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Food for Health in Solihull - Solihull Metropolitan Borough Council

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Food for Health in Solihull - Solihull Metropolitan Borough Council Powered By Docstoc
					 Food for
 Health in
 Solihull
Reducing Inequalities
   through a Food
 Strategy for Solihull




        June 2005
CONTENTS                       PAGE


Executive Summary               3


Why do we need a                5
Food for Health Strategy in
Solihull?


Developing a Food for Health    10
Strategy in Solihull


References                      19


Appendices                      20




                     2
Executive Summary

The aim of the Solihull Food for Health strategy is to:

Promote food for health and well being, prevent diet-related disease and
reduce food-related inequalities.

Improving the health of the residents of Solihull and reducing inequalities in
health by tackling the underlying causes of ill-health is a national and local
priority within the Local Strategic Partnership.

We know that poor diet is a major contributor to ill-health, premature
death and inequalities in health. It is strongly linked to inequality in life
circumstances, especially poverty. A healthy diet is important for people of all
ages, but especially infants, children and other vulnerable groups such as
pregnant women, older people and those living in disadvantaged
circumstances. We know that in some groups and communities eating
patterns and access to good quality food are relatively poor. The Food for
Health Strategy is one of a cluster of interrelated strategies and frameworks
for Solihull (including, smoking cessation, physical activity, obesity, CHD and
diabetes, renewal and regeneration). These strategies link to the LSP
Strategic Framework for Health Inequalities by highlighting the need for
resources to be steered towards reducing health inequalities, in particular
contributing to the Key Action Area of reducing deaths from cancer and
coronary heart disease in communities with the highest rates.

A Food for Health strategy in Solihull will provide the direction and context of
the development of integrated local action. Many different organisations,
groups and individuals are the stakeholders and have a part to play in
ensuring access to healthier eating locally.           The key stakeholders,
representing statutory and voluntary sector groups and organisations, have
been brought together to consider the background information and research
related to food and health. They have jointly agreed strategic objectives and
developed actions which could effectively address local food-related
inequalities and ill-health.

The agreed strategic objectives are:

1.    To develop a reliable database on eating patterns within the
      Solihull population.

2.    To improve access to and choice of, affordable healthier foods, in
      communities of greatest need.

3.    To ensure that the information given to the public and service
      users on healthy eating and the relationship between diet and
      health is consistent, accurate, timely and in an appropriate format.




                                       3
4.      To increase opportunities for the development of food-related
        skills and knowledge in the community.

5.      To ensure that provision of food by statutory agencies is in line
        with government healthy eating and food hygiene guidelines and
        minimum standards. To support voluntary and private sector
        organisations to do the same.

6.      To develop greater capacity to support individuals at higher risk
        of diet-related disease.

The proposed strategic level actions are:

    Establish a multi agency ‘Food Action Group’ to provide strategic
     leadership, coordinate activity and oversee implementation of strategy.
    Collate existing data sources of dietary intakes to establish local need and
     enable monitoring of change.
    Develop the role of 'Food Development Worker’ to engage with socio-
     economically disadvantaged communities and other high risk groups,
     developing initiatives to increase access and promote uptake of healthy
     nutritious food and to develop a programme to increase food skills.
    Deliver a training programme to ensure all workers who give nutritional
     advice are familiar with basic principles of nutrition.
    Review current provision of food by statutory agencies in line with current
     guidelines.
    Develop a structured approach to weight management services, including
     provision of training.
    Maximise/re-orientate existing resources and programmes to achieve
     greater equity in service provision and access to opportunity.

Conclusion

The proposed actions above were selected through a participative process
with a wide range of stakeholders. Action across this broad front is essential if
we are to achieve our shared objectives and meet national targets and policy
requirements.




                                        4
1.        WHY DO WE NEED A FOOD FOR HEALTH STRATEGY IN
          SOLIHULL?


1.1       A Healthy Diet is Essential for Good Health

The relationship between what we eat (our ‘diet’) and health is well
established. Poor diet is a significant risk factor for many of the major causes
of ill health and premature death in the UK .

Poor diet is responsible for (1):

         33% of all cancer deaths.
         At least 60% of coronary heart disease (CHD) deaths.
         Overweight and obesity, a result of poor diet (together with lack of
          physical activity), is responsible for 58% of diabetes and 21% of CHD.

A healthy diet is one based on a wide variety of foods, including at least five
portions of fruit and vegetables a day and plenty of starchy foods (such as
bread, potatoes and cereals) and foods containing a minimum amount of salt,
fat and sugar. For infants, breastfeeding provides the best nutrition and is
associated with better health outcomes for both mother and infant.

Dietary recommendations to reduce the risks of cancer and cardiovascular
disease have been developed by the Committee on Medical Aspects (COMA)
(2) and form the basis of the Balance of Good Health. This is a pictorial
model that represents what a balanced diet means in terms of different food
groups (Figure 1). It shows what proportion of the diet should come from
each food group.

Together with physical activity and good food hygiene, improving people’s
diets is an important public health measure. A healthy diet enhances not just
the length but also the quality of life.

Figure 1: The Balance of Good Health
          Food Standards Agency 2003




                                         5
1.2       There are Inequalities in Food-Related Health

There are considerable differences in what people eat depending on their
age, gender, socio-economic and cultural background.

Differences in eating habits are reflected in patterns of diet-related diseases.
The burden of ill health and early death due to diet-related diseases is not
distributed equally across the national population. It is well established that
those living in more disadvantaged life circumstances are more likely to die
early and suffer ill health than those who are of a higher socio-economic
status (3). Disadvantage can begin before birth with poor maternal nutrition
and continues as infants born to mothers from lower socio-economic
backgrounds are less likely to breastfeed.


1.3       What Affects Eating Patterns?

Nationally we know that socio-economic background (Appendix 1) affects
health (3). People on low incomes and from lower socio-economic groups are
known to:

         Eat less variety of foods.
         Eat more processed foods, which are higher in salt.
         Eat less fruit, vegetables, fish and high fibre breakfast cereals.
         Eat more sugar and fatty food.
         Have lower blood levels of vitamins such as folate, iron and calcium.
         Have a higher incidence of dental caries (dental disease).
         Suffer higher rates of coronary heart disease and diabetes.
         Experience higher rates of obesity in women and overweight in men
          (Appendix 2).

Food poverty has been defined as the inability to afford, or to have
reasonable access to, food which provides a healthy diet. Whilst the link
between nutritional status and low income is well established, food poverty
extends beyond economic aspects to include such issues as access,
disability, ethnicity and education. Typically, those experiencing food poverty
may have limited money for food after paying for other household expenses,
live in areas where food choice is restricted by local availability and transport
to larger supermarkets, or be lacking in the knowledge, skills or cooking
equipment necessary to prepare healthy meals.

The health and well being of certain black and minority ethnic communities
is proportionally over-affected by health and socio-economic inequalities,
including those related to dietary intake, when compared to the general
population in England (3). Research shows that (3):

         Bangladeshi men and women are more likely to eat both red meat and
          fatty foods and less likely to eat fruit than any other minority ethnic
          group. Pakistani men and women have the lowest vegetable


                                         6
       consumption of minority ethnic groups. Chinese men and women eat
       the most fruit and vegetables.

      The practice of adding salt to cooking is almost universal between
       South Asian and Chinese groups and more common in Black
       Caribbean adults than the general population.

      Stroke mortality rates are higher in South Asians, West African and
       Black Caribbean men and women.

      Coronary heart disease mortality is higher in South Asians.

      Diabetes is increased in Pakistani and Bangladeshi men and women,
       and in Black Caribbean men and women.

      Babies whose mothers were born in the Indian sub-continent are on
       average 200 grams lighter at birth.

Asylum seekers are a particularly vulnerable group. We know that single
adults will be in receipt of food vouchers, which are approximately 90% of the
value of income support. These food vouchers can only be used in certain
supermarkets. It is well known that there are difficulties eating a healthy diet
whilst receiving benefits (4) and therefore for asylum seekers who receive
even less, the situation will be even worse.

People with disabilities also have poorer access to healthy foods for many
reasons including reduced mobility, cognitive impairment, and they are more
likely to be on a low income.

The age group of individuals significantly effects what they eat. For example:

Children aged 4-18 in England (5) are eating:

      A quarter of the fruit and vegetables recommended
      More than twice the maximum salt intake
      50% more saturated fat than recommended
      50% more sugar than recommended, and
      Teenagers are getting insufficient calcium and iron

What children eat not only affects their health and behaviour at the time but
will also make a significant difference to their health in later life (3). Children
with learning disabilities may find it particularly difficult to achieve an optimum
diet. After the age of four, children who are overweight are increasingly likely
to be overweight or obese as adults. Before they reach their teens, children
can show the first signs of fatty deposits in their arteries.

The National Service Framework for Older People (6) has highlighted that
many older people are on low incomes and those living independently may
lack access to shops and transport in some areas. They may face difficulties



                                        7
in affording a healthy diet, have impaired mobility, difficulty in carrying
shopping, or fear of venturing out due to crime. Older people living alone may
not be inclined to cook because they may lack the confidence or skills to do
so.

1.4       What about Solihull?

There is little reliable information about local eating patterns and food
consumption; however it is reasonable to assume that local dietary patterns
reflect the national picture. This therefore means that our population, on
average, does not consume adequate amounts of fruit and vegetables, high-
fibre starchy foods, and eats an excess of fat, sugar and salt.

We know that Solihull as a whole is a relatively prosperous area compared to
other parts of the West Midlands. However, within the borough there is great
disparity between rich and poor. Residents in the north of the borough tend to
be younger than those in the south, but have poorer prospects in terms of life
expectancy, health, employment opportunities and educational attainment.
The largest concentration of older people is in the south of the borough.

From the data we do have, we know that diet-related diseases are observed
in Solihull and are distributed disproportionately amongst the wards. The data
demonstrate that diet-related disease patterns and inequalities in Solihull also
mirror the national picture. Therefore those people living in more deprived
socio-economic circumstances experience higher rates of diet-related ill
health.

What we do know is that:

         The average age of death in Solihull varies in as much as 9 years
          between wards and the life expectancy gap in Solihull is growing.

         The four wards with the lowest life expectancy are in the north of
          Solihull.

         The differences in life expectancy match the social conditions in the
          wards.

         There is a lower breastfeeding initiation rate in the north of the
          borough.

         There are variations in levels of cardiovascular disease between the
          different wards, with higher rates in the north of the borough.

         For cancer, the highest rates of death per 100,000 people are seen in
          the wards of Smith’s Wood and Chelmsley Wood.

         Children living in the north of the borough have one and a half times
          the dental decay than those in the rest of Solihull.



                                        8
           People from minority ethnic groups may be over-represented in certain
            diet-related diseases and therefore must be taken into consideration.

           Although numbers are small, asylum seekers have specific food-related
            needs.

           Disability can affect food-related health and nationally, people with
            learning disabilities have higher rates of diet-related disease, such as
            heart disease.

A recent mapping exercise of current food-related activity in Solihull, carried
out as part of developing this strategy (Appendix 3), suggests that there are
some pockets of food-related activity but much of this is currently un-
coordinated and may not reflect local need. A Food for Health strategy will
ensure that all stakeholders work towards common objectives that optimise
the use of limited resources.

1.5         Improving health and reducing inequalities in health
             is a government priority

A Food for Health strategy will help to deliver on both national and local
priorities and targets. For example;

           The National Service Frameworks for Older People (6), Coronary Heart
            Disease (7), Diabetes (8) Children, Young People and Maternity
            Services (9) and the Cancer Plan (10).
           Local Public Service Agreements.
           Choosing Health Food Action Plan (11)
           Value for Money Targets and Best Value Targets1.
           Renewal and Regeneration (12)
           Healthy Schools Blueprint and Healthy Schools Programme (13)



       A Food for Health Strategy is therefore needed because:

        Good nutrition is essential for good health
        Poor diet causes ill-health and contributes to health inequalities
        Improving diet is a government priority
        It will help the co-ordination of multi-disciplinary, multi-agency
         work
        It will assist in developing common aims and objectives
        It will make optimal use of resources




1
    Government requirement on Local authorities to work within best value framework.



                                                          9
2.     DEVELOPING A FOOD FOR HEALTH STRATEGY

2.1    What is Strategy?

Strategy is about how we move from where we are now to where we want to
be (Figure 2). It is about action that is determined by systematic examination
of what the needs of the population are, where inequalities exist, evidence of
what works in promoting healthy eating and what does not work and
examination of current action and gaps in that action. Strategies for food and
health provide an excellent basis for integrated planning across health and
local authority agencies.

Figure 2




      Where are we now?                               Where do we want to
                                      How?            get to?




       Health Needs               Research
                                                            Aim
       Current Activity/          Local
                                                            Objectives
       Resources                  Knowledge
                                                            Targets




2.2    Strategy into Action – the Process

A Food for Health strategy steering group (Appendix 4) was formed with
representatives from Solihull Primary Care Trust, Heart of England NHS
Foundation Trust and Solihull Metropolitan Borough Council. The group
undertook three main tasks:

              Identified key stakeholders (Appendix 5).
              Produced a background document including, an assessment of
               food-related health needs and inequalities, mapping of current
               activity, a review of the literature and research evidence base,
               and a policy analysis, to make a case for a Food for Health
               strategy.
              Ran a stakeholders' workshop (27th January 2004).



                                       10
2.3      The Stakeholders’ Workshop

At the workshop the tasks of the stakeholders were to:

      1. Develop and agree the aims and objectives of the strategy (Where do
         we want to get to?).
      2. Evaluate current activity and carry out a ‘gap analysis’ (Where are we
         now?).
      3. Develop strategic options for action (How do we get there?)


2.4      Where do we want to get to?

Stakeholders discussed and agreed the main aim of the Food for Health
strategy, which was:

To promote food for health and well being, prevent diet related disease
and reduce food related inequalities.

The following six strategic objectives were agreed:

      1. To develop a reliable database on eating patterns within the
         Solihull population.

      2. To improve access to and choice of affordable, healthier foods, in
         communities of greatest need.

      3. To ensure that the information given to the public and service
         users on healthy eating and the relationship between diet and
         health is consistent, accurate, timely and in an appropriate format.

      4. To increase opportunities for the development of food-related
         skills and knowledge in the community.

      5. To ensure that provision of food by statutory agencies is in line
         with government healthy eating and food hygiene guidelines and
         minimum standards. To support voluntary and private sector
         organisations to do the same.

      6. To develop greater capacity to support individuals at higher risk
         of diet-related disease.

2.5      Where are we now?

Stakeholders at the workshop were asked to ‘map’ all current food-related
activity against the six objectives (Appendix 3). The purpose of this mapping
exercise was to establish if current activity is adequate to enable the objective
to be met and therefore to identify where the gaps in activity/service exist.




                                       11
    ‘Gaps’ were defined as where:

          No relevant activity taking place.
          No clear rationale linking current activity to the objective.
          Current activity was not focussed on known need/priority groups.
          Current activity did not have the potential to decrease inequalities.
          Current activity did not involve users/consumers/public in planning
           and delivery.
          Current activity was not based on sound research evidence that the
           activity was likely to be effective2 (or evidence suggests that it is likely
           to be ineffective).


2.6        How do we get there?

           Identifying Strategic Options for Action

The next step in the process was for stakeholders to consider how we might
fill the gaps identified. During discussion, some common themes emerged.

They can be summarised as follows:

          There is a need to increase capacity and capability for food-
           related activity including human resources, funding, training etc.


          Existing resources need to be targeted for maximum effect.

          Food issues need to be integrated into other strategy and
           planning processes for maximum impact.

          There needs to be cohesion and integration at all levels so that
           food for health activity can be delivered effectively.

These were further developed into a set of proposed options for action, which
were then evaluated using the following criteria:

          There is a clear rationale linking the proposed action to the objectives.
          The action has potential to reduce inequalities, and certainly not to
           increase them.
          The action focuses on those in greatest need/priority groups.
          There is sound research evidence that the proposed action is likely to
           be effective (If no evidence is available then the action will only be
           considered as a pilot and subject to full evaluation).
          The action will involve users/carers in planning and delivery.




2
    For some types of activity or intervention there may be no research evidence available.


                                                     12
CONCLUSION

The proposed actions were selected through a participative process with a
wide range of stakeholders and are needs-focused and evidence-based.
Action across this broad front is essential if we are to achieve our shared
objectives and meet national targets and policy requirements.

Detailed Action Plans are to be developed for implementation of this strategy.
It is proposed that a Food Strategy Local Implementation Team will be
established to provide leadership, maintain an overview, and be responsible
for overall coordination of borough-wide interventions

The actions selected using these criteria are summarised in Table 1 below:




                                     13
 Table 1: Identified gaps and Proposed actions

         Strategic Objectives           Where we are now – identified gaps                        Proposed actions

1. To develop a reliable database on        Little reliable information about           Optimise existing sources of data by
eating patterns within the Solihull          adult local eating patterns.                 collating more effectively
population.                                 Health-related behaviour
                                             questionnaire does not cover all            Ensure capacity within PCT
                                             schools or pre-school children so            information team to support needs-
                                             information is limited.                      based planning and to monitor the
                                            Limited local information about              impact of interventions
                                             access to healthier foods.
                                            Very limited data about breast-             More investment in the Health Related
                                             feeding available.                           Behaviour Questionnaire to increase
                                            Limited local information on the             coverage
                                             accessibility of healthy food.

2. To improve access to and choice of       No known activity targeting                 Establish new community food
affordable,  healthier    foods    in        preschool or early years.                    development initiatives to work with
communities of greatest need.               Limited activity for people with             socio-economically disadvantaged
                                             learning disabilities.                       communities and other high risk
                                            Activity to support this objective           groups
                                             does not appear to be the
                                             responsibility of any person or             Use the National Healthy School
                                             organisation.                                Programme as a vehicle to promote
                                            Existing activity is disjointed and          healthy food and drink in schools using
                                             lacks cohesion.                              a whole school approach
                                            Accessibility to affordable, healthier
                                             foods is difficult for the less mobile      Promote government’s Breast-Feeding
                                             or people living in rural parts of           Voucher Scheme and Food Welfare
                                             Solihull.                                    Scheme (soon to be replaced by
   Some provision currently focussed           ‘Healthy Start’)
    mainly in the north, would benefit
    from being borough-wide, such as           Solihull Metropolitan Borough Council
    the availability of water and milk in       (SMBC) to seek to encourage and
    schools and the provision of                support provision of affordable healthy
    healthy breakfast clubs.                    foods across the whole borough
                                                through regeneration and planning
                                                initiatives and partnership




                     15
3. To ensure that the information given      Much of the information comes               Deliver a training programme to
to the public and service users on            from companies promoting their               ensure all workers have an adequate
healthy eating and the relationship           own products.                                level    of     nutrition knowledge
between diet and health is consistent,       Lack of quality training and                 appropriate to their role
accurate, timely and in an appropriate        guidelines to ensure people are
format.                                       giving out the same messages                Develop and disseminate guidelines
                                             Internet is a useful means of                for nutritional management and the
                                              disseminating information, but               appropriate and effective use of
                                              equity of access is uncertain,               resources/materials for different
                                              despite heavy usage.                         groups of workers


4. To increase opportunities for the         Lack of a co-ordinated, structured          Optimise support, co-ordinate and
development of food-related skills and        approach at all levels. The majority         build upon existing national schemes
knowledge in the community.                   of activity is short term funded and         such as the National Healthy Schools
                                              carried out in an ad-hoc manner              Programme, the Five-a-Day
                                              either due to lack of planning,              Programme, Welfare Food Schemes
                                              people working in isolation, or short        (Healthy Start) and other community
                                              term funding.                                education activities
                                             Lack of facilities to deliver skills-
                                              based training e.g. cooking facilities      Develop & deliver a new mainstream
                                              in community venues. Local                   funded programme to increase food-
                                              colleges, who train students for             related skills and nutritional
                                              NVQ levels in childcare, do not              knowledge particularly in socio-
                                              have adequate facilities or                  economically disadvantaged
                                              curriculum requirements to teach             communities
                                              cooking and food preparation skills.




                                                               16
5. To ensure that provision of food by  We do not know which, if any,                  Ensure that systems are in place to
statutory agencies is in line with       nutritional standards are being                 monitor food provision
government healthy eating and food       followed by statutory, private or
hygiene guidelines and minimum           voluntary sector food providers.               Implement the Healthy Schools
standards. To support voluntary and  More could be done in schools to                   Programme and National Food in
private sector organisations to do the   promote uptake and availability of              Schools Programme to ensure that
same.                                    healthy foods, especially in secondary          school communities, school food
                                         schools. This would need to be                  providers, and parents work together
                                         monitored.                                      to promote provision, access and
                                        Some users of the meals on wheels               uptake of healthy food and drink in
                                         service may have difficulty reheating           schools
                                         frozen meals, potentially causing food
                                         safety problems and inadequate
                                         nutrition.

6.    To develop greater capacity to           Lack of structured weight              Develop a structured approach to
support individuals at higher risk of           management services for the             weight management including the
diet-related disease.                           community.                              development of an obesity strategy
                                               Inconsistent nutritional advice given   and care pathway across primary and
                                                by different health care                secondary care
                                                professionals and other service
                                                providers e.g. leisure services.       Develop a coordinated approach to the
                                               Limited training in infant nutrition    training of health care professionals in
                                                for workers in early years services.    the nutritional management of diet-
                                               Limited ongoing nutrition training      related diseases e.g. coronary heart
                                                for health and other frontline          disease, diabetes, obesity, nutritional
                                                workers                                 support and infant nutrition.
                                               Schools in areas of high incidences
                                                of dental caries could make better     North Solihull schools should be
                                                use of mobile dental health unit.       encouraged and supported to make



                                                                17
Promotion of the dental services    more use of the mobile dental health unit
available would assist schools in   to promote oral health
optimising the use of facilities.




                18
3. REFERENCES


1.    WHO: World Health Report (2002). Reducing Risks, Promoting
      Healthy Life: WHO Geneva

2.    Department of Health (1994). Nutritional Aspects of Cardiovascular
      Disease: Report of the Cardiovascular Review Group of the
      Committee on Medical Aspects of Food Policy. London: HMSO

3.    Acheson D. (1998). Independent Inquiry into Inequalities in Health
      report. The Stationary Office: London

4.    Dowler E et al. (2001). Poverty Bites Food, Health and Poor
      Families. London: Child Poverty Action Group

5.    Gregory et al. (2000). National Diet and Nutrition Survey: young
      people aged 4-18 years (2001). Vol 1: report of the diet and nutrition
      survey. London: The Stationary Office

6.    Department of Health (2001a). National Service Framework for
      Older People: Department of Health

7.    Department of Health (2000). National Service Framework for
      Coronary Heart Disease: Department of Health

8.    Department of Health (2002). National Service Framework for
      Diabetes. Department of Health

9.    Department of Health (2004). National Service Framework for
      Children, Young People and Maternity Services. Department of
      Health

10.   The NHS Cancer Plan (2002). Department of Health

11.   Department of Health (2004). Choosing a Better Diet: a food and
      health action plan. Department of Health

12.   North Solihull Strategic Framework (Draft 2004). Solihull
      Metropolitan Borough Council

13.   Department for Education and Skills (2004). Healthy Schools
      blueprint. Department for Education and Skills

14.   Department of Health (2005) Healthy Start – Consultation on draft
      regulations. Department of Health

                                  19
   4. APPENDICES

   Appendix 1: Office for National Statistics Socio-Economic
   Classification


The National Socio-Economic Classification Analytic Classes
1       Higher managerial and professional occupations
        1.1 Large employers and higher managerial occupations
        1.2 Higher professional occupations
2       Lower managerial and professional occupations
3       Intermediate occupations
4       Small employers and own account workers
5       Lower supervisory and technical occupations
6       Semi-routine occupations
7       Routine occupations
8       Never worked and long-term unemployed




                                  20
      Appendix 2: Classification of Obesity

Obesity is classified using the Body Mass Index (BMI), a simple index of weight for
height. The index is measured by the formula:

BMI = weight (in kg) divided by height (in m2)

BMI is used as a method of classification because it is more strongly associated with
percentage body fat and health complications, than is weight alone.

The internationally accepted classification of weight is as follows:

 Classification                    BMI (kg/m2)                 Risk of co-morbidities
 Underweight                       <18.5kg/m2                  Low (but risk of other clinical
                                                               problems increased)
 Normal Weight                     18.5-24.9kg/m2              Average

 Overweight                        25-29.9kg/m2                Mildly increased
 Obese                             >30.0
 Obese class l                     30-34.9kg/m2                Moderate
 Obese class ll                    35-39.9kg/m2                Severe
 Obese class lll                   >40kg/m2                    Very severe




                                              21
Appendix 3: Summary of Current Activity

                       Objective                                                                Current Activity
1   To develop a reliable database on eating         Primary care data/clinical audit.
    patterns within the Solihull population          Dental services data.
                                                     School-based surveys.
                                                     West Midlands Lifestyle Survey planned for 2004. Previous survey 1995.
                                                     Entitlement to free school meals.
                                                     Breast feeding data


2   To improve access to and choice of               School children:
    affordable, healthier foods in communities of    National Fruit in School Scheme implemented in 99% of Solihull schools. There are breakfast clubs in
    greatest need.                                   some primary and secondary schools but the ‘healthiness’ of what is being provided is unknown. Some
                                                     schools have free school milk and some schools implement the Water in Schools Programme.

                                                     There are free school meals provided but exact uptake is uncertain.

                                                     Adults:
                                                     There is a farmers market in the south
                                                     A breast-feeding voucher scheme exists across the Borough

                                                     Older people:
                                                     Limited ad hoc activity: various luncheon clubs, frozen meals on wheels, some transport to shop
                                                     schemes, odd scheme for people to eat a school meal, some promotion of allotments.


3   To ensure that the information given to the      Internet information and media.
    public and service users on healthy eating and   Leaflets available in arrange of topics and from a range of sources.
    the relationship between diet and health is      National campaigns –some centrally provided materials.
    consistent, accurate, timely and in an           Advice given by health professionals and others such as home helps, leisure staff and support workers.
    appropriate format.




                                                                        22
4   To increase development of opportunities for    Some mandatory training on food hygiene is offered by the Environmental Health Department and this is
    the development of food-related skills and      done on a rolling programme.
    knowledge in the community.
                                                    The sessions offered by the cardiac rehabilitation team and the diabetes services are a useful start but
                                                    small in scale and it would be useful to extend similar schemes to the general public.

                                                    Sure Start in Chelmsley Wood is running a 6-week course about food and health, for local women.

                                                    Schools do offer some cooking skill development, as part of food technology but it is not part of the core
                                                    curriculum.

                                                    Health visitors may provide sessions on weaning which will look at food preparation and hygiene.


5   To ensure that the provision of food by         Various agencies (Local Authority , Ofsted) involved in looking at food provision as part of statutory
    statutory agencies is in line with government   inspections but not focusing on nutritional aspects or healthy eating guidelines.
    healthy eating and food hygiene guidelines      Standards exist for schools and hospitals both self regulating. Guidelines are also in existance for looked
    and minimum standards. To support voluntary     after children and young people, older people in careand people with learning disabilities.
    and private sector organisations to do the
    same.


6   To develop greater capacity to support          Activity to support delivery of objective 6 is delivered mainly by healthcare professionals, including the
    individuals at higher risk of diet-related      Dietetic Service, Cardiac Rehabilitation, Midwives/Health Visitors, District Nurses and GP’s.
    disease.
                                                    The Dietetic Service for Solihull Primary Care Trust is provided by the Nutrition and Dietetic Department
                                                    at Birmingham Heartlands and Solihull Trust. The funding to deliver this service in the community setting
                                                    is very limited: -

                                                    -WTE Senior I for North Solihull Community Diabetes Service
                                                    -0.5 WTE Health Promotion Nutritionist
                                                    -0.2 WTE General dietetic time, used to deliver a minimal service to Learning Disabilities and to provide
                                                    very limited follow-up to patients on home enteral feeding. Individual patients can also be referred for a
                                                    dietetic outpatient consultation by their GP (e.g. nutritional support or weight management). The waiting
                                                    time for this service is currently approximately 8 weeks.


                                                                       23
Steps have been taken to start to train other healthcare professionals to provide weight management
support. A screening tool has also been developed to enable healthcare professionals to identify patients
at risk of malnutrition and deliver first line basic nutritional support. Initial implementation training for
District Nurses has been carried out.

Some Solihull GP Practices are study sites for the Counterweight Project, investigating effectiveness of
training practice nurses to support weight management. There are opportunities to learn from this work
when developing local weight management services.

Mobile dental unit providing access to dental health services for children in areas of high dental caries
rates.




                    24
Appendix 4: Membership of Food Strategy Steering Group

Teri Knight                       Consultant in Public Health
                                  Directorate of Public Health
                                  6th Floor,
                                  Mell House
                                  46 Drury Lane
                                  Solihull
                                  B91 3BU

                                  0121 7128336
                                  teri.knight@solihull-pct.nhs.uk


Helen Reilly                      Nutrition & Dietetic Services Manager
                                  Heart of England NHS FoundationTrust
                                  Birmingham Heartlands Hospital
                                  Bordesley Green East
                                  Birmingham
                                  B9 5SS

                                  0121 4240674
                                  helen.reilly@heartofengland.nhs.uk


Jackie Paterson                   Food Safety Team Supervisor
                                  Food, Health & Safety
                                  Public Health and Protection Directorate
                                  Solihull Metropolitan Borough Council

                                  0121 7046858
                                  jpaterson@solihull.gov.uk


Sue Bridgwater                    Health Promotion Dietitian2
                                  Specialist Health Promotion Service
                                  Directorate of Public Health
                                  2nd Floor
                                  Mell House
                                  46 Drury Lane
                                  Solihull
                                  B91 3BU

                                  0121 7128323
                                  sue.bridgwater@solihull-pct.nhs.uk

2
  * Acknowledgement is given to my predecessor, Ruby Dillon, Health Promotion Nutritionist, for the
vast amount of work involved in the preparation of the original background document and draft food
strategy

                                                25
Appendix 5: Stakeholders (All stakeholders were invited to attend workshops. Those marked with an * did attend. All are to be
                          kept informed of progress).


                       Designation                                          Organisation
                       Age Concern Officer*                                 Age Concern, Solihull
                       Assistant Education Officer                          SMBC
                       Assistant Education Officer                          SMBC
                       Breast Feeding Specialist Midwife*                   Maternity Unit, Birmingham Heartlands
                                                                            and Solihull Hospital
                       Business Support & Community Development             Corporate Land & Property SMBC
                       Officer*
                       Cardiac Rehab Sister*                                Birmingham Heartlands and Solihull
                                                                            Hospital
                       Centre Manager                                       Chelmsley Wood Properties Ltd
                       Chief Dietician to Primary Care*                     East Birmingham PCT
                       Chief Executive                                      Colebridge Trust
                       Chief Executive Policy & Development                 SMBC
                       Children's Services Manager*                         SPCT
                       Clinical Director, Dental Health                     SPCT
                       Community Paediatrics*                               SPCT
                       Consultant in Public Health*                         SPCT
                       Coordinator, National Healthy School Standard*       SPCT
                       Deputy Director of Primary Care                      SPCT
                       Dental Health Promotion*                             SPCT
                       Dietetic Services Manager*                           Birmingham Heartlands and Solihull
                                                                            Trust
                       Director of Community Education                      Solihull College

                                                              26
Designation                                           Organisation
Director of Primary Care                              SPCT
Director of Public Health                             SPCT
Early Years & Childcare Services Development          Woodlands Campus, Chelmsley Wood
Officer
Economic Development & Research Officer               SMBC
Environmental Coordinator*                            SMBC Green Scheme


Environmental Health, Directorate of Public Health*   SMBC
Environmental Health, Team Supervisor*                SMBC
Head of Family Health Services                        SPCT
Head of Family Health Services                        SPCT
Head of School Improvement, Performance &             SMBC
Partnership, Education & Children's Services
Health Promotion Specialist, Physical Activity        SPCT
Health Visitor*                                       Sure Start
Horticultural Officer*                                SMBC
Inspector for Education & Children's Services         SMBC
LEA Inspector, Early Years                            SMBC
Leisure Team Leader*                                  SNAP
Manager*                                              Oak Trees Day Centre
Medical Director                                      SPCT
Medicines Management*                                 SPCT
Network & Inclusion Officer*                          Disabled People's Network - Solihull
Community Nursing Manager*                            SPCT
Nutritionist*                                         SPCT
Occupational Health Department*                       Birmingham Heartlands Hospital
Occupational Health Nurse                             Health & Safety, Seven Trent
Operations Manager                                    Solihull Children's Fund

                                        27
Designation                               Organisation
PEC Board Member*                         Sheldon Heath Surgery
Practice Nurse*                           SPCT
Primary Care Development Manager          SPCT
Principal Catering Officer*               Solihull Catering Services, SMBC
Principal Facilities Officer              Education & Children's Directorate,
                                          SMBC
Programme Director                        Sure Start


Project Worker                            Crossroads
Provider Manager                          Social Care & Performance Directorate,
                                          SMBC
Regeneration Co-ordinator*                Strategic Services Directorate, SMBC
Research Officer                          Solihull On Track
School Health & Social Care*              Solihull College
Senior Specialist in Public Health        SPCT
Smoking Cessation Service*                SPCT
Social & Community Issues                 Project Worker, Colebridge Trust
Store Manager                             Tesco Stores Limited
Store Manager                             Safeway Stores PLC
Store Manager                             J Sainsbury PLC
Store Manager                             Safeway Stores PLC
Store Manager                             Aldi Stores LImited
Store Manager                             Kwik Save Group PLC
Team Leader Early Years                   Solihull College
Town Centre Manager of Solihull           SMBC
Weight Management Advisor                 BHST
Work Health Advisor                       Land Rover


                                     28
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