Research and analysis

PHE centres: South of England

Updated 15 February 2021

Oxfordshire

The local authority took a system-wide approach to managing childhood obesity. They perceived childhood obesity as everyone’s business, therefore it was a system-wide priority. Their objective was to reduce childhood obesity.

At the time this research took place, Oxfordshire’s population was 683,200 (Office for National Statistics, 2016). It’s a rural county in the South East of England where one-third of its population lived in towns or villages of less than 10,000 residents. Oxfordshire also has a metropolitan area that had an estimated population of 161,300 at the time (Office for National Statistics, 2016).

Local approach

Oxfordshire implemented a series of strategies and initiatives.

The Healthy Weight Action Plan was the strategy in place when this research was conducted. The strategy was designed following a workshop with organisations and individuals which mapped priorities in this area:

• healthy eating
• workplaces
• schools
• the environment.

The public health team’s role was to facilitate the meeting and then formulate a plan. There was no public consultation, instead the focus was on the current service provisions already provided and maximising existing assets.

In relation to Tier 1 services, they related to health visitors, school health nurses and the school curriculum. There were, however, no Tier 2 services at the time this research took place as they had been decommissioned due to challenges with recruitment. Two Tier 2 services previously existed, MEND (Mind, Exercise, Nutrition, Do it!), and a children’s weight management service. However, they were not cost effective due to the lack of uptake.

HENRY (Health, Exercise and Nutrition for the Really Young) used to be offered. However, there was confusion at the time this research took place on if, or how, it would be delivered going forward, due to the planned reorganisation of children’s services it relied on.

Oxfordshire focused on and invested in breastfeeding. The health visitor service achieved a level 3 in the Baby Friendly Initiative and the midwifery service achieved a level 1.

There was an awareness of some work around active travel and links between public health and the council. This was shown in the strategy.

Deprivation

The area is fairly affluent, with pockets of deprivation. However, deprived areas were not targeted: programmes and schemes were universal. At the time this research took place, Oxfordshire was about to start offering focused drop-in sessions in 2 schools that had been identified as high need in terms of the rates of overweight children. Parents were invited to attend if they had any concerns about their children’s weight and the invite was sent to parents alongside the National Child Measurement Programme (NCMP) letter.

National Child Measurement Programme

The NHS Trust was commissioned to run the NCMP, therefore, school health nurses ran the NCMP and completed the weighing and measuring. Letters were routinely sent to parents. The standard Public Health England (PHE) template was used with additional information included on what services were available locally. Complaints about the letter were directed to PHE. The letter itself signposted parents to the school health nurse service, and then parents would decide if they wanted to make contact or not. The letter also suggested contacting their general practitioner (GP) and a leaflet was sent alongside this relating to the school health nurse service. If an appointment was made with a school nurse, they undertook an assessment (health and well-being questionnaire for the parent) and provided a Tier 2 form of intervention based on nutrition, exercise and readiness for change. The parent decided if the child attended the appointment or not. GPs were also signposted as they could refer children into primary or secondary care for example, to see a dietitian or nutritionist.

There wasn’t a lead school nurse because Oxfordshire believed that this was everyone’s responsibility.

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

When this research took place, there were plans to further upskill health visitors in healthy weight and nutrition (training provided by the Institute of Health Visiting) to help identify problems with children’s weight early.

Portsmouth

Portsmouth worked collaboratively with the school nurse team to increase parental engagement in weight management and focused on consistent health messages. Their objective was to reduce childhood obesity.

Portsmouth is a port city in Hampshire, England, and in 2010 the estimated population was 207,100.

Local approach

In the early years of the NCMP, Portsmouth had children centres in areas of deprivation. These centres offered food-based work and obesity campaigns at scale. The local authority had also heavily invested in training staff in key settings (such as children centres, nurseries, schools). The percentage of settings participating fluctuated.

The Health Weight Strategy for Portsmouth 2014 to 2024 mentions the NCMP. It talks about shifting cultural norms towards healthy weight. Its strategic objectives are to:

1. Make healthy weight a priority for all.
2. Tackle the obesogenic environment.
3. Invest in prevention.
4. Capitalise on early intervention and treatment.
5. Utilise the wider workforce.

The strategy takes an assets-based approach, putting ownership into the hands of communities and using resources that are already available to their fullest potential to get the best use out of them, making the best use of restricted finances.

At the time this research took place the wider workforce was utilised by rolling out the Making Every Contact Count (MECC) training. The MECC training began in 2014 and had excellent reach across a wide variety of roles. A 2-day MECC course was offered to staff.

The strategy mentions work to check that local bylaws were suitable for limiting takeaways and betting shops. At the time this research took place this work had not been prioritised, although Portsmouth followed the national planning regulations (EIA, HIA).

When this research took place, work on the pathway for weight management and healthy weight for children and young people was ongoing. This public health team and the integrated commissioning service were involved in a refresh of the pathway for adults and children, which consisted of:

• looking at how referrals were made to the appropriate service
• ensuring that there was enough capacity
• checking that what was being provided was needed
• ensuring Portsmouth was applying best practice based on available evidence around weight management

The school nurse team worked with I.S.S (the local authority’s school catering provider used by most maintained schools in the city) to run a healthy eating promotion event for schools and students. This helped to ensure consistency of message and joined up thinking. The city also began promoting the daily mile and the golden mile initiatives in spring 2017. Training and access to the portal was offered for free and the public health team wrote to heads and governors to let schools know about it. It was also included in a newsletter sent to all council properties. To promote this to schools with restricted outdoor space, they were putting together some case studies from schools with similar challenges to give ideas on how this initiative could still be accessed.

There was also a focus on personal, social, health and economic (PSHE) education in schools, and the role of education and schools. For example, using teachers as role models, giving clear and consistent messages from a young age and trying to get parents to understand what being above a healthy weight means for their children (as a method of trying to increase engagement and behaviour change).

National Child Measurement Programme

The NCMP was delivered by the school nursing team and had been commissioned by the children’s social care until 2019. For reception children, the NCMP was integrated into a more comprehensive health check including hearing and vision screening.

The NCMP letter included a contact number so that parents could make contact for more personalised information and support. If parents made contact, they were offered 6 one-to-one sessions with the school nurse team but this was flexible depending on their needs. The school nurse team may have also offered additional measure points for children or signposted to sugar swaps and other national schemes such as Change4Life. Support offered was face to face or over the phone, or information was sent through the post. Portsmouth was aware that the uptake via referrals from the NCMP was quite low, and they were uncertain if other referral routes would be more successful. In theory, parents were able to self-refer but in practice this might not have happened. There was a website where parents could refer children.

At the time this research took place, work had recently started on a quality improvement project aimed at increasing engagement with parents of year reception children who had been identified as obese by the NCMP and the school nursing service (SNS). Plans for this included targeting one school with high participation rates and high obesity rates and then seeking to include a further school with high obesity rates but lower engagement. The project was receiving 6 months of support from NHS Elect, which had helped with issues such as how to analyse the data and how to identify change.

Anecdotally, the SNS found it hard to engage parents. If parents were not home when the SNS called, they left a return phone number but that line was not manned, so the parents had to leave a message, otherwise the contact would go cold. The phone was checked 3 times a day and parents were called back within 2 days. Portsmouth was considering other ways for the SNS to improve engagement, such as sending a text message reminder the day before the service visits the school and also giving parents more information about the NCMP.

Home-educated children were invited to take part in the NCMP. The school nurse team sent letters to education who distributed this offer to elected home-educated children. The NCMP could then be carried out during a home visit or a community visit.

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

Portsmouth was exploring the different universal pathways on offer for children’s weight management. As well as this, Portsmouth was looking into the PHE NCMP letters sent to parents and considering different approaches to the style and information included. There were plans for a focus group with parent and carers to explore if the information included was clear and to try to understand if barriers existed, such as language and health literacy. Portsmouth also planned to discuss the parent pre-measurement letter with PHE to investigate if behavioural insight work had been undertaken and to understand how much scope there was to localise them without reducing their effectiveness.

Portsmouth was also about to undertake a small-scale study within one classroom, in one school, investigating how pupils felt towards being weighed and measured. An age-appropriate survey was planned, and the public health team were going to speak to teachers about any parental contact they had regarding the NCMP. They hoped to be able to upscale this study across the city. In addition, within secondary schools, the public health team was delivering training to teachers in all public health subjects and discussing what the role of the team in schools should be. Portsmouth’s public health team was planning to send a survey to all secondary schools to find out what their current provision was to help identify what schools wanted from the team in advance of sex and relationships education becoming mandatory. It also gave an opportunity to promote sex and relationships providers and organisations that offered support to schools such as the PSHE Association.

Somerset

The local authority took an integrated and holistic approach aiming for weight management interventions to be at a population and community level. Their objective was to reduce childhood obesity.

Previously, health-related issues were looked at in isolation, and when this research took place, Somerset wanted to look at how they could tackle the underlying causes and how they could be linked. Somerset was aiming for weight management interventions to be at a population and community level, as it can take two-and-a-half hours to travel across the area – a challenge when attending events with only limited resources available. Examples include:

• developing websites such as Healthy Somerset and Health in Schools
• building community capacity
• encouraging community organisations to develop physical activity and healthy eating initiatives through grant funding, such as health walks, community pounds and Man v Fat
• training the wider workforce in MECC

At the time this research took place, around 545,390 people lived in Somerset and 48% of the population lived in a rural area. The county comprises 5 districts: Mendip, Sedgemoor, South Somerset, Taunton Deane and West Somerset.

Local approach

Many initiatives and schemes were put in place.

There was a strong county sports partnership in Somerset which lead a number of physical activity programmes in schools.

School-based lifestyle programmes were targeted to schools in areas of inequality and in areas that were in the top quarter of excess weight. The school-based lifestyle programme could be evaluated by measures such as how many schools they worked in and how many staff attended the training sessions.

Food for Life and ‘Make School Meals Matter’ strategies for healthier school meals, however, were both short lived. At the time this research took place, there were standards and guidance for school meals which covered providing healthy meals.

Health Walks were successful in Mendip, but these were aimed at adults.

The Field to Fork project supported the development and delivery of outdoor learning linked to healthy eating, farming, emotional well-being, play and exploring the natural world.

There was a physical activity strategy in place.

Schools and school nursing teams, library, health and social staff, and children’s centres all worked together. There was a pre-school physical activity programme called Jumping Beans.

Somerset felt that the MapMe tool was a positive intervention used in the 2 years prior to this research taking place. It was a visual resource allowing parents to see what a child looks like in each of the weight categories. This work was carried out with Newcastle University as many parents did not recognise that their child may be overweight.

National Child Measurement Programme

The main approach had been changing the way the NCMP was delivered in the 2 years before this research took place. Sending results letters provided an opportunity to raise awareness of the NCMP and subsequent healthy lifestyles through the dissemination of resources such as Change4Life, MapMe, and a locally produced resource leaflet.

The school nursing team carried out the height and weight measurements. The schools received general feedback. Somerset sent results letters to every parent and every GP irrelevant to the child being classified as obese or overweight. Pre-measurement events and parent focus groups were used to make this decision. The PHE NCMP template letters were adjusted to remove any medical language and to soften reactions. The letter included information on how parents can plot the weight category of their child themselves. Updates to the NCMP results letter also stemmed from parental focus groups.

Up until December 2017, children identified as overweight or very overweight were referred to the Children’s Weight Management Programme (CWMP). The CWMP had a family-based approach and a parent needed to attend. After December 2017, the CWMP was no longer made available, and an alternative follow-up or service was being considered at the time that this research took place. Overall, local family weight management programmes were linked with the NCMP and with schools, however, there was a low uptake for the signposted weight management programmes.

Somerset viewed the NCMP data as one of the most useful pieces of data available, allowing the use of targeted interventions for schools that regularly showed up within the results. Data from the NCMP was shared when required to prioritise interventions and used to develop the PSHE programme in schools. The participation of schools in the NCMP was good with all schools in the county taking part. However, uptake among pupils was lower than the South West and this may have masked the true figures for overweight and very overweight in Somerset.

In relation to service tiers for weight management, Tier 3 weight management services for children were accessed through the NHS community dietetic service and Tier 4 services were accessed out of the area via paediatric referral.

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.

The local authority did find that the MapMe Tool was successful for parents to have a visual guide as to each weight category for children.

Further work

The healthy weight team was developing a healthy eating strategy for information sharing with their partners and the schools at the time this research took place. It was an aspiration for Somerset to have data robust enough to link health inequalities with each other in order to have a more holistic approach and to track children with overweight, tooth decay and other indicators.

Advice to other local authorities

Results letters should be seen as an opportunity to inform and equip, as parents often do not recognise that their child is overweight.

South Gloucestershire

The local authority took a whole-systems approach to strengthening partnerships across the life course. Their objective was to reduce childhood obesity.

It was decided that a whole system life course approach would be the most effective to include evidence informed programmes such as Unicef Baby Friendly Initiative.

At the time this research took place the estimated population of South Gloucestershire was 277,600. Approximately, 86.5% of residents lived in ‘urban’ areas, 4.8% in ‘towns or fringe’ areas, and 8.7% in ‘rural’ areas.

Local approach

Childhood obesity was an area for collective action in the updated Joint Health and Well-being Strategy 2017 to 2021, a spotlight within the Director of Public Health report and a priority (by encouraging physical activity and healthy eating) in the South Gloucestershire Council Children Young People and Families Plan.

It was very difficult to attribute the identified trend to any one piece of work as the approach over the last decade before this research had been holistic and strategic, delivering specific interventions through a life course approach as well as addressing wider determinants. This work was led by South Gloucestershire Public Health in partnership with health, local authority and voluntary organisations. Specific initiatives involved working in partnership with families.

Strategic documents

These are the:

• Joint Health and Well-being Strategy 2017 to 2021
• Joint Strategic Needs Assessment (JSNA), 2016 (which was being updated at the time of this research)
• South Gloucestershire’s Healthy Weight and Obesity Strategy 2014 to 2020
• South Gloucestershire Physical Activity Strategic Partnership and Physical Activity Strategy 2015 to 2020
• Draft Food Plan 2017
• South Gloucestershire Children, Young People and Families Partnership Plan 2016 to 2020

Work in early years

Work in early years involved:

• investing in additional support for pregnant women and new mothers to breastfeed
• achieving Unicef Baby Friendly Initiative accreditation (South Gloucestershire Primary Care Trust 2014)
• delivering HENRY (2012 to 2013) parenting programme through children centres and voluntary organisations
• working collaboratively with pre-school settings to encourage physical activity, to increase knowledge of nutrition and encouragement of good oral health
• developing the Maternal and Childhood Guidelines resource and disseminating it to the wider public health workforce, supported by training

Building workforce capacity in the wider public health workforce included multi agency raising the issue of weight training. This training was a response to practitioners’ feedback that they did not feel confident talking about weight. Research in collaboration with University of the West of England to explore South Gloucestershire mothers’ infant feeding experience particularly around available breastfeeding support was also conducted.

Partner-led strategies and initiatives

• Active Travel and Active Play schemes
• encouraging health lifestyles through community settings such as libraries, leisure and fitness centres, local sports facilities and golf courses, parks and open spaces and play facilities
• park schemes
• Recreational Running programme
• REACH (Re-thinking Eating and Activity for Children’s Health)
• Healthy Schools Programme
• partnership working, such as Be Safe Be Seen, Road Safety, Physical Activity Strategic Partnership

REACH was a fun, family and community-based programme to help children aged 8 to 11 to manage their weight. The weekly programme was completely free for families, and featured fun physical activity sessions for children and healthy eating activities, recipes and support for parents. The programme lasted for a total of 10 weeks and helped young people gain confidence and make new friends.

Examples of specific initiatives:

• monitoring and evaluating strategic documents outlined above
• continued commissioning of the breastfeeding support service
• development of the healthy weight care pathway
• delivery of a CWMP
• delivery of a parenting programme in the early years by early years practitioners
• resource development and dissemination
• the commissioned 0 to 19 service had healthy weight as one of its high impact areas for both health visitors and school health nurse
• increasing the uptake of the healthy start scheme

Deprivation

Deprivation was a priority, the council identified 5 priority neighbourhoods. These geographic areas identified health action plans and some included work to reduce childhood obesity.

There was a public health inequalities and partnership officer who lead on this. The health visiting service also included a specialist post to work with the Gypsy and Traveller community.

Schemes

These included:

• Healthy Start scheme for disadvantaged families to increase access to free vitamins helping to ensure a nutritious diet
• Active Play vouchers to ensure disadvantaged families had free access to some activities in local active centres
• South Gloucestershire Public Health and Well-being developed ward profiles that, along with NCMP data, could be used by professionals to inform practice.
• Street Games and Fit and Fed that helped make sport more widely available for disadvantaged young people, Foodbanks and Wild4life (outdoor project working with families)
• the public health and well-being division ensured reducing health inequalities was a focus within all of its programme areas

National Child Measurement Programme

At the time this research took place, the school health nursing service completed the measurements for the NCMP and there was a school nurse lead. Annual data was provided to schools and GPs received anonymised data only.

Universally, all children were offered advice by the school nursing team. However, those identified as overweight or very overweight had information about the CWMP included within the NCMP parent feedback letter. Data from the NCMP was used to collate information for the health profiles of the Wards. The childhood obesity team could focus their child weight programmes in these areas. The child and young people team had strong links with their colleagues in the adult obesity team. A whole family approach was being considered at the time this research took place within the context of reviewing and future delivery of a CWMP.

The NCMP developed well and participation rates in schools improved. South Gloucestershire council developed an NCMP webpage which was well used by parents and the number of visits to this website increased. Further, there was good partnership working with the school health nursing service and public health, for example in terms of providing technical support and training.

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

When this research took place, South Gloucestershire was carrying out a review of services to evaluate what needed addressing and how to measure impact. Weight management services and tiers were going to be evaluated, as well as potential budgets, funding, resources and time frames. South Gloucestershire was working towards strengthening partnership working. The voice of the child was going to be considered within this review.

Research with Bath University on the NCMP feedback letter given to parents of overweight and very overweight children was being conducted using narrative accounts form a child’s perspective.

Advice to other local authorities

South Gloucestershire’s advice would be to use a whole-systems approach.

Surrey

The local authority took an iterative whole-systems approach to childhood obesity with a focus on building stable partnerships and moving forward with the times through social media.

Their objective was to reduce childhood obesity.

Surrey is a county in South East England where, at the time of this research, 1,132,400 people lived (based on the 2011 census).

Local approach

Surrey took a whole-systems approach and had a successful and effective out of home award scheme called ‘Eat Out Eat Well’, with an estimated 300 businesses taking up the scheme across the past 5 years. At the time this research took place it had been rolled out across the South East and a version was being developed for younger years.

When this research took place, Surrey had been running HENRY for 4 years and 450 facilitators had been trained to deliver the programme within children’s centres. The organisation managing the programme (Surrey Nursery Links) delivered the training and ensured it was targeted at high need areas. HENRY had an evaluation system built into the programme.

Guildford is an area of affluence, with well-educated parents who have a good level of health literacy and a keen interest in being healthy. Surrey found that such individuals were more engaged in the healthy weight agenda. In Woking, there are affluent areas but there are also pockets of serious deprivation. Surrey highlighted these differences as complexities in tackling childhood obesity.

The whole-systems approach had been iterative and unofficial until the year before this research took place, when a strategy document was drawn up in support. The Health and Well-being Board signed it in November 2017, and the strategy supported the creation of the Healthy Weight Alliance. Working together and making childhood obesity everyone’s business was driven by the need for efficiency. The county was also using its Twitter account and other social media to spread health messages.

Surrey is perceived as quite an affluent area, so funding was limited and there was a need to make the most of the assets: it had to gain the best value from them. The approach had also developed almost naturally from identifying where departments or partners were already working together. The Eat Out Eat Well award provided a great starting place as public health was working together with environmental health. The alliance brought together children’s centres including those planning to join, as well as active travel and others.

Surrey also promoted active travel and had a whole team on the council dedicated to it. They were also a member of the Healthy Weight Alliance. It was hoped that the Healthy Weight Alliance’s action plan would enable progress to be tracked, but there was an awareness that it would be very difficult to say if the interventions made a difference or not. Surrey emphasised how attitudes and culture needed to change to tackle obesity and they believed it was important to help people to care for themselves.

Deprivation

Surrey had a focus on deprivation with schemes targeted in areas of health inequality. In the year prior to this research taking place, the Tier 2 CWMP called Alive ‘N’ Kicking had been targeted towards those at greatest need.

National Child Measurement Programme

The school nursing team delivered the NCMP. At the time this research took place feedback from the NCMP was not provided to GPs. There was a school nurse lead and they were the first point of contact for the public health team. The public health team ran a pilot on child weight management, whereby school nurses visited people’s homes to give first contact, followed by 3 more visits over 6 months and further telephone support. This project worked well, increasing engagement in the CWMP and won an award as a result. However, engagement was still not sufficient, and it became more similar to a Tier 3 intervention than a Tier 2. Due to financial pressures, the focus was on Tier 2 interventions that could reach a wide number of people rather than on smaller reach Tier 3 programmes.

Surrey had its own analysts who prepared the data to be released into the public domain in an understandable format and they also had a dedicated NCMP analyst.

Schools received aggregated 3-year data annually. It was emphasised that this may not always be useful when broken down at school level. The need to focus on obesity could become obscured and there was a concern that if obesity was not viewed as a priority, it would become a greater issue.

The CWMP linked in with the NCMP. Children who were identified through the NCMP were offered the CWMP through the letter parents received. Alive ‘N’ Kicking delivered sessions to whole classes in targeted schools and as it was a commissioned service, evaluation was built into the contract.

The NCMP letter sent to parents of identified children was based on the PHE template but it included information regarding the CWMP and it was reviewed and amended every year to try and increase engagement.

Tiers for weight management were linked – on Tier 3, the paediatric services, individuals were signposted to the Tier 2 offer, Change4Life and One You (for adults).

Public health in Surrey had a very close relationship with its Tier 2 provider and this was highlighted as vital to their success.

Public health in Surrey had a very close relationship with its Tier 2 provider and this was highlighted as vital to their success.

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 Healthy Weight Alliance was going to put together an action plan that recognised existing and continuing work and extended to new projects and practice. It was hoped that this would help to identify what was already happening and highlight how it worked with the overall strategy and helped create new partnerships. Surrey also hoped that this would in some cases give rise to new initiatives and actions. The key thing for Surrey was that although obesity is everyone’s business, the action plan makes clear who is accountable for what in order to avoid it becoming ‘no-one’s business’.

In relation to the link between NCMP data and the CWMP, in the future Surrey hoped that a member of the CWMP staff would be seconded to the school nurse team to follow up letters with phone calls in order to increase uptake of the services (this was dependent on resources). The phone calls could be used to encourage parents to sign up to Change4Life, or to signpost them to the healthy weight page on the Healthy Surrey website that had recently been refreshed at the time of this research to make it more accessible and engaging.

The public health team in Surrey viewed it as vital to move with the times and harness social media and the digital world as much as possible. For example, there was hope that the NCMP could be promoted through a digital campaign. Further, in January 2018 Surrey was hoping to undertake a digital campaign on what a healthy weight looks like, due to feedback that parents did not recognise what a healthy weight is. Surrey hoped for support from their Tier 2 provider’s national social media team and they had involved CAMHS youth advisers due to the recognition that mental health is connected to healthy weight. In addition, this group already had strong links to schools and provided one-to-one assessments with children and young people, with mental health issues related to weight.

West Sussex

The local authority took a whole family and schools approach to childhood weight reduction. Emphasis was on families and schools and strong collaboration with the sports development team to increase opportunities for physical activity. Their objective was to reduce childhood obesity.

As resources became limited, West Sussex reviewed what resources they could link up with what schools needed. From the county council perspective, they were looking at how to make the county a nicer place to live overall.

West Sussex is a county in the south of England, bordering East Sussex, Hampshire and Surrey. In 2016 the population of West Sussex was estimated at 843,765 (JSNA). The population is relatively affluent and well educated so one might expect national messages to be more readily digested and responded to here.

Local approach

Within West Sussex, there was a corporate target for childhood obesity within the county council, however, there was no childhood obesity strategy at district level. The aim was to improve health in general. At a district level, there were statutory duties to work in partnership in order to increase the health of the population. However, nothing was specifically defined in relation to childhood obesity.

Schemes and initiatives

The children and family centres had a Healthy Families Programme where the aims were to increase physical activity and healthy eating.

Libraries provided resources for PHE campaigns such as Sugar Smart, Food Smart, and 10 Minute Shake Ups. They also promoted family-based activities.

Through the sport premium initiative, schools were given funds to improve their sports. In West Sussex, this was spent on increasing the number of sessions and developing sports clubs whereas other areas lost their sports development programme or moved them to the private providers.

The West Sussex Walking and Cycling Strategy looked to improve infrastructure to make it more accessible (for example, footpaths). County council and district council invested in cycle routes and cycle challenges in both Horsham and Chichester Districts.

West Sussex County Council was working with the charity Living Streets and street audits were carried out to promote walking to school and improving the environment to encourage walking.

Through the sugar reduction programme, West Sussex School catering services reduced their sugar content by over 2kg per child per school year. Work had been done with the school meals programme as part of the universal programme.

They also implemented the Set4Success talented athlete support scheme.

Programmes and campaigns

West Sussex had a very active Healthy Schools Programme from the late 1990s and early 2000 to around 2010.

The Change4Life campaign was promoted.

The Sugar Smart campaign was promoted and reached 1,500 children a week in a junior citizen event in Horsham District. They were given Food Smart packs as resources.

Promoting physical activity

There was a very strong sports and community development team in Horsham alongside the health and well-being and community development teams. A significant number of initiatives enabled activity programmes and health improving messages to be communicated across the district and taken to the most disadvantaged neighbourhoods. It supported the district’s schools in the following regards:

• inter-school competitions provision
• young leader’s development
• curricular and extra-curricular coaching services in primary and secondary schools
• coordination and partnership support (for example network groups)
• emphasis on ‘alternative’ sports development to increase diversity of opportunities and encourage less naturally sporty and SEN children
• teacher training
• facilitating school-club linkage
• funding advice
• equipment hire

At the time this research took place, they were working to provide more health-based workshops to primary schools.

In addition, outside of schools the sports development team encouraged children to be active by:

• supporting (through funding advice, training or school links) local clubs and leisure centres to provide more opportunities to a higher standard
• setting up new local clubs or sections to cater for juniors
• running a range of regular junior disability sports programmes in swimming, cycling, football, various other sports and arts-based programmes
• providing and facilitating community competitions and events
• recruiting and deploying volunteers, young leaders and work experience placements to increase the local capacity to cater for young people
• running regular sessions in schools with a dance outreach officer for 3 different age groups up to 16
• organising junior park runs, where approximately 150 under 14 year olds ran 2km each week on a Sunday morning in Horsham Park. In addition, 5 to 14 year olds could run with an adult during the adult park runs and over 14s could run independently. On the last review prior to this research taking place, there were nearly 200 under 18 year olds taking part.

Deprivation

Deprivation was a focus, but there was a greater emphasis on inclusion, access to services and opportunities through programmes such as Think Family, Inclusive Arts and Sports. Further, there were targeted health interventions and health promotion messages. Health checks were taken into specific community settings so that they were more accessible in neighbourhoods for the greatest impact (family nurse partnerships and weight management services for children and adults).

Through the Think Family Neighbourhoods programme, advice, interventions and opportunities were targeted at the most deprived communities. This enhanced the possibility of the messages being heard and new healthier behaviours being adopted. However, the small number of contacts made in these communities would not have accounted for a ‘trend bucking’ performance at population level.

National Child Measurement Programme

The school nursing team completed all measurements with one nurse taking a lead role. From April 2017, there was a new contract of the Healthy Child Programme which covered delivery interventions through the school nurse team as well as the NCMP measurements. West Sussex adapted the contents of the NCMP results letter sent to parents of children with weights outside the healthy range resulting in fewer complaints. The letter signposted parents to local offers such as the community sports development.

At the time this research took place, schools received a report for the school as a whole, as opposed to individual pupils. GPs did not receive routine feedback. Tiers for weight management were not well linked for children and there was no Tier 3 available. However, the Child Healthy Weight pathway and the NCMP worked together to offer families the weight management programme. Parents or school nurses could refer to the family weight management programmes. In the weight management services, there was a retention rate of over 75% (completing more than 6 visits) when the programme ran (it finished in March 2017 and ran for 4 years). In some areas it was difficult to engage people to the service. Three hundred children and their carer (a total of 600 families) across the county were involved per year. Those who engaged did well.

The data from the NCMP did not specifically drive the services provided at district level but it provided useful information that helped to shape services and maintain programmes of work that contributed to 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.

Lessons and challenges

West Sussex Healthy Schools Programme worked very hard to spread the messages of healthy eating and promoting health from the late 1990s to early 2000s. They worked across a lot of schools, contributed to after school sports and engaged with organisations outside of schools.

West Sussex learned how important language is in health messages to encourage healthy lifestyles rather than focussing on obesity. It would have also been useful for West Sussex to have more training for those working with children and families to help improve their confidence when discussing weight. More than half (60%) of the adult population was overweight and it was seen as normal to be overweight. The mindset of the population had to be changed to increase engagement.

Challenges included limited resources in terms of manpower and finances, as well as the length of time it can take to have conversations with planning department.

Further work

West Sussex was looking to focus on the number of takeaways near schools and assess how accessible healthy food choices were. The public health lead had started to work with planning colleagues in the county council looking at plans for developments. The Royal College of Public Health had a Healthy High Street document and public health would be keen to see these referred to in planning submissions going forward.

Advice to other local authorities

Whole-systems approach is important as well as an emphasis on improving general well-being.