Research and analysis

PHE centres: London

Updated 15 February 2021

Hounslow

The local authority took an iterative whole-systems approach to weight management where obesity was viewed as everyone’s business: planning, housing, clinical commissioning group, leisure centres, libraries, local providers, the school nurse service, catering providers, health visitors, education, and family. Their objective was to reduce childhood obesity.

At the time of the research the London Borough of Hounslow was the ninth largest borough in London. It’s situated between the Thames, Heathrow Airport and central London and had an estimated population of 239,748 in 2011.

Local approach

Prior to 2013, the local authority had the MEND (Mind, Exercise, Nutrition, Do it!) programme. When this was decommissioned in 2013 there was a period when the area had no Tier 2 provision. Then, in 2015, One You Hounslow started a Tier 2 offer that worked with 350 children a year and linked up with the oral health offer.

The HENRY (Health, Exercise and Nutrition for the Really Young) programme trained local children’s centre staff to provide advice. This program was partly funded by Hounslow council and staff costs were absorbed by the Family Nurse Partnership and Sure Start Children’s Centres.

Hounslow was working to improve the uptake of healthy start vouchers and joint workshops in healthy eating were offered to schools.

The One You 5 to 19 programme included information on weight management, physical activity and parent education.

Beat the street initiative was delivered by Intelligent Health on behalf of London Borough of Hounslow. This involved a free 7-week challenge to see how far people could walk, cycle or run around their local area.

The junior citizen scheme was a borough wide programme for 10 to 11 year olds prior to transitioning to secondary school. It included topics from knife crime to nutrition, health and physical activity.

A collaboration existed with Transport for London called Play streets, which was an initiative where public streets were closed for a period of time to allow children to play. This happened at the request of the local community and the travel team worked with communities to support this.

Super Active Schools! was a pilot at the time this research took place. This included 10 schools that incorporated an hour of physical activity in the school day. In the first year, the approach had been to work with schools that were already well engaged, in order to create an evidence base for less engaged schools. It was hoped that this project could be self-funded by the income from the Soft Drinks Industry Levy in 2018.

Hounslow also used the existing workforce that had contact with the public by providing Making Every Contact Count training and by encouraging people to refer clients to One You. Two hundred workers had been trained, including registrars, who had contact with people at life changing moments.

Hounslow incorporated elements of the Change4Life campaign including sugar swaps and promoting the food smart app. Therefore, they not only developed new and creative schemes, but used and incorporated resources that were available to them.

Strategies and programs also included the following:

• junior park runs
• the daily mile
• an obesity task force which utilised strategic planners

Deprivation

Deprivation was a consideration in all the public health work and initiatives incorporated. Deprived schools or families were looked at primarily and an evidence base was built, and deprivation data was incorporated into the key performance indicators (KPIs) of these specific areas. Further, bids for grants for additional funding were also focused on areas of deprivation.

National Child Measurement Programme

The school nurse service ran the National Child Measurement Programme (NCMP) and the standard Public Health England (PHE) letter with local service information included was sent out to parents of identified children. Three-year aggregated data was sent back to the schools, however, this had only happened since 2016. The programme used NHS numbers which allowed GPs access to individual children’s NCMP data. The NCMP letter requested permission to share the NCMP data with the Children’s Weight Management provider (a service commissioned from the NHS). The letter also contained links to other sources of information for parents, for example on physical activity.

Outcome

At the time this research took place it was too early to say whether this approach would reduce childhood obesity.

Further work

Hounslow planned to focus on high impact areas and consistent messaging. Resources and sustaining interventions in the future were highlighted as a potential issue. However, Hounslow believed that it was vital to make small behaviour changes that would impact a big group of people.

Lewisham

The local authority took a whole-systems approach to reducing childhood obesity focusing on strong partnerships to prevent takeaways and increase availability of active green spaces. Their objective was to reduce childhood obesity levels.

A year and a half before this research took place, London Public Health undertook an improvement review on obesity and Lewisham assessed themselves on their whole-systems approach and the different sectors challenged each other to make an action plan. The Obesity Action Plan had 3 prongs:

• Sugar Smart
• Daily Mile
• increasing the use of the green spaces.

There were Nature’s gyms and Health Walks for older people but not many activities for children and young people in parks. A new app had been developed for park activities for over 16 year olds.

At the time of the research, Lewisham was the 13th largest borough in London and was one of the greenest parts of south east London. Lewisham had an estimated population of 292,000 in mid-2014.

Local approach

At the time this research took place, Lewisham had become UNICEF stage 3 baby friendly in community and hospital settings.

Children’s centres were involved in promoting healthy eating, increasing exercise and healthy lifestyles.

According to Lewisham, they had one of the best early years attainment scores in the country. They ran the Healthy Early Years scheme and the nurseries, childminders and schools were the best in the country.

There were 22 schools with 7,000 children involved in the Daily Mile. The London Healthy Schools Programme was encouraged in Lewisham.

In the 2 years before this research took place there had been a national pilot scheme for a whole-systems approach for obesity. This was run by PHE and Leeds Beckett University. Lewisham was the only local authority in London to be involved.

They implemented a cycling strategy. There was Bikeability training and Lewisham had London’s first quiet cycle way (cycling through areas with quiet roads).

The local authority also initiated:

Pregnancy Plus

A maternal obesity pathway.

A takeaway planning policy

In the 2 years before this research took place there had been a planning policy in place to stop takeaways from opening within 400 metres of a school – 9 takeaway applications in 2 years had been rejected.

The Sugar Smart Campaign

Lewisham was the first local authority in London and the second in the country to join this. At the time this research took place, 78 businesses had been involved (since October 2017), including childminders, Lewisham Hospital and Goldsmith’s University.

Strong food partnerships

Lewisham was in the Good Food Guide for London which consisted of 11 different categories, including healthy catering.

Sports partnerships

Lewisham collaborated with the Obesity Alliance and sports initiatives for primary school children which included football, tennis and basketball.

Deprivation

Deprivation was a priority for Lewisham council, which was committed to reducing inequalities. The deprivation in Lewisham was heterogeneous, with one affluent ward and others with varying degrees of deprivation. Due to this, most of the interventions or initiatives were universal.

National Child Measurement Programme

The school nurse team carried out all measurements. All children regardless of their weight category received a letter with information signposting them to the relevant resources available. The public health team and school nurses worked closely to coordinate activities within the schools. There was routine feedback provided to schools following the NCMP, but not to GPs. Weight management programmes linked in with the NCMP, parents were signposted to weight management services that were family based. The tiers for the weight management were linked officially, however a lot of services from the integrated pathway had been decommissioned and there was no Tier 3 for children. Lewisham had found the NCMP data extremely useful to continue placing childhood obesity at the top of the agenda.

Outcome

At the time this research took place it was too early to say if this approach would help reduce childhood obesity in the area.

Further work

The school nurse service was being redesigned to include weight management services. Funds for increasing access to cycling and improving cycle routes in Deptford had come through.

Lewisham continued to focus on changing the environment to make it more conducive to healthy lifestyles and were cutting down on weight management services.

Redbridge

The local authority undertook an iterative whole-systems approach to weight management with numerous partnerships, led by a steering group where every member department and organisation had a level of responsibility. Their objective was to reduce childhood obesity.

At the time of the research, the Joint Strategic Needs Assessment estimated the population of Redbridge to be 301,416 in 2016. Redbridge was a fast-growing London Borough and the 13th largest borough in London in population terms.

Local approach

Following the growing media interest in obesity, Redbridge appointed a lead for obesity responsible for creating a strategy in response to the challenge. Initially, the focus was on the ‘energy in, energy out’ equation and a year later, physical activity coordinators were appointed in partnership with Vision, the borough’s leisure provider. This role was responsible for promoting and increasing physical activity in the borough and was jointly funded by Vision, which was responsible for the borough’s Tier 1 services, including leisure centres, parks and play areas.

Strategies

In 2006 to 2007, an obesity steering group with representation from the NHS, GPs, health visitors and midwives was formed, which linked in with pre-existing work to increase breastfeeding prevalence (Unicef Breast Feeding Initiative level 3). The steering group developed the borough’s first obesity strategy.

MEND was offered in 2007 to 2008 as a 10-week programme, but Redbridge developed their own version after 2 years. However, following a struggle with parental engagement, a family centred approach was taken, where parents and siblings of the child could also attend.

Following the transition of public health from the NHS to local authorities in 2013 the team began building upon strong links between the leisure providers and built similar links with environmental health and transport teams. Membership of the steering group was revised and an overall whole-systems approach was chosen due to participation in sector led improvement work on childhood obesity.

There was a London-wide obesity leads forum which met quarterly and provided a great opportunity for shared learning. This is what led to the decision of taking a whole-systems approach. For example, Redbridge learnt about the Healthier Catering Commitment through this collaboration. Moreover, the forum provided a structure of support for the directing of resources and PHE increased the level of information available.

The borough signed a healthy food and drink declaration which committed the whole council to providing healthy food and drink on their premises and at events, with the aim of becoming sugar smart. The leisure contractor was providing more healthy options and removing sweets and sugary drinks from its vending machines.

The whole-systems approach was led by the steering group, with an action plan paired with the strategy, where every member department and organisation had a level of responsibility. The environmental health team had provided a member of staff for a half-day every 2 weeks to drive forward the Healthier Catering Commitment with takeaway owners. The transport team offered various services to help businesses and organisations make active travel plans.

Redbridge participated in the Great Weight Debate, a London-wide conversation on childhood obesity that included road shows to encourage people to complete a survey on views and opinions and focus groups were run within children’s centres. Issues of fast food availability, inability to cook healthy meals, lack of healthy options and attractive unhealthy food packaging were raised. As a result, cooking lessons were delivered in children’s centres in deprived areas. The evaluation from these demonstrated that parents were willing to promote healthy eating but felt overwhelmed by fast food and unhealthy options. The borough also received some food poverty funding from the Greater London authority to improve the uptake of healthy start vouchers. They talked to local businesses to encourage them to accept the voucher and discussed what they would offer.

Obesity had been a priority since 2006 to 2007 via the steering group, strategy and action plan. It had support from the councillor for health and the chief executive. For example, the chief executive of the council agreed to ban the Coca-Cola Christmas truck from visiting Redbridge.

Deprivation

The south of the borough had high levels of deprivation and high levels of obesity, therefore, schools within these areas were targeted. The physical activity coordinator wrote to the school offering support, for example, in how to spend the pupil premium. All services were double checked to ensure they focused on obesity in areas of deprivation.

Following this, the NCMP and the borough started using the data and geographic information system mapping to target hotspots of obesity and found a clear crossover between prevalence of obesity and deprivation. Redbridge was known as a fairly affluent borough but there were big variations in affluence between wards and even within some wards.

National Child Measurement Programme

The NCMP was delivered by the 0 to 19 health provider contractor and run by the school nursing team. Letters were sent to parents of all young people and letters to those identified with overweight or obesity contained details of the support on offer. There was routine feedback for schools directly from the public health team which was agreed in 2006 to 2007. For the 2 years prior to this research taking place, the team had been using PHE’s new system to print off the results for individual schools and they had been adding deprivation information to this. GPs, on the other hand, did not receive feedback, however, they were aware of the weight management service available and could refer and signpost to these.

There was no real connection between local family weight management programmes and schools. The services took place in other community settings as opposed to within schools. There was a school nurse who had a lead role on childhood obesity who also sat on the steering group and disseminated information back to the school nurse team.

Services offered to those identified by the NCMP data as obese and overweight were as follows.

Both groups were offered a brief intervention on healthy weight and a referral to the weight management service, which was a 6-week course.

In addition, the obese group received a follow up phone call from the school nurse team 3 months later to encourage them to take up the referral to the weight management service, to find out generally how they were getting on and to support or sign post to local offers such as leisure centres.

Overall, there was no pathway to the weight management services, however, they were delivered by 2 partners and both were members of the steering group which ensured communication.

Outcome

At the time this research took place it was too early to say if this approach would help reduce childhood obesity in the area.

Advice to other local authorities

The main message that Redbridge would share with other local authorities is the importance of doing a local healthy food and drink declaration, as this helps to improve food in the whole of the area, and to get it signed takes senior leadership buy-in, which is essential in achieving aims within the obesity agenda.