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 imescale RAG IMPROVEMENT DELIVERY PROGRESS OPERATIONAL MANAGEMENT STRATEGIC GOV OBJECTIVES STRATEGIES RESPONSIBILITY RESPONSIBILITY RESPONSIBILITY 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 NHS Highland Board NHSHighland 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 imescale RAG IMPROVEMENT DELIVERY PROGRESS OPERATIONAL MANAGEMENT STRATEGIC GOV OBJECTIVES STRATEGIES RESPONSIBILITY RESPONSIBILITY RESPONSIBILITY 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 imescale RAG IMPROVEMENT DELIVERY PROGRESS OPERATIONAL MANAGEMENT STRATEGIC GOV OBJECTIVES STRATEGIES RESPONSIBILITY RESPONSIBILITY RESPONSIBILITY 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, edition of Promoting Health and Wellbeing in 0-5 years • Early Years Green other than adolescent red Green otherthan toddlers, pre Settings guidance folder, to be distributed end August Development school and 2010. Officer NHS Highland Board NHS Highland primary aged • Adolescent lead children and Staff training needs assessment questionnaire to 2011 August 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 imescale RAG IMPROVEMENT DELIVERY PROGRESS OPERATIONAL MANAGEMENT STRATEGIC GOV OBJECTIVES STRATEGIES RESPONSIBILITY RESPONSIBILITY RESPONSIBILITY KEY OUTCOMES Healthy Start e-learning CPD module linked to AT-L and