The UK is facing an obesity crisis and employers are being urged to act now to stop the prediction of 11 million obese people by 2030 becoming a reality. In healthcare, hospitals across Britain are being increasingly looked at to take a lead in improving the health and wellbeing of staff. Incentives are being offered to encourage the NHS to set an example, including the mandatory CQUIN for staff health and wellbeing, and the long-awaited Childhood Obesity Strategy that arrived in August. Pulse takes a look at the cost of obesity and ill-health to the NHS and what can be done about it.
Speaking at the Leadership and Development Forum of the Hospital Caterers Association (HCA) earlier this year, Rosie Boycott, Chair of the London Food Board, argued that the role of hospitals is to promote good health and it is hugely important to have healthy staff.
Boycott revealed statistics that say 25% of NHS staff are themselves obese or suffering a long-term health problem, but in spite of this, 75% of NHS Trusts don’t have an obesity strategy. The ramifications of staff ill-health are obvious – it can impact productivity, performance and sick days – and obesity is known to increase the risk of developing long-term health conditions, such as diabetes and cancer.
She argued that there is no place in hospitals for fast food outlets or full sugar brands that are just concerned with generating sales and nor should hospitals be an extension of the high street. “If we can’t get it right in hospital how are we ever going to get it right anywhere?”
Boycott also referred to the plight of night staff who have no access to healthy food because the hospital canteen or restaurant is closed - one in three NHS Trusts don’t offer healthy food options in the evenings. This is an issue she frequently comes up against and in a recent survey of NHS Trusts in London, over 90% of staff that work night shifts said they would like to see this changed.
Childhood Obesity Strategy
It was a long time arriving, and before the ink was properly dry on the Childhood Obesity Strategy it was being criticised by health lobbyists, MPs, consumer groups and the odd celebrity chef. It has been called "weak," "underwhelming," and "vague."
The Childhood Obesity Strategy brought no big surprises. The soft drinks tax had already been announced and it was confirmed that the revenue from the tax will be invested in programmes to reduce obesity and encourage physical activity and balanced diets for school-age children. Controversially, a sugar reduction target of 20% has been set for products that contribute to a child's sugar intake by 2020 - health lobbyists had wanted to see this set at 50%.
Hospitals are included within requirements for public sector buildings, which are to be called on to set an example to children and families. The strategy document states: “Every public sector setting, from leisure centres to hospitals, should have a food environment designed so the easy choices are also the healthy ones.”
This involves a pledge to ensure there is full uptake of the Government Buying Standards for Food and Catering Services (GBSF) in central government departments. The Department of Health will also collaborate with PHE, NHS England and the Behavioural Insights Team to trial behavioural interventions in NHS hospitals. “These interventions will measure changes in purchasing behaviour and the impact on revenue from sales.”
Healthcare professionals are also being encouraged to support families by discussing nutrition and weight issues and Health Education England (HEE) and PHE have launched some resources aimed at supporting the healthcare workforce to “Make Every Contact Count.”
Other measures within the strategy include funding for physical activity within schools, updating the nutrient profile model and R&D to create healthier and more sustainable products.
Critics feel the Obesity Strategy does not go far enough and have made their views very plain. Which? says: “The Government is in denial.” Action on Sugar says the Prime Minister, Theresa May, has “failed the nation.” The Obesity Health Alliance says: "The Government’s plan falls disappointingly short of what is needed.” Chef and healthier food campaigner, Jamie Oliver says: "Too much of it is voluntary, suggestive, where are the mandatory points?”
Incentives
Health and wellbeing isn't just about a healthier diet, a healthier lifestyle is also important. In March, Simon Stevens, the Chief Executive of NHS England, announced a £600m financial incentive to NHS healthcare providers to improve the support they offer to frontline health staff to stay healthy.
To earn their share of the incentive fund, organisations have to take action on junk food and obesity, offer frontline staff access to workplace physiotherapy, mental health support and healthy workplace options and increase the uptake of the winter flu vaccine for staff.
Taking action on junk food and obesity involves ensuring healthy food options are available for staff and visitors, including those working night shifts. To qualify for the scheme, Trusts need to remove adverts, price promotions and checkout displays of sugary drinks and foods that are high in fat, sugar and salt from their NHS premises. They will also be required to submit information on their current fast food franchises, vending machines and retail outlets in preparation for the NHS ‘sugar tax’.
Announcing the incentive, Simon Stevens, Chief Executive of NHS England, said: “As the largest employer in Europe, the NHS needs to practice what it preaches by offering better support for the health and wellbeing of our own 1.3 million staff. A good place to start is by tackling the sources of staff sickness absence including mental health and musculoskeletal injuries, while doing our bit to end the nation’s obesity epidemic by ditching junk food and sugary drinks in place of tasty, healthy and affordable alternatives.
“If we can do this well, we hope that more parts of the public and private sector will see the sense of it and also take the plunge.”
The incentive programme will help hospitals, ambulance Trusts, community and mental health providers to fund schemes that promote physical activity and reduce sedentary behaviour.
A mandatory CQUIN (Commissioning for Quality and Innovation) for NHS staff health and wellbeing became operational in April to further underline the drive for healthier food and drink on hospital premises.
Scotland
NHS Scotland is ahead of the game. In September 2015, the Scottish Government published its criteria for the Healthcare Retail Standard (HRS). The aim is to create a consistent approach to healthy eating for all food service providers across the NHS in Scotland. Caterers must follow ‘healthyliving award’ criteria at the point of contract negotiation or re-negotiation. Retailers must join the Scottish Grocers Federation Healthyliving Programme and meet their Gold Standard criteria at the point of contract negotiation or re-negotiation.
The HRS applies to all retail outlets within healthcare buildings. It consists of specific criteria covering food provision and promotion and provides a list of qualifying food items. Food provision criteria aims to ensure any retail outlet in a healthcare building provides a range of food items that are not high in fat, salt and sugar.
The Royal Voluntary Service has become the first hospital retailer to achieve the HRS in its shops at West Glasgow Ambulatory Care Hospital at Yorkhill and Western General Hospital in Edinburgh.
Royal Voluntary Service is the biggest hospital retailer in England, Scotland and Wales and manages over 500 hospital shops, cafés and trolley services. The charity has taken an early lead on the NHS workforce health agenda by implementing Healthy Choices, an ambitious programme to transform its entire UK retail estate into hubs for healthy eating. The phased introduction of new Healthy Choices menus and options will be complete by March 2017 in Scotland, with a greater range of healthier options and space for crisps, confectionery and sugary drinks dramatically reduced.
Scotland's Minister for Public Health and Sport, Aileen Campbell says: “It is a huge milestone to have our first Healthcare Retail Standard compliant store and I want to congratulate Royal Voluntary Service, SGF and all at NHS Greater Glasgow and Clyde and NHS Lothian for this achievement. As part of our Health Promoting Health Service programme, I now look for others to follow suit so that we can better support staff, visitors and patients to make healthier food choices in our hospitals.”
Other help
"Use whatever help and accreditation schemes are available," recommends Rosie Boycott. One such example is the Healthy Workplace Charter, a self-assessment framework, initiated by the London’s Mayor’s office, which recognises and rewards employers for investing in workplace health and wellbeing. Several London hospitals are already signed up and Boycott’s aim is for every London hospital to join.
“The whole hospital approach is very important,” she says. “The whole hospital has to buy into the fact that the hospital is going to be a healthy place.”
Help is also available from the Better Health at Work Alliance (BHWA), the UK workplace health industry’s first broadly inclusive membership body, launched in February 2015, which offers members access to solutions, information and guidance around how employers can tackle the obesity crisis. BHWA has the endorsement of over 30 key industry organisations and shares expert knowledge via a simple to use website.
BHWA has advised that straightforward steps an organisation should be looking at include access to healthy food options, promoting an active workplace, providing information on being healthy and incentivising staff to follow it, or making adjustments to the work environment that encourage behavioural change such as standing desks, walking clubs or bike racks.
Charlotte Cross, Director of BHWA, says: “Obesity is relevant to all employers and can impact the bottom line of any organisation through obvious health ramifications and associated productivity and performance issues. As the obesity problem grows, employers will inevitably face more of these challenges.”
