item: 6 report: CYP12/11
FHC3 ACTION PLAN – FOOD AND NUTRITION by Sally Amor
Summary
Maintaining a healthy weight is a problem and a challenge across western societies. Since 2008 a focused programme of work by the Joint Committee for Children and Young People partners has sought to address some of these challenges and enabled the achievement of the HEAT 3 and HEAT 7 targets across Highland communities.
1. Background
In 2008 Scottish Government allocated funding to NHS Highland to support child healthy weight interventions (HEAT 3) and to support the nutrition of women of child bearing age and infant feeding (CEL 38 (2008)). Within Highland the funding was aligned to support nutrition, infant feeding and healthy weight activity that is orientated around communities and family lives. This approach has enabled a range of activity: the implementation plan, capturing key activity and outcomes for this work programme is detailed in Appendix 1.
2. Progress to date
2.1 Healthy child weight Data from Highland children collected in 08/09 and 09/10 suggests that P1 children in Highland are more overweight and obese (24%) than the Scottish average (20%). These figures indicate that 1 in 4 P1 children in Highland are overweight or obese, and these rates increase with age, and this has serious implications for the physical, emotional and economic wellbeing of our population.
The HEAT 3 target and SOA for family based child healthy weight interventions has been in place since 2008. The target details the number of healthy weight interventions to be undertaken with 5-15 year olds by April 2010. To date, Highland has met this target through a combination of an 8 week community intervention (X programme) and a 2 week school based intervention (mini X programme).
2.2 Infant feeding The HEAT 7 target and related SOA seeks to improve breast feeding rates at 6-8 weeks. The target is likely to be achieved but will be challenging. A range of activity is undertaken to support women to breast feed their babies from school based class room activity in primary schools, to supporting clinical services to achieve the UNICEF Baby Friendly Initiative and the development of peer support in communities across Highland. Where peer groups have been operating in the North there are early signs that breast feeding rates are improving.
3. Highlights: good practice
3.1 The Maternal and Infant Nutrition Best Practice Guidance The guidance was developed to support practitioners across Highland in delivering consistent messages to pregnant women and families over health and weight. It has been noted as an exemplar model of good practice by the Scottish Government.
4. Healthy Start
The Healthy Start scheme provides vouchers for fruit, vegetables, milk, vitamins and minerals for pregnant women and children under 4 years on low incomes, and all pregnant women under 8 years. The Maternal and Infant Nutrition Best Practice Guidance has been instrumental in providing professionals with consistent advice on the scheme and highlighting opportunities to raise awareness. We have established a system for distribution of the Healthy Start Vitamins an minerals to all eligible recipients in Highland and are working with our national partners to develop meaningful monitoring data.
5. Implications arising from this Report
At the current time it seems likely that we will achieve HEAT 3 and HEAT 7 targets. The programme of work undertaken over the last two and half years has informed and underpinned this success however there is no room for complacency. The targets remain challenging and require further activity and support into the next round of funding.
5.1 Resource Implications The current budget runs to August 2011.
5.2 Legal Implications None
5.3 Equality Implications Elements of the work programme have undergone equality and diversity assessment.
5.4 Climate Change Implications None
5.5 Risk Implications Non achievement of the HEAT 3 healthy weight target trajectory which is overseen by the NHS Highland Improvement Committee.
Recommendations
The Joint Committee for Children and Young People are asked to note: • The activity detailed and undertaken to support healthy weight for infants, children and young people across Highland • The progress made in the implementation of the Heat 3, Heat 7 CEL 36 Implementation Plan (attached) • Achievement to date of HEAT 3 and HEAT 7 targets • The ground breaking work undertaken to: o Development of X Programme community and mini X to support the HEAT 3 target o Develop healthy eating/nutrition best practice guidance across pregnancy, infant and toddler/pre school/primary ages o Establish a distribution network for healthy start vitamins across Highland o Establishment of peer support for breast feeding accessible across all Highland communities o Development and trialling of health and well being outcomes for Curriculum for Excellence breast feeding awareness sessions for P5,6 and 7 – to be adopted Summer 2011.
Sally Amor Child Health Commissioner/Public Health Specialist
HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES • The establishment of H3 working group in August 2008 with a defined role and remit. The group Various members of Child Health Improvement includes representation from: Public Health and the public Commissioner / Committee NHS Health Improvement (public health, healthy weight, health/health Public Health Highland infant feeding, early years): Communications Team; improvement team Specialist/IFA’S the four Highland CHPs; oral health promotion colleagues; Highland Council active schools and the youth service. Strategy 1 • CHPs were invited to discuss representation at the Support the Development group with health improvement colleagues in the development of of a structure CHPs. family orientated to coordinate • Decision to add value to the aim and intention of community based and implement H3 by incorporating the goals of H7 and CEL36 – to nutrition and the create synergy and opportunities to work in NHSHighland Board healthy weight requirements community settings. interventions to of H3, H7 and • Discussions were held in late 2008 as to how best August 2011 support the CEL 36 with to make links with maternity colleagues in the CHPs Amber delivery of the and the incorporation of the H7 and CEL 36 HEAT 3, HEAT consideration agenda 7 and CEL 36 of the • CAMHS advise was sought November 2008- (2008). associated January 2009 to ensure H3 healthy weight governance and proposals were not giving mixed messages re risk children and young people vulnerable to eating arrangements disorders • Paper detailing proposals for the H3, H7 CEL 36 Implementation Group re CHP and Raigmore posts and infrastructure were put to the DHS Operational Group in December • Paper also went to the Lead Midwives group in January 2009. • An initial financial plan was drawn up in February 2008 and revised in April 2009. Further revision undertaken Aug/Oct 2010 when SG required savings to be made from CEL 36 funding stream. • A risk log was commenced in April 2009. HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES • H3 Trajectory revised March 2009 in light of deferred delivery of H3 interventions during 2008/09 as the H3 work programme was being developed • H7 Trajectory remains is at risk of not meeting target although work in progress to address CHSP quality issues and improve data collection • Potential risks have been logged. Remains under scrutiny of NHS H Improvement Committee HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES
Pregnancy, infant and todderl/pre school/primary best • Midwifery Managers of the CEL 36/H3 /H7 Delivery practice pathways completed June 2010. Noted by Development above posts Implementation Strategy 2 Scottish Government as exemplar work. Officer Group Support the Vulnerable development of Maternal and Child Nutrition Best Practice Guidance Families healthy eating document distributed (300 copies) June best Document uploaded to NHS Highland intranet. • Infant Feeding practice/guida Document upload to Forhighlandschildren Advisors nce pathways for pregnant Reference to Best Practice Guidance included in new women, infants, editionSettings of Promoting Health and Wellbeing in 0-5 years • Early Years Green otherthan adolescent red toddlers, pre guidance folder, to be distributed end August Development school and 2010. Officer NHS Highland Board primary aged • Adolescent lead children and Staff training needs assessment questionnaire to August 2011 to be identified adolescents inform development of training completed. One day health behaviour change to support healthy weight developed and to run March 2011 onwards.
HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES
Healthy Start e-learning CPD module linked to AT-L and eKSF for Health staff.
Adolescence Not scoped to date
• WHO Growth Charts • Guidance on correct usage and changes to new WHO/UK Growth Charts from ages 0 – 4 years – including preterm and low birth weight guidance
Health needs assessment (HNA) of v. overweight children and their families to be undertaken by Dec
2010: completed and training being developed.
Gaps in the medical/dietetic assessment of v. overweight children prior to enrolment in the X programme have been identified. Criteria for referral to hospital paediatricians has been reviewed in light of limitations in current service levels but this will require further review by all stakeholders in order to ensure a safe level of sustainable healthcare staff support.
Health needs assessment of pregnant women BMI> 40 to commence Sept 2010 and in progress.
HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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OBJECTIVES STRATEGIES RESPONSIBILITY RESPONSIBILITY RESPONSIBILITY
KEY OUTCOMES
Training has been developed around raising the issue of weight using a health behaviour change (HBC) approach, for midwives during consultation with women during pregnancy. This training will also include the key nutrition messages during pregnancy and it is anticipated to deliver this training across NHSH. The main challenge has been the lack of hours for the Midwifery Development Officer to support the CEL 36 dietetic post in delivering this training. Whilst this is reviewed, a session on healthy weight management in pregnancy will be delivered at the Practice Development Day for midwives on 26/11/10.
A training pack is being developed to support primary care staff in adult weight management is an opportunity to support work with parents. Training will
highlight a HBC approach to healthy weight management and the role of primary care in the NHSH Adult Healthy Weight pathway. Training of SE CHP primary care staff on the Counterweight programme will be running in Sept and Nov 2010. At present one GP practice has signed up for training.
HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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OBJECTIVES STRATEGIES RESPONSIBILITY RESPONSIBILITY RESPONSIBILITY
KEY OUTCOMES
• X Programme resource developed October 2008- Healthy Weight Senior Health CEL 36/H3 Delivery January 2009 to support H3 interventions for 5-15 Officer Promotion Specialist Implementation Strategy 3 year olds. Training delivered (2009 and 2010) Diet and Nutrition Group Build the across 4 Highland CHPs with integrated children’s capacity skills service partners. and knowledge • mini-X programme developed December 2009 – of the work February 2010 to extend reach of interventions to force working whole class settings, and complement Curriculum with children, for Excellence Health and Wellbeing Outcomes young people • Subsequent modules to be developed as pathways and families are completed NHS Highland Board around • Training post in place to work across NHS Highland nutrition, on healthy weight/motivational interviewing. August 2011 healthy weight, Training post vacated Spring 2010. Training to be Amber oral health and delivered through redesign of corporate posts well being in • Delivery of generic motivational interviewing community courses in all northern CHP’s. settings • Development of blended learning motivational through the interviewing course. development • mini-X training for Active Schools Co-ordinators and delivery of developed and delivered in early 2010 a series of • Guidance for PHP’s developed and distributed modular • First of ongoing series of development days for training PHP’s and associated 3,7,36 staff held December resources and 2009 and various through 2010) materials • Breast Feeding support training carried out across region and related audit of trainers/activity • New Growth Chart training carried out across region, and being cascaded at CHP level
HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES Facilitator training for X-programme rolled out in CHPs – delivered by PHP’s with peer support and guidance from Healthy Weight Officer
Further development day for PHPs and associated 3,7,36 development staff held troughout 2010 and
planned for 2011.
Contribution to NHS Health Scotland’s national planning around developing a healthy weight workforce; and building an infrastructure to support rollout of Raising the Issue of Healthy Weight Training – national guidance pending HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES CEL 36/H3/H7 • NHS Highland Communications representation Lead Communications Child Health Implementation Delivery involved in H3 CEL 36 Implementation Group until Officer Commissioner/ Group Strategy 4 late 2009 – replacement contact pending Public Health Develop a • December 2008/January 2009 tender inviting Specialist/IFA social external consultant to undertake focus groups was marketing/com not successful. munication • MSc Research dissertation undertaken with focus strategy to groups with parents to seek their views and support the perceptions of healthy weight issues and how best H3/H7 CEL 36 to support interventions at a community/family life key messages level • Article in local free paper detailing the aim and intention of the X Programme
• Article in Highland Life detailing breastfeeding and NHS Highland Board
Support August 2011
• 2 month article in VUE magazine for July and Amber August highlighting breastfeeding benefits (both
of which highlighted the reduced incidence of childhood obesity in breastfed neonates) • Involved with National Marketing campaign in November 2009 with NHS Scotland • Involved with Best Beginnings art gallery in Inverness Merkinch in January 2010 • February 2010 large article about X-programme in Inverness area local paper, featuring participant family. Opportunity to repeat in North CHP • Improved tracking beginning early 2010 of response to different modes of informing families of X-programme (including letters home, school newsletter, website, stall at parents’ evening) • Social marketing sub-group initiated early 2010 and tender out for further work to support further healthy weight activity and programme development.
HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES o Ongoing positive H3 coverage in local press: John O’Groats Journal featuring health days in Halkirk Primary Oban Times featuring poster competition around the X-programme Inverness Courier featuring participant family experience in, and positive description of, recent X- Programme • To date NHS Highland has been involved with the National Breastfeeding Awareness Campaign through marketing campaigns in the Eastgate centre and art exhibition at Merkinch. • Breast Feeding Awareness Week 2010 has incorporated the Curriculum for Excellence and targeted primary 6 and 7 children at breastfeeding awareness sessions appropriate to age.
• A design a “NHS Highland Poster” was run in conjunction with BFAW very successfully with the winning poster becoming our local campaign poster. • Breastfeeding awareness has been celebrated regularly within the local press through liaison with the communications team at NHS Highland. • A baby Show in Eden Court in October proved to be the ideal setting to raise awareness of breastfeeding and allow the peer supporters to highlight their work within NHS Highland HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES CHP Based PHP posts CHP managers CEL 36/H3/H7 • A range of discussions in H3 H7 CEL 36 Implementation Delivery Implementation Group and with partners over how Group Strategy 5 best to support community based activity Detail service • Resulted in development of CHP Public Health Posts models/capacit to support the delivery of H3 and implementation y to deliver of CEL 36. These are now submitted for grading. community • This approach will also devolve budgets to CHPs to based healthy support local delivery/implementation weight • Outcomes for CHP based delivery being scoped and interventions discussed (to ensure support across the H3 CEL 36 across the agendas: community based activity and NHS Highland interventions, support for breast feeding and baby geography friendly initiatives/peer support, oral health activity in the early years/baby welcome sticker NHS Highland Board scheme up-take
• Also considering how best to support specialist August 2011 services where children/young people and pregnant Amber women have high BMIs – this is proving challenging given the lack of evidence to support interventions and recruiting to time limited posts • Mini-X developed to support trajectory delivery and is being rolled out throughout region. Minor adjustments to session design and flexibility in delivery have enabled greater engagement with schools – e.g. one whole ‘health day’ plus follow up session • X-programme delivery also tested in twice-a-week format – mixed success. • Parents-only model for X-programme, with occasional participation by children, considered. Approval attained from Scottish Government to test as delivery model; awaiting confirmation of the programme being arranged.
HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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OBJECTIVES STRATEGIES RESPONSIBILITY RESPONSIBILITY RESPONSIBILITY
KEY OUTCOMES
Universal BMI for all P1 and P7 children undertaken in late 2008 to inform interventions and allocation of Research post to be Research post to be H3/H7 CEL 36 Delivery budget appointed to – appointed to – Implementation Strategy 6 • Development of evaluation paper forms to support interim Healthy interim Health Group Develop an CHP delivery Weight Officer Weight Officer evaluation and • Evaluation post being developed and due to be monitoring submitted for grading IFA/health framework to • Specialist Registrar in Public Health developing a Improvement and underpin and range of evaluation tools and supports Knowledge team inform the • Options for developing an e-standardised tool for NHS Highland H3/H7 CEL 36 assessing interventions being scoped work • Engagement in national H3 Evaluation Group programmes • On-going monitoring through CHSP data of
breastfeeding rates at 6 – 8 weeks NHSHighland Board • Liaison with Health information and Knowledge team to report on data received via the CHSP-PS August system Amber
• Evolvement of SBR Implementation Group to enable 2 0
data at birth and discharge from hospital to be 11
recorded accurately within NHS Highland using the Scottish Birth register Data • Through regular UNICEF audits the BFI is evaluated effectively and efficiently • All breastfeeding training is evaluated by means of questionnaire • The referrals to the breastfeeding clinic are evaluated by means of a questionnaire returned by the patients • All breastfeeding work is reported on through ANMAC, lead midwives, Health Improvement committees and local health improvement groups. • The breastfeeding trainers network is currently being evaluated •
HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES
CEL 36: Evaluation post not taken forward.
Qualitative evaluation proposal for CEL 36 developed but not taken forward due to budgetary constraints. Qualitative evaluation plan to be developed in-house. Quantitative evaluation reporting tools developed from set down from 2nd Development Day on 22nd June.
Minimum data set recording tools to support CHP reporting currently being developed
Healthy Start management information data received from SG will be collated for Highland.
H3: Ongoing revision of recording templates to capture learning and improvements as well as reporting data.
Emphasis on complete data collection to contribute to qualitative evaluation. There are challenges with obtaining these complete data sets – reasons for this and solutions to be investigated further.
HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES NHS Highland Board
Delivery • Training to increase completion of ante-natal Infant Feeding Head of Midwifery H3, H7 CEL 36 Strategy 7 checklist and education of pregnant women Advisors Implementation Support the • Monitoring of breastfeeding rates at birth Group promotion of through SBR system and increase • Media campaigns to increase the knowledge and the uptake and cultural acceptance of breastfeeding Review trajectory Reviewquarterly duration of • NHS Highland baby welcome sticker scheme to be breast feeding encouraged for all NHS Highland and partner locations to increase public acceptance and approval of breastfeeding in public • School education to link with curriculum for excellence on breastfeeding – pilot carried out May 2009 with primary 6 • Training of all staff, volunteers and partners in accordance with UNICEF BFI to increase the knowledge and skills of those caring for pregnant or breastfeeding women • Production of numerous policies and leaflets as Green as perImprovement Committee cycle identified in the NHS Highland Information trail – revised July 2009 – which encourage uniformity and reduces conflicting advice given to women • Use of post-natal checklist and health visitor checklist to ensure that breastfeeding is going well and any problems are identified and managed correctly • Clear pathways for breastfeeding problem referral including tongue tie and clinic evolvement • Infant feeding Advisors completed training for division of tongue tie in Southampton general Hospital in November 2009 – now ensures that a tongue tie division service can be offered locally in NHSH
HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES • Peer support established and accessible across all Highland communities at 48 hours after delivery • Peer supporters are providing telephone contact for breastfeeding post-natal women • Peer groups have commenced in Inverness, Alness, Fortrose, Thurso and Fort William. Groups are planned for Tain, Wick and Sutherland also • Plans are in place for the peers to become involved in ante-natal education and also having a presence on post-natal wards. • Breastfeeding problem clinic is running very successfully every Friday afternoon in the paediatric clinic offering specialist treatment for women who are dealing with a feeding problem • A tongue Tie division service is also proving to be very successful helping to ensure that women breastfeed for as long as they wish without suffering from the additional problem of a tongue tie HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES
• All of NHS Highland is at present implementing NHS Highland Board Deliver the BFI process. Infant Feeding Head of Midwifery H3, H7 CEL 36 Strategy 8 • Raigmore has been re-accredited as a Baby Advisors Implementation Support the friendly Hospital in September 2009 Group assessment • Caithness General has been accredited also as a processes for baby friendly Hospital in October 2009 Baby Friendly • The rest of NHS Highland has achieved stage 1 of Initiative the Baby friendly process on the 30th of July across NHS 2009 Review quarterlyasinformed Highland • All areas have agreed and ratified action plans in place to ensure that awards are either maintained or achieved by 2011 • BFI training curricula has been ratified for all levels of staff, volunteers and partners who have contact with pregnant or breastfeeding women – roll –out is on-going • Agreement with G.P sub-committee to accept BFI
training either face – to- face or on-line Green • Resources have been implemented, ratified and by auditandBFIaccreditation
rolled out to support adherence to BFI • Funds have been secured through CEL to fund BFI assessments in all areas as per action plans – funding has been devolved to 4 CHPs with priority to use for BFI • Clear media releases informing the general public re progress with BFI in all areas • Identify potential breastfeeding peer supporters in each area
• Liaison with personnel department and collaboration through the NHSH Volunteer Draft strategy to evolve job descriptions and effective training programmes to ensure volunteers are valued and respected members of the breastfeeding team HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES • Contract with both the NCT and BFN to deliver accredited peer support training in accordance with NICE 11 guidance • Identify areas especially with a link to areas of disadvantaged groups to focus on delivery of breastfeeding peer support. • Work with partners such as NCH and Surestart to involve with programme • Work closely with members from Scottish Infant Feeding Advisory Network and Scottish Baby friendly Implementation Group • Infant Feeding Advisors have both accessed the project management courses and train the trainer courses from UNICEF • A train the trainers event has been scheduled for
the 26th of February 2010 to train new breastfeeding trainers to support established successful trainers network
Caitheness General achived full BFI Accrediataion in October 2009 Raigmore Hosptial were successfully re-accredited in November 2009 UNICEF Stage 2 assessment has been achieved by all CHPs in the Highland partnership,
Stage 3/final accreditation due August 2011 for Mid and North Highland CHPs.
HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES Action plans to be developed to ensure full accreditation of all 4 CHPs and accompanying CMU’s by end of CEL 36 funding in August 2011
HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES
Delivery Concerns over uptake of vitamins and lack of Interim: Midwifery Child Health NHS Highland Strategy 9 coordination raised in October/November 2008 with Officer Vulnerable Commissioner/ Board Increase the Director of Nursing and Director of Public Health, Families – CHP Public Public Health up take of issues as follows: Health posts once Specialist Healthy Start • Uptake appointed entitlements • Lack of local data and vitamins • Absence of distribution network/mechanisms Work now in progress to: • Raise awareness of entitlement by midwives • Options for distribution in NHS and in pharmacies • Consideration of local audit as per developed NICE
audit tool NHS Highland Board
August 2011 Proposal for distribution of Healthy Start vitamins to Green eligible women and children developed and implemented
for Highland
Maternal and Child Nutrition Best Practice Guidance distributed June 2010 raises awareness of the programme.
Staff training needs assessment questionnaire developed and distributed with Guidance
Healthy Start management information reports being received from SG and collated on a monthly basis.
Healthy Start CPD e-learning module linked to AT-L and eKSF for health staff
HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES
Plan for raising awareness of Healthy Start scheme in Highland localities e.g through the Post Office network under development
Healthy Start reminder included in the Fun with Fruit
leaflet sent to all pre-school centres, August 2010
Healthy Start and healthy eating awareness included in Playalong pilot programme, Inverness
HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES Support the 2008/2009: Oral health Senior Dentist Oral Consultant Dental implementation Caithness improvement Health Public Health NHS and delivery of Merkinch/Dalneigh in Inverness coordinator Improvement Highland Improving Oral Health and 2009/2010 Oral health support Public Health Modernising NHS Hilton Inverness worker Nursing Team Dental Services Dingwall Leaders Invergordon Extended duties Targets: Alness dental nurses Roll out of Islay All pre school Integrated Jura Oral health children in areas Childsmile East Sutherland educators of greatest need Programme – will be offered Pan Highland 2010/2011 Ongoing Public Health Nurses dental advice, by 2012. Raigmore A dietary advice, Culcabock support and Smithton preventative Ft William packs through Skye community based Kintyre organizations. 2011 Onwards
All remaining areas within NHS Highland area
HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES 80% of three to Promotion of dental registration at appropriate points five year old throughout childhood. children to be registered with a NHS dentist by 90% of nurseries brushing on a daily basis. 2010/2011. Maintain Regular input and support from the oral health team to Supervised maintain the toothbrushing programme. All nursery Toothbrushing schools will offer Programmes in supervised nurseries. School nursing staff distributing oral health packs on fluoride School nursing an annual basis to all children starting school. toothbrushing staff to schemes and distribute oral support healthy health packs to Ongoing support to schools throughout Highland. eating and all children drinking water starting school. Bi yearly toothfayres made available to all primary one policies. and nursery age four children. Work with
All children schools to starting school raise will receive awareness of preventative Oral Health packs. and how it can be achieved 60% of 5 year through olds (primary 1) training and with no signs of simple practice dental disease. such as healthy food choices, 60% of 11 year regular dental olds (primary 7) attendance, with no signs of and daily dental disease in toothbrushing permanent teeth. with fluoride toothpaste.
HEAT 3 HEAT 7 CEL 36 (2008) Implementation Plan (For Highland’s Children 3 Format) T
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KEY OUTCOMES Increase the percentage of under 18’s under the care of an NHS dentist.
20% of Primary Maintain 84% of target schools currently brushing on a daily
School with the supervised basis. highest need toothbrushing committed to programmes in Regular input and support from the oral health team to supervised tooth primary maintain the toothbrushing programme. brushing schools, programmes in P1 intensive & P2. support and vocational centres.