COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY

Inquiry into Obesity

23 April 2009

Members present for all or part of the proceedings:

Mrs Michelle O’Neill (Deputy Chairperson)
Mr Thomas Buchanan
Mr Alex Easton
Mr Tommy Gallagher
Mr Sam Gardiner
Mrs Carmel Hanna
Mr John McCallister
Mrs Claire McGill

Witnesses:

Ms Karen Smyth, Northern Ireland Local Government Association
Ms Katrina Morgan-Talbot, Belfast City Council

The Deputy Chairperson (Mrs O’Neill):

The next item on the agenda is the evidence session with the Northern Ireland Local Government Association (NILGA). We have received submissions from NILGA as well as from several local councils.

I welcome Karen Smyth, who is head of policy at NILGA, and Katrina Morgan, who is leisure operations manager at Belfast City Council. I invite you to make your presentation, after which members may ask questions.

Ms Karen Smyth (Northern Ireland Local Government Association):

Thank you, Chairperson, for inviting NILGA to give evidence to the Committee. We appreciate the opportunity. Unfortunately, I must apologise for the absence of elected members at the meeting. We would have liked to have brought along some of our elected members; however, several other meetings are taking place. The Committee will be aware that our members are busy with the review of public administration (RPA) and policy development panel meetings. Therefore, trying to get someone to attend has been problematic.

We intend to run through the NILGA submission that the Committee has already received. I will then bring Katrina Morgan in to discuss more fully the projects that Belfast City Council, in particular, is working on.

Preventive healthcare is a key issue for local government. It has a huge impact on communities; citizens’ well-being; and on the economy, which relies on people’s fitness for work. The integrated work of councils’ environmental health, community and leisure services officers currently provides demonstrable success at local level. It indicates that a more joined-up approach to the issue is key to a successful approach to tackle obesity. Local government is particularly well placed to tackle regional issues such as obesity at local level and to initiate projects that make a real difference to local communities.

We have found that the best and most successful projects are often implemented in partnership with other agencies, such as the education and health boards, which provide a link to schools, as well as the Fit Futures teams and health-promotion teams. Often, councils assume the role of enabler in much of that work. They have a civic-leadership duty to ensure that citizens maintain a healthy lifestyle.

Councils have played a full role in Investing for Health partnerships. A number of examples show how councils have taken the lead on well-being. For example, in the Newry and Mourne District Council area, the council’s facilitation of the well-being action partnership has been an exemplar of how a partnership approach can improve health.

The Chief Environmental Health Officers’ Group is to convene a nutrition subgroup to look at how environmental health officers can best become involved in tackling obesity in the general population and also to share ideas and initiatives that might be happening elsewhere in Northern Ireland, the rest of the UK and the Republic of Ireland. That subgroup will also include members from the Food Standards Agency Northern Ireland (FSANI), and we will be working in partnership with them.

Local government environmental health officers have been involved in promoting schemes. For example, in conjunction with food manufacturers, they have been promoting the Food Standards Agency’s traffic-light scheme. We are willing to work with the agency on further emerging initiatives, such as its campaigns on saturated fat and salt. Other projects of that nature include the implementation of the Chartered Institute of Environmental Health’s awards for healthier foods and special diets.

Members will also be aware that councils are the foremost providers of leisure facilities in Northern Ireland. Their leisure services offer a wide range of physical activity programmes and facilities that target the entire community, often according to age. They encourage citizens to engage in sport and other physical activities.

Ms Katrina Morgan (Belfast City Council):

Good afternoon, folks. I will cite some examples of the successful programmes that Belfast City Council has run over the past year for various age groups. Choose n Move is a programme that is targeted at children between the ages of four and 16. It was designed by our health development unit and contains two key messages: eat more fruit and vegetables and become more active. The programme consists of 11 activities, and children are referred to it and are tracked through leisure centres, and parents can also obtain information from our Choose n Move website.

Moving up through the age groups, the FRESH project is targeted at children between the ages of 11 and 13. FRESH stands for food, relaxation, exercise, self-esteem and health. It is partly funded by the Eastern Health and Social Services Board, and it is delivered in partnership with the Belfast Health and Social Care Trust, Belfast Community Sports Development Network (BCSDN) and other councils, such as Lisburn City Council, Down District Council and North Down Borough Council.

Belfast City Council has three programmes in place, and they are based at Shankill leisure centre, Avoniel leisure centre, Ballymacarrett recreation centre/Andersonstown leisure centre. We like to target families, as well as kids. One of our programmes is called Fit Families, and it is run in conjunction with the Maureen Sheehan Centre, which is part of the Belfast Trust. It is a pilot project, which involves five families in west Belfast. The programme includes activity books, education, physical activity opportunities and weekly review meetings. We hope to have the first evaluation of that project by June 2009.

Other projects that are targeted at families include the parent, toddlers and children programme, which is delivered with the help of the Healthy Living Centre Regional Alliance. In total, we have rolled out 13 programmes that are being delivered through 50 different educational workshops; their evaluation is due in May 2009.

We consider some of our other programmes to be innovative. For example, two Kidzfit gyms are based in Belfast: one is at the Shankill leisure centre, in the north, and one at the Falls leisure centre in the west. Figures show that, so far this year, more than 2,000 kids have participated in those programmes, which involve activities specifically for kids. We are trying to branch out beyond leisure centres, and the Greater Shankill Sports Committee and the Shankill Junior Football Club have become involved.

Finally, the Healthwise programme runs in many council areas across the North. It is funded by the Eastern Health and Social Services Board and offers a free 12-week programme. Patients are referred to a leisure centre to participate in the programme, and that referral can be based on anything from weight or obesity problems to general health problems. The participants are evaluated at the end of the 12-week programme. Last year, more than 1,000 people participated in the programme through Belfast City Council. That is a little flavour of what Belfast City Council and some of its local partners do.

Ms Smyth:

Members will be aware, and I have already referred to the fact, that NILGA works intensively on the review of public administration and local government reform. It is essential that local government grasps the opportunities, particularly those presented by the health and social care reforms. A local council plays a vital role as service provider, civic leader, partnership convener, community focus and advocate on health issues. We draw the Committee’s attention to the Lyons Review, which identified local government as a place-shaper and highlighted the need to take a wider view of health and wellbeing. In addition, a recent World Health Organization report refers to urban planning as a key aspect in the consideration of the wider elements of health provision.

Councils should be taking up opportunities in the new joint-working pilot schemes and local commissioning groups. In addition, following local government reform, community planning, the power of well-being and other powers will increase the ability of local government to influence the health of local communities.

We are keen to think differently and to innovate, focussing on outcomes and not on who does what, and we look forward to working with the new Public Health Agency at regional and local level on obesity issues. The new health structures will provide a greater role for local government through participation in the Public Health Agency and in local commissioning. The Minister has already invited expressions of interest from councils on the possibility of hosting joint pilot schemes to focus on addressing specific health and well-being inequalities. We will meet the Minister shortly to take that work forward.

The Minister’s letter indicated the possibility of collocating health and social care staff with local government staff to support councils in exercising their power in well-being and community planning and in inter-sectoral partnerships, and we will explore the way forward on that. Those staff could also assist in developing local health-improvement plans to reflect local needs with regard to issues such as obesity. We would also support the local commissioning group in developing commissioning plans to deal with Health Service provision and measures to prevent ill health. We want to develop and extend those arrangements post-2011.

NILGA makes a number of recommendations on taking forward work on obesity. It hopes that the ‘Fit Futures: Focus on Food, Activity and Young People’ report will be fully implemented. We believe that a comprehensive, cross-cutting, long-term Northern Ireland strategy to tackle obesity needs to be drafted and implemented as soon as possible, bringing together all major stakeholders. There should be a scoping exercise of existing good practice, to be shared with all relevant agencies and central and local government departments.

Central Government should fund the roll-out of known successful initiatives, such as the Cook it! programme, and develop a joined-up approach at regional level in order to ensure consistent messages on healthy eating. Cooking skills should be made a mandatory part of the school curriculum, and healthy food choices should be available in all schools. We want to continue to work in partnership with the Food Standards Agency and the food industry in order to improve the nutritional quality of the foods that are available for sale.

Healthy eating awards should be available to food-business operators in Northern Ireland, and social marketing tools should be used in a campaign directed at the parents of young children and at the general population to increase awareness of health-related issues that are caused by obesity, because the accessibility of young people to the wrong foods needs to be addressed at regional level. There should also be adequate opportunities for young people to participate in physical activity at school and in the wider community.

The Deputy Chairperson:

Thank you for your presentations. Local government will play a key role in tackling obesity and a number of other issues. As we move forward with the RPA, the transfer of community planning powers to local councils will be crucial for tackling health inequalities, because, quite often, people from socially deprived areas are more likely to be obese or to have long-term illnesses. With regard to the way in which local government feeds into the cross-departmental obesity steering group, do NILGA representatives sit on that group?

Ms Smyth:

As far as I know, there are links between that group and the Chief Environmental Health Officers’ Group. We have participated at officer level rather than at elected-member level, but I can check that.

The Deputy Chairperson:

That is a key matter, because, every week since this inquiry began, we have been hearing about access to leisure services and about a lack of play facilities. Obviously, that is all part of the whole process.

Ms Smyth:

Community planning will be crucial, and working things out in local area agreements in the community planning processes will be vital in sorting out the whole problem.

The Deputy Chairperson:

Katrina, you spoke about people in the Healthwise programme being referred. Is that referral from a GP?

Ms Morgan-Talbot:

Yes. It is commonly known as the GP referral programme, but, technically, it is called the Healthwise programme. An individual can be referred for anything, including obesity or obesity-related illnesses such as high blood pressure or heart disease. People do, therefore, pass through the programme, and it is open to all age groups.

The Deputy Chairperson:

Does that happen only in Belfast City Council, or does it happen across the board?

Ms Morgan-Talbot:

It happens in a majority of councils in Northern Ireland.

The Deputy Chairperson:

This is the first time that I have heard of that programme. The Committee has previously teased out the issue of what a GP can do.

Ms Morgan-Talbot:

We roll out the GP referral programme, and, in Belfast, we link up with GPs through the Eastern Health and Social Services Board. The GPs sign up to the programme, and there is a process through which individuals are referred and which involves indicators and suchlike. In the past, individuals have come into leisure centres to inquire about the programme. If their GP was not on the list, we would have gone back to our partners to try to encourage that GP to sign up to the programme and to come on board.

The Deputy Chairperson:

OK. Is that programme free for the participants?

Ms Morgan-Talbot:

Yes. It is a 12-week programme, and it is free for participants.

The Deputy Chairperson:

That needs to be publicised to make more people more aware of it. That message is not currently out there.

Ms Morgan-Talbot:

It is quite well known. Last year, more than 1,000 people participated in the programme, even though there was only enough funding for 800 people. However, we decided that, despite the fact that that funding ran out around November, we should continue to take people on the programme, because we did not want to stop it dead.

We find that the biggest hurdle for people is the fear factor of making that first appointment and coming to see us. People can be referred, but sometimes it takes about three months for them to visit us. Perhaps a little more awareness of the benefits of the programme would be helpful.

Mr McCallister:

How many GPs are involved in the programme? Are all GPs aware of it?

The Deputy Chairperson:

The Committee recently heard evidence from representatives of the British Medical Association (BMA) and they did not discuss the programme. That is why it seems to be new to us, and why I think that doctors are unaware that they can refer patients to it.

Ms Morgan-Talbot:

OK. I can double check that information. I know that information on the Healthwise programme is normally sent out to local GPs, but I do not know whether that is enough to entice them into the programme. I will check what mechanisms exist for informing people.

Mr Gardner:

Has that trial programme dealt solely with GPs in Belfast?

Ms Morgan-Talbot:

No. Several other councils are involved —

Mr Gardner:

I have not heard anything about it. I represent the Upper Bann constituency, which includes Lurgan, Portadown and Banbridge, and I am not aware of any activities in those areas.

Ms Smyth:

I will contact the councils to find out which ones are participating, and I will inform the Committee.

The Deputy Chairperson:

The Committee would appreciate that. A GP sits on this Committee, and he is unaware of the programme, because he has talked about what he would do —

Ms Smyth:

That may have something to do with the board area in which he works.

The Deputy Chairperson:

It would be good if you could provide that information to the Committee.

Mrs Hanna:

Good afternoon, you are very welcome. It all sounds so simple: eat more fruit and vegetables, get out more and, maybe, eat a bit less, but that seems to be very hard to do. The councils, more than any other bodies, are closest to those on the ground. Not only that, the councils operate the leisure centres and the playgrounds, and we must utilise those facilities better.

Ms Morgan-Talbot:

We should not concentrate only on the leisure centres; we should also examine the role that our parks can play. We must try to make the parks more user-friendly to entice people into them, rather than just keeping them as green spaces. We want to work in partnership with the parks.

For example, we engage with schools. We run a very successful cross-country championship, during which we carry out awareness sessions that deal with nutrition and various other things. We try to include families. We see family engagement as crucial, because if families can be encouraged to adopt a healthy lifestyle, the children will naturally fall in to sync.

Mrs Hanna:

It seems that much research and analysis has been carried out, yet the solution is so simple. It seems that attempts to motivate people to become more active are not working. Do you agree?

Ms Morgan-Talbot:

Motivation plays a huge role, but culture is also very important. For example, there are areas in Belfast that suffer socio-economically and have higher rates of children not attending school or not finishing qualifications. In those areas, the level of parental participation in fitness sessions is also lower. Therefore, it is key that we reach those hard-to-reach communities.

The World Health Organisation’s Commission on Social Determinants of Health recently published a report that suggested that urban planning was a key to improving health. We very much agree with those sentiments and want to utilise things such as cycle schemes as a way of encouraging people to become socially involved in exercise rather than just visiting a leisure centre. Indeed, Belfast City Council is carrying out a strategic review of leisure this year, and we see that review not just as a way to examine our stock, but as a way to examine methods of improving community engagement and getting people from the wider community into our parks. We will seek to do that by joining up with other partners, clubs, groups and societies in an attempt to promote leisure, whether in participation or as recreation.

Mrs Hanna

You referred to schemes at the Shankill and Falls leisure centres, have you measured any outcomes of those?

Ms Morgan-Talbot:

It can be hard to actually sit down and determine how to measure the outcomes, but, through the local schools, we have found that the children who participated in the programmes — those who possibly would have skipped PE classes in the past — have found that they have become interested in, and actually look forward to, exercise. As a result, those kids will come in at weekends with their parents.

The council operates a means-tested benefit pricing policy in all our leisure centres to attract folk who are on low incomes or unemployed. It runs month by month, depending on which schemes we run. If we run a successful scheme in an area, we discover that many more families join leisure centres. They become involved, and leisure centre usage increases. However, actual health outcomes are harder to determine.

Mrs Hanna:

Those results are very powerful. You are saying that the people who are taking part in your initiatives are becoming more active and more involved, and that is what we want. If the simpler things, such as those initiatives, are working and are helping children to be more active, we should be doing more of that. We keep thinking of other things that we need to do, but maybe it is better to keep doing the simple things.

Ms Morgan-Talbot:

When programmes such as the FRESH project, which is an 18-week course that is aimed at 13-year-olds, come to an end, we find that many of the kids come back to the leisure centres. We try to get funding to bring them back with their youth clubs, for instance. We incorporate various elements — not just leisure, but nutrition advice and other things — to make the programme interesting, and to make people see that a leisure centre is more than just a swimming pool and a main hall.

Mrs Hanna:

If something like that is working we should be using it. We already have the leisure centres, the parks and the playgrounds.

Ms Morgan-Talbot:

I am not sure whether members are aware of the Active Communities investment programme, which is open to all councils and is funded by Sport NI. Belfast City Council has received funding to employ coaches to deliver key health benefits to communities. We hope to have 17 coaches in place by October. In order to do that, we have linked up with local government bodies and local groups that have identified their key aims and sport-development programmes for increasing participation among hard-to-reach groups in communities, such as people with disabilities, children, young mothers and older folk. It is a three-year programme that will reach out into the community. We often find that people do not want to leave their community, and they want to go to classes in their local community centre or church hall. It is crucial to empower people to get involved.

Mrs Hanna:

Although I appreciate that it is sometimes difficult to measure outcomes, I would welcome a report on such schemes that says what Ms Morgan-Talbot has been saying — that such programmes make a difference. Participation can be measured to some extent.

Ms Morgan-Talbot:

Yes, it can.

Mrs Hanna:

We need to know whether people are becoming more active and going back to the leisure centres or participating more in schools. That is the natural way to get children to be more active, and if it is working, that is good.

Mr Gardiner:

Do you have any direct link with Craigavon Borough Council? Lurgan Park, which is the largest park in Northern Ireland won the green flag award. The next largest park is Phoenix Park in Dublin.

Mrs Hanna:

It must be big.

Mr Gardiner:

It is. Well, you can do a one-mile walk around the lake, or a two-mile walk, if you want to get young people involved in exercise and keeping fit. There is fishing, and new stands have been put up for people who want to fish.

Ms Morgan-Talbot:

I am not sure if we have any direct links. I know that —

Mr Gardiner:

That is why I am pushing this. You represent NILGA, which covers all local council areas. Craigavon Borough Council is involved; it has to be a two-way process.

Ms Morgan-Talbot:

That is great; thank you very much.

The Deputy Chairperson:

Katrina is speaking from Belfast City Council’s perspective. Karen is the representative from NILGA.

Ms Smyth:

When I was researching our report, I was inundated with examples of good practice from different council areas. It was my understanding that those examples had already been fed to the Committee, and I did not want to repeat information that members had already received. I will forward that to you.

Mr Gardiner:

OK.

The Deputy Chairperson:

NILGA recommended a scoping exercise on existing good practice; that is exactly what we are talking about. Have you done that work?

Ms Smyth:

Yes. We have done a partial scoping exercise of what already exists. When we ask councils for information, we do not get 26 replies very often. The work is under way, and we could take that forward for the Committee if it wants us to do so.

The Deputy Chairperson:

It would be very helpful to have that information.

Mrs McGill:

I would expect there to be particular focus on neighbourhood renewal areas because of deprivation and, by extension, poor diet. How is that addressed by Belfast City Council?

Ms Morgan-Talbot:

The council has a strategic neighbourhood action programme (SNAP), which has developed action plans for 11 or 12 areas. The action plans address key themes from the environment to health. Each individual area, through a specific working group and various partners, has identified key actions that we will deliver.

Mrs McGill:

Do those actions link to exercise and issues around obesity in particular?

Ms Morgan-Talbot:

Yes.

Mrs McGill:

I think that that would be fundamental, given that there are links.

Ms Morgan-Talbot:

The council’s leisure services division had an input into how it would help to deliver all the action plans. I cannot tell you, off the top of my head, whether those plans are directly related to obesity, but I would be very surprised if they did not link into it in some way. I can look into our plans and come back to the Committee.

The Deputy Chairperson:

There are no other questions. Thank you very much for coming along and giving your presentations today.