Report of the Director of Public Health

David Johns, Acting Consultant in Public Health, introduced the themed discussion on Obesity. He gave the Board an overview of Obesity in Nottingham City, which has increased in recent years, outlining the correlation between high levels of deprivation and high levels of obesity in children in Nottingham. David emphasised the need for a whole system approach, incorporating partner organisations and stakeholders in order to tackle the issue.

Caroline Keenan, Insight specialist for Public Health presented the Board with information on the new adult weight management services available in Nottingham. She highlighted the following points:

(a)  There are 4 tiers of weight management provision for adults, the first 2, health promotion & primary care and lifestyle interventions are primarily the responsibility of the local authority. The third and fourth tiers, including specialist weight management services and bariatric services are traditionally the responsibility of health care trusts.

(b)  Nottingham City Council currently offers two interventions, Slimming World weight management on referral and Ladle, a digital weight management course.

(c)  Eligibility for referral to Slimming World is based on BMI, includes 12 weekly classes and is available across the city at various different times of the day. Priority groups include:

·  People with learning disabilities

·  People with mental health problems

·  Pregnant women

·  People of African, Caribbean or South Asian descent; and

·  Men.

Mark Fulford, Facilities Manager (Catering) for Nottingham University Hospitals detailed to the Board work ongoing within the Trust to improve the food offering for staff visitors and patients. He highlighted the following points:

(d)  There are 4 trust wide standards which all catering outlets are subject to:

·  A ban of price promotions on sugary drinks and foods high in fat, sugar or salt.

·  A ban on advertising sugary drinks and foods high in fat, sugar or salt on NHS premises.

·  A ban on sugary drinks and foods high in fat, sugar or salt from check out areas

·  Ensuring that healthy options are available at any point, including those staff working night shifts.

(e)  Other standards introduced ensure that at least 75% of prepacked sandwiches and other savoury prepacked meals contain 400kcal or less per serving, and do not exceed more than 5g saturated fat per 100g and that 80 % of confectionary and sweets do not exceed 250kcal;

(f)  Going forward there are a number of initiatives taking place to continue to theme of healthy eating within NUH trust. A fruit a veg stall will be introduced onto the City and QMC Campus’. There will be continued work with retail partners to deliver the standards set out above and checks and audits to ensure that the maintained.

Gemma Poulter, Head of Integration – Adult Social Care and Amanda Chambers, Getting Active Strategic Lead introduced information to the Board on the Sport England local delivery pilot aimed at reducing physical inactivity.

Gemma presented the story of a citizen who had a long term condition which had led to her becoming increasingly inactive. She detailed her meeting with a community activator, who spoke to the citizen and her partner about what they wanted to achieve, supported the citizen to access the leisure centre and swimming facilities. The outcome for the citizen was not just becoming more active, but increased their confidence, increased their feeling of belonging to the community, increased motivation for healthier eating, and improved the relationship with her partner.

After presenting the case study, the following information about the programme was highlighted to the Board:

(g)  The aim of the pilot is to make being active easy, integrate physical activity into the community and co-ordinate work of partners and organisations who are working towards making physical activity the norm for people who live in our communities;

(h)  It is recognised that how active someone is, is influenced by a range of different factors around them that are beyond the limits of their own motivation and the control of any single service, club or programme. The pilot is exploring with local communities how these factors can be tackled to increase activity;

(i)  The most significant benefits can be seen in citizens who move from being inactive (no physical activity, light intensity activity or activity limited to up to 30 minutes a week) to being fairly active.

(j)  Outcomes for citizens engaging in physical activity are not limited to health benefits, they also report better mental wellbeing, increased feeling of community integration, and improved interpersonal relationships;

Penny Poyser, Chair of the Nottingham Good Food Partnership (NGFP) introduced the partnership to the Board and outlined some of the work the Partnership is doing in Nottingham to promote healthy and sustainable food. She highlighted the following points

(k)  In 2018 Nottingham Good Food Partnership became a member of the Sustainable Food Cities Network, a network of over 60 members working towards developing best practice in all aspects of sustainable food;

(l)  In 2018 NGFP ran two new programmes in Sneinton focussed on providing children with healthy food and fun activities during the school holidays. This included a healthy eating and play programme over a number of sessions to reach low income families to help alleviate the issue of holiday hunger;

(m)108 young children and 50 parents were fed at a cost of £0.31 per head. The meals provided were nutritiously dense  vegan meals including home made baked beans and beetroot falafels. Surplus food was distributed to participant to take home.

(n)  The partnership also hosted the city’s first healthy food festival for children called Veg Power which attracted over 400 children and their parents.

(o)  The festival had a number of creative activities available, home baking ideas, a pop up allotment, and food from a diverse range of cultures. Feedback from parents was that children tried foods they would normally refuse at home.

(p)  Future projects include the Family Veg Power Festival on 4August 2019 in Sneinton Plaza and Square and more work on holiday hunger.

Following discussion and comments from the Board, the following points were made:

(q)  There is a piece of work currently looking at the provision already in place across the sectors, and collating information on where there is need for services. This information will feed in to work to ensure a responsive system is in place.

(r)  A focus on work with faith groups and the culturally diverse community groups across Nottingham is helping to raise awareness.

(s)  Workforce education is essential and work at NCC continues and healthy eating options have been introduced at the food outlets at Loxley house. This not only raise awareness for staff but prompts frontline staff to engage with service users around healthy eating;

(t)  The introduction of planning legislation to create exclusion zones for fast food outlets around schools has recently been turned down at a central government level, further work is being done at a local level to attempt to restrict expose around schools;

(u)  A 10% reduction in childhood obesity is abmitous but the Board questioned whether there should be a target to reduce obesity in adults too.

RESOLVED to:

(1)  Commit to the Nottingham City Council objective of reducing childhood obesity by 10% by 2023

(2)  Encourage conversations with citizen on moving and eating for good health and, where appropriate, refer citizens to one of the weight management services available in Nottingham City

(3)  Support exploration of a new, systems approach to eating and moving for good health in Nottingham City; and

(4)  Sign-up to the Physical Activity and Nutrition Declaration, which has previously been endorsed by the Health and Wellbeing Board.