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Nutrition and Dietetic Health Improvement Plan

2018 - 2021

Department of Nutrition and Dietetics

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Nutrition and Dietetic Health Improvement Plan 2018 – 2021 Our Nutrition and Dietetic Health Improvement Team lead on the nutrition and food agenda throughout NHS Forth Valley. We work in partnership with health promotion, oral health, midwives and health visitors, as well as local authorities and third sector organisations to empower and support communities to use food related activities to build capacity and improve the health of individuals, groups and communities. National and local policies including Local Outcome Improvement Plans (LOIP’s) provide direction to our 3 main and interlinking work strands:

Maternal, Infant and Early Years Nutrition

Health Inequalities (communities)

Organisational settings and campaigns

We use an asset based, food development approach, which is community led and outcome focussed. Nutrition and food related health improvement activities are taken forward by engaging with local networks, building relationships, increasing knowledge and skills and providing resources and support to empower communities to take forward food related activities. We encourage food to be used as a means of engagement, as well as a mechanism to address a range of health and social issues. We aim to provide the right action, in the right place at the right time recognising that priorities and needs of communities evolve over time. We also use a behaviour change approach focusing on developing ownership and self management using an asset based approach. For example

Individual assets – build resilience, commitment to learning, self-esteem, a sense of purpose.

Community assets – engage and support social networks, social capital, and community cohesion. ‘’We strive to improve the health and wellbeing of individuals and communities throughout Forth Valley by leading on the nutrition agenda, with a focus on reducing inequalities.’’ “We offer training, resources and support to individuals, groups, organisations and communities to help them build their capacity, knowledge, skills and confidence around nutrition, food and cooking.”

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Key Priorities

1. Support and empower changes in individuals, groups, communities and partner organisations to have access to and make healthier food choices.

2. Translate nutrition and health policy documents and drivers into local practical application.

3. Promote consistent, up to date and accurate key nutritional messages in all settings to improve health and nutritional wellbeing.

4. Build capacity and enable partners including NHS staff to deliver and cascade food activity and nutritional messages to their service users and communities.

5. Improve local communities’ knowledge and understanding of food and nutrition and its impact on general health at all ages and stages of life.

6. Use continuous improvement methodology to evidence, plan, monitor and evaluate the impact of food and nutrition programmes.

Our Health Improvement Team: Whole Time Equivalent = WTE

Public Health Lead Morag MacKellar (0.1 WTE) AHP Manager & Public Health Nutritionist

Department Lead (0.08 WTE) Janice Fry (0.08 WTE) Dietetic Co-ordinator

Professional Lead (0.5 WTE) Rhonda Archibald (0.5 WTE) Health Improvement (Nutrition) Lead

Maternal Health and Early Years

0.8 WTE

(0.6 B6 + 0.2B3)

Lesley Hetherington (0.4 WTE) Public Health Dietitian

Vacancy 0.2 WTE (secondment cover)

Health Improvement Specialist/ Public Health Dietitian

Shona Davies (0.1 WTE) Dietetic Assistant

Health Inequalities

2.9 WTE

(0.6B6 + 2.1 B5 + 0.2 B3)

Fidelma Guest (0.6 WTE) Health Improvement Specialist (Community Development)

Claire McCool (0.2 WTE) Health Improvement Specialist (Community Development)

Peter Marriott (0.5 WTE) Community Food Development Worker

Sonya Kaila-Tierney (0.6 WTE) Community Food Development Worker

Ellen Cowie (0.1 WTE) Dietetic Assistant

Organisational settings & campaigns 0.9 WTE (B6 + 0.7B5) (Prisons, Health Promoting Health Service, Healthy Working Lives)

Pamela Murray (0.42 WTE) Public Health Dietitian

Jenny Hynes (0.2 WTE) Public Health Dietitian

Wendy Handley (0.7 WTE) Food Development Worker

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Overview - What we do and partners we work with:

Maternal & Infant Early Years Nutrition Health Inequalities Settings/Campaigns

Implementing national and local maternal, infant and early year’s nutrition and oral health strategies.

Supporting food activities with local organisations and staff to address health and economic food issues, particularly those working with vulnerable individuals and families.

Supporting settings such as NHS, prisons, workplaces, schools, nurseries to drive our key nutritional messages forward.

Promote key nutrition messages for families with infants and children 0-5 years. Build capacity for early years organisations. Implement early years’ nutrition standards. Promote and increase uptake of Healthy Start Scheme, including Healthy Start vitamins Support staff to deliver nutrition and health activities with families using developed resources and programmes. Offer food activity grants. Promote positive health messages about preconception and maternal health, including managing obesity. Develop a plan to implement child and family healthy weight programme.

Food development work. Support food and nutrition activities. Offer food activity grants and support funding applications. Support food initiatives – fruit barras, community cafes. Accredited training (cooking and nutrition skills). Build capacity. Life skills – budgeting & planning. Use food as an engagement tool. Food activity that supports food insecurity and poverty. Support healthy weight strategies. Evaluation and impact of cooking skills. Welfare reforms impact.

Deliver local and national nutrition campaigns. Develop resources and nutritional information. Review and update Community Nutrition and Choose To Lose web pages. Use social media to support and increase the reach of our work. Building capacity in criminal justice settings. Increasing engagement with priority communities through food based activities. Advising on strategic and operational delivery in order to support best practice in public and third sector food based provision.

Early Learning Childcare Staff Childminders Health Visitors Midwives Family Nurse Practitioners Family Support Workers Third sector child and family organisations Further Education Establishments

Local Communities Homelessness Criminal Justice LAAC –Leaving care Employability Community Learning & Development teams Voluntary sector partnerships

Scottish Prison Service NHS Staff - Health Promoting Health Service Workplaces – Healthy Working Lives Team NHS FV Communication team AHP and clinical services Primary Care Education

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Priority 1. Support and empower changes in individuals, groups, communities and partner organisations to have access to and make healthier food choices. Through addressing inequalities with vulnerable adults, families and communities

- Focussing on worst 15% from SMID

- Working with existing communities

- Identifying new communities

Outcome Organisations and individuals are accessing healthier food choices through a variety of mechanisms. Measures Number of: - Communities involved in food activity - Website usage - Food initiatives - Individuals attending accredited training

Output/Activity Develop action plans with partners, 3rd sector and statutory organisations focusing on health inequalities. Engage and build capacity with partner organisations, groups and individuals by identifying community needs and assets. Support: - practical cooking activities

- existing Fruit & Veg barras and where a need is identified develop new ones

- Deliver accredited nutrition courses for staff, families and communities (Practical Cooking Skills,

Food & Health)

Provide and signpost to appropriate resources eg. - Toolkits - Information leaflets - Healthy recipes - Budgeting - Food insecurity

Developing the use of social media to support community food activities.

How we will meet our priorities – overview of work activity

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Priority 2. Translate nutrition and health policy documents and drivers into local practical application. Outcome Organisations are aware of current nutrition standards and policy and are able to implement into working practice. Measures Organisations are evidencing outcomes linked to national drivers and policy. Number of organisations requesting further support or guidance and accessing the website.

Output/Activity Working in collaboration with partners and third sector organisations to enable a consistent approach to nutrition policy through:

- Raising awareness of current policy and guidance

- Influencing best practice

- Providing advice and guidance on how to implement at a local level within the organisations

practices.

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Priority 3. Promote consistent, up to date and accurate key nutritional messages to all settings to improve health and nutritional wellbeing. Outcome Individuals, organisations and staff have access to accurate relevant nutrition resources. Measures Audit of resources and their usage from Health Improvement Resource Service (HIRS). Website usage and hits to web pages. Number of organisations requesting support, guidance or incorporating resources into their food and nutrition programmes.

Output/Activity Continually review evidence, research on nutrition and implement legislation, policy and guidance from key professional bodies; including British Dietetic Association (BDA), Food Standards Agency Scotland, NHS Health Scotland and other Scottish Government agencies. Ensuring that up to date nutrition resources and training materials are accessible, they are regularly reviewed and renewed and are available from Health Improvement Resource Service (HIRS) and uploaded to our website and available from our nutrition and dietetic department. Nutritional materials are available in a variety of formats relevant to specific settings, groups and individuals, taking into account level of need as well as considering the use of literacy and language examples of good practice include:

- Campaign materials

- Networking events

- Newsletters

- Workshops

- Awareness and training sessions

- Funding

Supporting and advising communities and organisations on how to utilise the resources and information, either on an individual basis or when cascading nutrition information.

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Priority 4. Build capacity and enable partners including NHS staff to deliver and cascade food activity and nutritional messages to their service users and communities. Outcome Organisations, staff and volunteers are confident to relay basic food and nutrition messages and deliver appropriate activities. Organisations are accessing and using the appropriate resources. Organisations use food activities as a tool to engage with people and to address wider health and social needs. Measure The number of- Staff and organisations who deliver food activities including those that who traditionally would not have included food in their programmes. Organisations and individuals attending training Organisations embedding or sustaining food activity Grant Applications Visits to website pages and staff intranet

Output/Activity Ensure staff have the skills and resources to be able to cascade food and nutrition messages appropriate to the patients, communities and individuals they work with. Support and enable a range of organisations and volunteers to attend national and local food related events in order to create opportunities for food activity. Facilitate training for staff, volunteers and community members, supporting employability, training and education including:

- REHIS* - Elementary Cooking Skills

- REHIS* - Train the trainer - How to Cook with Groups

- REHIS* - Introduction to Food & Health

- REHIS* - Elementary Food & Health

- Setting the Table Nutritional Guidance and Food Standards for Early Years Childcare Providers

in Scotland.

Provide ongoing support to communities and organisations with resources and funding to sustain food initiatives and activities. Develop key actions and methods for staff to use that can support welfare reform and food insecurity e.g. food banks, budgeting and crisis management. *REHIS – Royal Environmental Health Institute of Scotland

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Priority 5. Improve local communities’ knowledge and understanding of food and nutrition and its impact on general health at all ages and stages of life. Outcome Organisations engage and integrate food activities within their service. Food related activities are appropriate for the needs of the service user/organisation/community. Measures Number of organisations accessing nutrition training and delivering food activities or programmes. Number and type of resources accessed by organisations and groups.

Output/Activity Implementation of nutritional programmes, initiatives and resources to support organisations and staff to use food to build self confidence, break down barriers, address literacy, food poverty, parenting, life skills and social interactions addressing inequalities. Improve healthier choices and options in:

- Prisons (catered meals and additional food purchase lists) - Early years establishments - Hospitals - Workplaces - Schools - Community food activities - Individuals and family home environment

Key nutrition and public health messages thread throughout all 3 work programmes include:

- Healthy Start Scheme

- Vitamin D supplementation

- Weight Management

- Eat Well Guidance

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Priority 6 To use continuous improvement methodology to evidence, plan, monitor, evaluate and review programmes. Outcome Organisations are encouraged and supported to undertake quality improvement ‘Plan-Do-Study-Act (PDSA)’ methodology to test and learn how to support changes to improve the nutrition and food for families in areas of deprivation and need. To ensure quality, use continuous improvement methodology to monitor, review and evaluate all food and nutrition programmes delivered by the Health Improvement nutrition team. Measures Number of organisations who use or are supported to use the PDSA (Plan, Do, Study, Act) methodology Number of evaluations and reports completed by organisations with regards to quality improvement.

Output/Activity Topic leads will continue to implement and review SMART, focused outcomes for their priority area of work i.e. Maternal, Infant and Early Years, Inequalities, settings and campaigns. All team members will be responsible for developing work plans and utilising any budget linked to the programme plans. Using the food and health improvement process as our delivery model, all team members will be responsible for completing their GANT chart. All team members when asked to or wish to promote an aspect of Health Improvement work will use qualitative and quantitative data. This can be used for case studies poster presentations or as required for inclusion into local and national reports. Organisations and partners will be provided with an appropriate reporting template in order to provide feedback on grant funding received.

Priority 7

To manage and ensure governance and reporting of the health improvement budget. Outcome The Health Improvement budget is allocated to appropriate areas of work that meet priorities 1-6. Measures Quarterly health improvement team meetings with team members taking responsibility to chair/ take notes on a rotational basis. Quarterly monitoring and review of budget spend on health improvement work. Finance procedures/spreadsheets in place for funding received, and grants given. End of year summary of activity outlined in an annual Health Improvement report for key stake holder partners. Other reporting including flash reports and reporting from evaluations.

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National Drivers:

A Healthier Future - Action and Ambitions on Diet, Activity, and Healthy Weight

Everybody Matters: 2020 Workforce Vision

Improving Maternal and Infant nutrition: A Framework for Action

Setting the Table – Nutritional Guidance and Food Standards for Early Years Childcare Providers in Scotland

National oral health improvement strategy for priority groups

Equally Well

Report of the Ministerial Task Force on Health Inequalities (2013)

Health Promoting Health Service: CMO Letter April 2018

Revised Dietary Goals for Scotland

Better Health, Better Lives for Prisoners

Public Health Priorities for Scotland

Local Drivers: NHS Forth Valley Health and Strategic Plans

NHS Forth Valley Healthcare Strategy 2016-2021 Our vision: • Prevention keeps people well whilst early treatment and support stops

conditions from getting worse.

• Unnecessary delays and variations in services are minimised and our

workforce is fully supported to deliver high quality, safe and effective

care.

• Planning ahead and working in partnership with staff, patients, local

councils and community organisations avoids emergency hospital

admissions and reduces A&E attendances.

• Care is provided closer to home, and fewer people need to go to hospital.

• Health inequalities are reduced and people are encouraged and

supported to take personal

• Responsibility for managing their own health and health conditions.

• Health and social care services are person centred recognising that people

have differing needs, circumstances and expectations of care.

Our Corporate Objectives: • Plan for the future.

• Improve the health and wellbeing of the people of Forth Valley, whilst

reducing health inequalities.

• Improve our focus on safety and quality.

• Value and develop our people.

• Deliver best value using our resources.

• Promote and build integrated services locally and regionally.

• Display leadership behaviours that nurture and support transformational

change across our health and care system.

NHS Forth Valley -

A Thriving Forth Valley 2017-2021 - Health Improvement Strategy

Shaping the Future 2017-2021 – Healthcare Strategy

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AHP & Dietetic Outcomes:

To enhance community capacity building and support early interventions as part of the asset based model and redesigning ‘enabling’ services.

To initiate support to individuals to enable them to remain in or return to work.

To use each consultation as an opportunity to improve overall health and wellbeing. AHP & Dietetic Outcomes

Aspire: Allied Health Professionals Supporting and Promoting Improvement Rehabilitation and Enabling Others

The Active and Independent Living Programme (AILP) supports AHPs, working in partnership with multi-disciplinary teams and agencies to improve the

health and wellbeing of the population throughout the life-course.

Local Outcomes Improvement Plans (LOIP’s)

Local Outcomes Improvement Plans are the mechanism by which Community Planning Partnerships deliver improved outcomes for communities over a ten year period. They are based on an understanding of local needs and reflect agreed local priorities, as well as the National Performance Framework developed by the Scottish Government.

Stirling Community Planning Partnership Clackmannanshire Alliance Falkirk Community Planning Partnership

The Stirling Plan Local Outcomes Improvement Plan 2017 - 2027 Key Priorities: • Inclusive and sustainable economy

Tackling poverty

Early identification of need and support for

vulnerable families

Care and support for our elderly people and

tackling social isolation

Health and wellbeing mental health

Substance misuse

Improving access to learning, training and jobs

Improving our Places and environment

Outcomes:

Inclusive and sustainable economy

Local Outcomes Improvement Plan 2017 - 2027 Key Priorities:

Improving outcomes for children and young people living in poverty

Improving outcomes for women and girls living in Clackmannanshire

Improving outcomes for people living in Alloa South and East

Outcomes:

Clackmannanshire will be attractive to businesses and people and ensure fair opportunities for all.

Our families; children and young people will have the best possible start in life

Women and girls will be confident and aspirational, and achieve their full potential.

Our communities will be resilient and empowered

Strategic Outcomes and Local Delivery Plan (SOLD) 2016 – 2020 Key Priorities:

Improving mental health and wellbeing

• Maximising job creation and employability

• Minimising the impact of substance misuse

• Addressing the impact of poverty on children

Outcomes: • Our area will be a fairer and more equal place to live

• We will grow our local economy to secure successful

business, investment and employment

• Our children will develop into resilient, confident and

successful adults

• Our population will be healthier

• People live full, independent and positive lives within

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Tackling poverty

Early identification of need and support for

vulnerable families

Care and support for our elderly people and

tackling social isolation

Substance misuse

Health and wellbeing mental health

Improving access to learning, training and jobs

Improving our Places and environment

Sustainable affordable housing

Connecting People and Places

so that they can thrive and flourish

Priority Groups:

Low income households and workless households

particularly where there are children

Women; lone parent families and young

mothers/teenage pregnancies

Those living with poor physical and mental health

and those affected by alcohol and substance use

Young people in and leaving the care system

Community of Alloa South and East which has

experienced deep rooted poverty for decades

People living with disability

People with caring responsibilities

Refugee and Asylum Families

supportive communities

• Our area will be a safer place to live

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Community Nutrition www.nhsforthvalley.com/nutrition

Choose To Lose www.nhsforthvalley.com/weight

‘Encourage and support local people to choose a healthier lifestyle by promoting good food choices and encouraging more activity.’

Like us on facebook/nhsforthvalley

Follow us @NHSForthValley Updated November 2018