NHS ENGLAND’S Chief Executive Simon Stevens has today announced details of proposed new action to cut obesity and reduce the sales and consumption of sugary drinks sold in hospitals.
England would become the first country in the world to take action across its health service in this way. A formal consultation launched today gives details of a proposed new fee to be paid by vendors, or alternatively seeks views on an outright ban.
As Europe’s largest employer, with over 1.3 million staff, the NHS committed in its overall strategy, the Five Year Forward View, to improve the health of its workforce.
A recent survey found obesity to be the most significant self-reported health problem amongst NHS staff, with nearly 700,000 NHS staff estimated to be overweight or obese.
Rising rates of obesity amongst NHS staff are not only bad for their personal health, but also affect sickness absence and the NHS’s ability to give patients credible and effective advice about their health.
NHS premises also receive heavy footfall from the communities of which they are a part, with over 1 million patients every 24 hours, 22 million A&E attendances and 85 million outpatient appointments each year. The food sold in these locations can send a powerful message to the public about healthy food and drink consumption.
Addressing the ukactive National Summit, Simon Stevens said: "Confronted by rising obesity, type 2 diabetes and child dental decay, it's time for the NHS to practice what we preach. Nurses, visitors and patients all tell us they increasingly want healthy, tasty and affordable food and drink options. So like a number of other countries we're now calling time on hospitals as marketing outlets for junk food and fizzy drinks. By ploughing the proceeds of any vendor fees back into staff health and patient charities these proposals are a genuine win/win opportunity to both improve health and cut future illness cost burdens for the NHS."
Today's formal consultation proposes levying a fee for any vendor of sugar-sweetened beverages (SSB) on NHS premises. It is complementary to the government's proposed sugar tax, but would begin sooner - in 2017 - and based on best evidence would cover the full range of sugar sweetened drinks. Subject to consultation the drinks affected would be any drink with added sugar including fruit juices, sweetened milk-based drinks and sweetened coffees.
Proceeds from the fee would be used directly to fund expanded local staff health and wellbeing programmes and/or the trust's patient charities. It also seeks views on an outright ban on certain products being sold on NHS premises, an approach now beginning to be taken by hospitals in several other countries.
The consultation will ask for the views of patients, carers, NHS staff, the public and suppliers and will close on January 18 when feedback will be considered and a decision taken about how this should be taken forward into the NHS standard contract.
A recent two month NHS pilot of different types of sugar policies at four hospitals has already taken place and showed positive results. For example, one site reported that although no sugary drinks were sold during the trial, the overall total number of drinks sold did not decrease and they were financially unaffected.
A year ago NHS England introduced a number of initiatives to improve staff and patient health and well-being including the following which are now delivering real benefits for staff and patients:
Staff Health and Wellbeing CQUIN
This included the introduction of a new staff health and well-being financial incentive (Commissioning for Quality and Innovation), which NHS England is now announcing will be extended for at least the next two years.
To receive some of the fund hospitals and providers have had to introduce staff health and well-being programmes and healthier food choices. The wellbeing initiatives include mental health programmes, physical activity schemes and fast track access to physiotherapy for staff with back and other MSK problems.
The healthier food choice scheme includes incentives for hospitals and trusts that end price promotions on high fat, salt, saturates, sugar foods; that stop advertising of unhealthy foods on NHS premises; and that end the sale of unhealthy foods at checkouts, while ensuring healthier meals are available out of hours.
The Healthy Workforce Programme
In addition, 75,000 staff across 10 Trusts, one CCG and NHS England have taken part in a pilot scheme to improve health and well-being focusing also on mental health, physical health, improving the food environment, culture and leadership.
To increase physical activity and help staff manage their weight they have trialled a variety of schemes including appointing health trainers and dieticians to give staff tailored advice on diet and exercise, as well as discounts with local gyms. All sites used a Weight Watchers discount, negotiated by NHS England.
Examples of successes include West Midlands Ambulance Service which in partnership with Slimming World has helped nine per cent of its staff (392) lose over 3350lbs – the equivalent of 18 adult men.
Bradford District Care have set up a Couch to 5K group, appointed an onsite chef who prepares healthy food daily, have reduced portion sizes of meals and implemented a price premium on unhealthy foods.
The Walton Centre participated in the NHS Games in 2015, which included a 5k run and other sports competitions and they opened their specialist physiotherapy gym to staff after 5pm.
Support for General Practice
The £19.5m ‘NHS GP Health service’ launching in January 2017: it is a free, confidential service provided by health professionals specialising in mental health support to doctors, accessible via a confidential national self-referral phone line, website and App, enabling GPs and GP trainees to seek information about services available, access self-help tools, and access clinical support. An occupational health specification has also been developed to ensure there is a consistent level of occupational health support for staff working in primary care across the country.
Phil Shelley, National Chair HCA
“Hospital caterers are the frontline of delivering NHS wellbeing campaigns including the proposed NHS sugar tax and CQUIN. The HCA believes that excellent health and nutrition is an integral part of patient’s recovery and staff wellbeing. Working together to find a solution in order to provide best-in-class catering solutions for the multitude of dining experiences within hospitals is challenging and we welcome this upcoming consultation and our role within it.
We ask that decisions made from the consultation are rolled out fairly and equally throughout the NHS estate including external retailers. Our members have first-hand experience of losing vital income when tax levy’s such as a sugary drinks tax have been imposed on NHS caterers but not on other retailers within the same environment. Income they simply cannot afford to lose and which they need to provide a safe and healthy service. These decisions have often worked against the catering teams and unfortunately patient feeding can suffer from income reduction.
The issue of sugar consumption is complex. A lot of excellent work has been achieved over the last ten years with patient food. As an organisation we have reached out to complementary professionals such as Dietitians and Nurses to ensure that the catering approach is a truly 360degree approach, always seeking to put the patients individual needs first.
As NHS England now turns it focus to the wellbeing of its staff and visitors, our member insight from over 400 NHS caterers’ nationwide consistently demonstrate the CQUIN targets are easier to manage and achieve if the catering is in-house. Catering is currently approximately evenly split with 50 % in-house and 50 % external retailers or suppliers, in order to help improve wellbeing with visitor and staff caterers will need to take back control of the whole catering service, from ingredient to consumption.
The HCA recognises that the provision of catering to night staff within the NHS is currently at a disconnect with the other types of catering services and any new measures to help reconnect an affordable and practical solution for these valuable members of staff is welcome. Along with CQUIN updates we believe that this consultation is only the start of the work required to improve visitors and staff nutrition. We have to recognise the differing nutritional and energy needs of staff working long shifts and unsociable hours and provide something that is suitable. Alongside tax’s and bans, some serious innovation is going to be required to meet these needs.”
