Aims and objectives:
To provide the basis for the development of services for the management of childhood obesity within the areas of greatest social deprivation in Nottingham City.
To identify the prevalence of overweight/obesity at school entry in children living within the City of Nottingham.
To ascertain professional views on existing services and resources for the management of childhood obesity in Nottingham City and how a new service should be developed.
To develop, implement and evaluate a fun physical activity session for children based at a local leisure centres with referrals from primary care.
To consult with potential service users regarding how a local service should be developed.
Strategic Fit
Contributes to the NHS Priority One target to halt the year-on-year rise in obesity among children under 11 by 2010 (from the 2002-2004 baseline).
Support for the change:
Funding for the project was secured from the Children's Fund and Local Strategic Partnership through strategic influencing by the Assistant Director of Public Health and Senior Local Authority officers. At the time this process was supported by the increasing evidence base on child obesity as a major public health problem and health inequalities issue. Service development and change was ensured through a multi-disciplinary/agency steering group with representation from Specialist Health Promotion, Dietetics, School Nursing, Paediatrics, a Healthy Living Centre and Leisure Services. Due to this, Neighbourhood Renewal Funding has been secured until March 2006 to continue the work and develop a pilot service.
Patient and public influence:
A company specialising in engaging and consulting children was commissioned to develop relevant methods to obtain the views of children and their families. These included innovative participatory appraisal techniques such as pectoral methods and focus groups using community radio and traditional data collection methods such as questionnaires. The views of service users are being utilised by the project development worker and steering group to ensure the service to be launched in 2005 meets identified needs.
Impact on the workforce:
This project has engaged the school nursing service in the important public health issue and has identified training needs in relation to the identification of overweight/obese children and the approach school nurses take to supporting children. It will enable school nurses to refer into a service which will expand upon the care they are able to offer to their patients and enable those with a special interest to expand their skills in motivational interviewing and behaviour change. The project has created two specialist school nurse posts and a project coordinator post within the Specialist Health Promotion Service. Within the local authority this provided experience of managers for developing a health improvement service and provided guidance on how their staff should be selected for working with vulnerable children.
Measuring the results:
The uptake of the 'Go 4 It' fun leisure centre was monitored by leisure services and demographic details were collected to monitor if children from our target communities accessed the service. Child and adult satisfaction with these sessions was recorded qualitatively using group work and questionnaires as described above. Stakeholder involvement in the evaluation was coordinated through the project steering group. This will ensure the service becomes integrated into Leisure Services and School Nursing. Although other organisations are developing services to tackle child obesity, we believe the approach taken will ensure that the service will better meet local need in a coordinated and integrated way. The uptake of the 'Go 4 It' fun leisure centre was monitored by leisure services and demographic details were collected to monitor if children from our target communities accessed the service. Child and adult satisfaction with these sessions was recorded qualitatively using group work and questionnaires as described above. Stakeholder involvement in the evaluation was coordinated through the project steering group. This will ensure the service becomes integrated into Leisure Services and School Nursing. Although other organisations are developing services to tackle child obesity, we believe the approach taken will ensure that the service will better meet local need in a coordinated and integrated way.
Improved performance:
The project has enabled Nottingham City PCT to progress against the new national children obesity targets. This includes the development of a system for monitoring child obesity prevalence through the prospective entry of weights and heights by school nurses. This model already gained interest from the Trent Public Health Observatory and could be transferable to other PCTs. The project tested out a referral system and a leisure centre activity session (Go 4 It!) for children. This was attended by 78 children, the majority of whom were from the most deprived areas of the city. The approach taken has strengthened partnership working between the PCT and Leisure Services and the pilot service will enable school nurses to take a lead role in the this agenda.
Reflecting diversity:
Nottingham city is the 12th most deprived local authority in England with 15 of the 27 wards amongst the top 10% most deprived nationally. The social deprivation that exists within certain areas of the city means that the city significant health inequalities issues which need to be addressed. These include a 10-year difference in life expectancy between wards within the city. Fifteen percent of the population are from black and minority ethnic groups, many of whom live within the most deprived areas. Research suggests that child obesity is more prevalent amongst lower socioeconomic groups (this is reflected in our local findings) and amongst Asian and African Caribbean groups. This data guided our rationale for prioritising families living within the most deprived areas of this city so that the new service would reflect the needs of those most at risk of child obesity. Participants were consulted about issues of cost and accessibility of the new service to ensure that this was taken into consideration.
Sharing the learning:
The project has been disseminated at a local obesity conference attended by delegates from the 3 local PCTS and 2 acute Trusts and to local GPs and practice staff through Protected Learning Time Events. Local PCTs are interested in learning from this project to enable them to develop local services. We are sharing information with colleagues in other PCTs (including Northampton, Stoke and Burnley) and with the East Midlands Public Health Observatory who are compiling an obesity report. The project has been included in Loughborough University's evaluation of the Nottingham Child's Fund Project which will be disseminated through the Children's Fund Networks. It has been shared within Local Authority Leisure Services as an example of good partnership working.
Outstanding features:
Innovation is demonstrated through the combination of collating prevalence information, patient and public involvement, professional consultation and service development. This will ensure that a relevant service can be developed which will meet the needs of local people and add to the evidence base of effective interventions in child obesity.
