.

·  Use the Responsibility Deal to work with the food industry and find opportunities to have less offers on unhealthy options, eg “buy one get one free” on pop, cakes etc.

·  Ensure Public Health is embedded into the spatial planning system to allow the built environment to be designed with physical activity in mind.

·  Continue to encourage innovation and experimentation (against a challenging context of diminishing resources).

·  Align healthy weight priorities more effectively with, for example, the Healthy Child Programme and other broader children’s services’ priorities led by LAs.

·  Within two-tier LA areas, the District “voice” needs an equal weighting (re Health & Well-Being Boards).

Weight Management Programmes

·  Who will commission the obesity services that sit between prevention/universal and bariatric surgery? It is important to look at all levels of need, not just the “nudge” and the treatment “extremes”.

·  Important to continue with the NCMP. With next year’s data we will be able to compare the first reception year cohort data with where they are at in year 6.

·  How can we engage the parents when we refer to weight management programmes – when many parents do not accept their child is overweight.

·  Where is Change4Life heading?

·  Obesity is not just about weight - need to consider different levels of fitness and selfesteem.

5. THEMED WORKSHOP DISCUSSIONS

Delegates split into three groups to consider how specific aspects of the obesity agenda may operate in the new system: Change4Life, Healthy Start and the National Child Measurement Programme. They considered:-

·  the levers to encourage LAs to invest in obesity

·  the opportunities

·  the risks .

5.1 Change4Life

(session facilitated by Malcolm Fawcett, Change4Life Partnerships Team)

Opportunities and Levers

·  Health & Well-Being Boards will be key to ensuring Change4Life is embedded in all LA departments’ programmes

·  Need to sell Change4Life to LAs as an additional resource which they can use (with resources and branding which are available to them free of charge)

·  Identify a Councillor as the “Change4Life champion”

·  The Change4Life brand and messages have been consistent both pre and postelection; and are likely to continue in the longer-term. To ensure continuity we need to use/foster it at local level

·  Need to identify new organisations to promote the campaign. Need to take the opportunity now/immediately - to embed Change4Life within Children’s Centres, NHS Trusts and Foundation Trusts and LA services including leisure services. Further opportunities to be identified once public health is embedded within LAs.

·  Need to stipulate the requirement for all providers to use Change4Life branding and promote Change4Life messages in service specifications.

·  The organic growth of Change4Life has been a strength (so far).

·  Use the opportunity to link Change4Life with 2012.

Risks

·  Loss of leadership. Who will provide leadership at local level? Will embedding Change4life in commissioning specifications suffice?

·  There will be reduced staff and capacity to invest in the campaign, particularly if the way forward is for DH to roll-out short-term (quarterly) campaigns. As a minimum, more notice would need to be given to Local Supporters in order to give them more leadin time to rally local providers.

·  Need to run the campaign for 10 years in order to make an informed assessment as to its impact on society – but already showing changes in behaviour, eg the baskets of families engaged in Change4Life are getting healthier when compared with a sample of demographically similar shoppers who are not engaged with Change4Life

·  No further budget for TV advertising means that new Change4Life audiences need to be identified via frontline services.

Other Comments

Local Supporters may email MalcolmFawcett () and request copies of the Change4Life TV adverts for local use, including local websites.

Malcolm would welcome any local examples of good practice which may be used to demonstrate how Change4Life is being used locally.

5.2 Healthy Start

(facilitated by Maria Kidd, Public Health Nurse Specialist,

South Birmingham PCT)

Opportunities

·  Annual conversation LAs have with Children’s Centres – the DPH could influence this to ensure Healthy Start is included as a priority

·  Health & Well Being Boards are an opportunity to join up across the whole system (if it can be linked to an outcome)

·  Need to mobilise people to want the vouchers and the vitamins - as this will help influence LA members

·  Government have committed to increase Family Nurse Partnerships – these are an important delivery route for Healthy Start

·  Government have committed to more Health Visitors – link to Children’s Centres

·  PH located in the LA can exploit links to housing and community regeneration

·  Need to link to the whole Big Society movement and breastfeeding being the norm.

Levers

·  The health visiting service specification should stipulate that Healthy Start should be raised in the first visit

·  The midwifery service specification should stipulate that midwives should signpost women to Healthy Start

·  May need contracts to define the need for outreach workers with particular communities

·  The current annual conversation between the LA and Children’s Centres.

The Risks

·  GPs may pull Health Visitors and Midwives out of Children’s Centres

·  LAs may not see Healthy Start as a priority

·  How would the contracts for delivery be overseen? In the short term we need it in the contract for Health Visitors – commissioned by the NHS commissioning Board but also Midwives need to signpost- so needs to be in their contract and they are commissioned by GP consortia

·  need to think through the data flows as may not know take up.

·  The evidence base is good – need to articulate it and sell it to GPs.

·  Nudge people for it to become the norm that women and babies take the vitamin drops.

Good Practice

One example of a local Healthy Start programme working with local partners to increase vitamin uptake is attached as Appendix 2.

5.3 National Child Measurement Programme (NCMP)

(facilitated by JoHudson, NHS Walsall)

Introduction

The NCMP was established in 2005 with local areas now in their fifth ‘full year’ of measurements so the data is increasingly robust. Year Reception and Year 6 children are measured annually (some areas do measure other year groups) and this is carried out in schools via ‘opt out’ consent.

The NCMP enables population level surveillance to support analysing and understanding childhood obesity and overweight prevalence at national and local level and to inform planning, commissioning and delivery of services. In addition to this, NCMP aims to engage families in issues on healthy weight and healthy lifestyles using routine feedback of weight status and some areas also proactively following up children (including underweight children).

Opportunities and Levers

·  Participants felt it was useful that the programme had been cited in the PH White Paper consultations. The group agreed this was a useful programme and it was positive if it was staying.

·  It was recommended that the child development check at 2.5 years outcome should be aligned with the NCMP programme and the measures for healthy weight could be at 2-3 years, 4-5 years and 10-11 years. Other years earlier than Y6 were also suggested (as some areas had measured Year 4 students or even whole schools). The child development check provided an existing opportunity to focus at an earlier age. However more work was required to ensure more children attended the check, potentially using the increasing numbers of health visitors anticipated in the system to ensure parents came to the check. Theoretically, all children should be having a 2.5 year check as part of the Healthy Child Programme and this should include a height and weight check. However, particularly in deprived areas, people did not turn up.

·  Overall the group was of mixed opinion as to whether other school age groups should be measured in addition to 4-5 and 10-11 age or if an earlier age group should replace the 10-11 indicators. It was agreed a core data set and consistent approach was needed nationally and if local areas wished to do extra measurements, and had the resources to do so they could.

·  Some areas felt that Y6 measures were harder to collect with higher opt outs due to sensitivity around e.g. body image and vulnerability at this age. Year 6 is also a busy time for children with SATS and transition to secondary school approaching and therefore may not be the best time. It was suggested Year 5 may be a better time.

·  Overall it was agreed Y6 measures should be retained, at least for this year as we will soon have data to compare children that were first measured in YR who are now moving into Y6 next year. This will provide some useful longer term analysis and tracking of obesity in children and this analysis should continue to be done at a national level. This also provided an opportunity to use NCMP data to better evaluate child weight management programmes on a longer term basis - as this is notoriously difficult data to collect. The data was also crucial to inform JSNAs and local Health & Well-Being strategies in LAs.

·  A discussion was held around what role GPs had to play in the healthy weight agenda and NCMP. The group agreed more emphasis was needed in the QOF around obesity prevention. Primary care training needs were identified in taking heights, weights, BMI (ie using the right tools) and in motivational interviewing. Tacking obesity needed to be in the QOF and the core contract.

·  There was a discussion around GP templates and how height, weight, diet and activity measures should be included on these. It was noted that all practices had templates with height and weight on them so these should be used more effectively. This could also be added to the health check template. As part of

·  New patient checks, practice nurses could collect this data. There was a strong feeling that the focus for local work was with the parents; engaging with parents and families; developing support and pathways and that funding/resources should be aligned with follow on work and support following children being identified through the NCMP eg investment in school health, in specialists in obesity and behaviour change, community support and services to support parents and families. There was also strong feeling that this needed to be done as early as possible.

·  A Note on Adults: for adults, a suggestion was made that this be collected as part of the Census in future years. Adult healthy weight measures remain a challenge, however, data from existing programmes eg health checks should be better aligned and utilised