18
Examination of witnesses
Nicky Dennison and Dr Katie Cuming.
Q53 The Chair: I welcome our second panel of witnesses this morning. Unfortunately Claire Pritchard, who was due to join the panel, has been unavoidably delayed. We are not sure whether she will arrive, but we are going to carry on with our two witnesses.
The meeting is being broadcast live on the parliamentary website. We will be taking a transcript. Eventually it will be published on the Committee website, but you will have an opportunity as witnesses to make any corrections to it that you see as necessary. Members of the Committee have declared their interests. Anybody who has not yet spoken and who has interests to declare should declare them the first time they speak.
Before we get on to the questions, I would like you to introduce yourselves for the record.
Dr Katie Cuming: I am a consultant in public health, working at Brighton & Hove City Council.
Nicky Dennison: I am a public health specialist and I work in Blackpool Council leading on healthy weight work with nought to 19s in the borough.
Q54 The Chair: Thank you. I will kick off with a very general question. We will go into more detail on a lot of the issues later in the session, so perhaps at this point you could just give us an overview answer.
What is your assessment of the levels of poverty and food insecurity that you are seeing in your areas, Brighton & Hove and Blackpool, and have the levels changed over time? As an additional point, what are the key drivers of poverty and food insecurity in your areas?
Dr Katie Cuming: In Brighton & Hove, we have been carrying out an annual city tracker survey since 2014. From that, we know that one in five residents in the city says that they will not have enough money after housing costs to meet their basic living costs. That includes buying food and paying for water and heating. It is even higher among those who rent their homes rather than being homeowners, and among carers, our younger residents—under 35s—BAME groups and those who have a health problem or disability. That rises to one in three.
We also have some data from our food banks. Again, we have had an annual survey since 2014 when we began more focused work around food poverty. In 2019, we had 21 food banks. They currently supply 430 parcels a week. That is a significant increase since 2014, when we had 13 food banks supplying 266 parcels. By last year, we had experienced demand from universal credit recipients. A number of people in work were also attending food banks, as were disabled people, people with mental health conditions, large families and single parents. Those were the groups that seemed to be at increased need.
We had a recent LGA peer challenge, which revealed information from our local schools and various community and voluntary sector organisations, which all cited lack of food and hunger as a significant issue for families across the city. As regards drivers, high rents and living costs are a significant factor in the city. Although this is outside local authority control, low wages and zero hours contracts also contribute significantly.
Although our local figures have shown a reasonably steady state, with one in five experiencing poverty at this level, given the very challenging circumstances of the last few years we are celebrating a certain degree of success in even holding steady.
The Chair: Could I have a bit of clarification about one of the figures? One in five of the overall population of Brighton & Hove experiences poverty in some manifestation. Then you mentioned subgroups and you gave the number one in three. Was that for people who are renting or for people who are disabled? What was that figure for?
Dr Katie Cuming: That was for those who have a health problem or disability. It is a representative sample survey from across the city and one that is carried out annually in a standard way.
The Chair: Thank you. Nicky, would you give us your perspective from Blackpool?
Nicky Dennison: I will start with the drivers. In Blackpool, we do not have industry; work in the town is very seasonal. There is high unemployment and ill-health unemployment, with people not having the ability to work. Our life expectancy in the town is significantly lower than in other parts of the country. If you are a male you are expected to live to 74, and if you are female perhaps to 79. As a male with ill health, your life with good health is until 54, and as a female 58. People are living with a lot of ill health for long periods, which has an impact on whether they can get employment.
In Blackpool, we have really poor housing stock. We have a lot of population churn; a lot of people move into Blackpool because our accommodation is so cheap. We have over 4,000 houses in multiple occupancy that are often one-room accommodation with multiple people living in them. They are of a very poor standard. The landlords who own them are not interested in doing them up, and if they are of a poor standard people’s health deteriorates, so one of the key drivers in the town is looking at how we can improve our housing stock.
It is very clear that universal credit is having an impact on our families. It takes time for them to get their funding through in order for them to be able to buy food and pay their rent. That causes an impact on our families. We have definitely seen an increase in our food banks being used; people are using them tremendously more. I am not just talking about unemployed people; people on very low wages have to utilise the food banks.
In the summer, we offered a summer holiday scheme that we were able to fund through the Opportunity Area programme. We managed to get something like 576 children through; 58% of them were on free school meals. They came in to have food and activities over the summer to keep them busy, active and their tummies full. It was really important for us to do, because in Blackpool we offer a universal free school breakfast across the town so that we know our children are fed in the morning while they are at school so that they can, hopefully, focus and concentrate during lessons.
We have 26% of children living in poverty within the town. Over 5,000 children are on free school meals. Talking to our citizens advice bureaux, there is a sea change in what people discuss there. It used to be credit card debt. Now it is fuel poverty, and how they are going to pay their rent and mortgage. There is a real sea change in the debt that is discussed.
At Christmas time, we were fortunate to have the Sunday Times do a Christmas appeal for us in Blackpool around poverty and the difficulties that some of our families face. Over the Christmas holiday, one of the schools ran a five-day scheme; 100 individuals, both children and families, went there so that they could receive food and do activities to keep them entertained. Over £3,000-worth of vouchers were given for fuel so that they could keep their homes warm.
The Chair: To make sure that I have fixed it in my mind, the figure you gave for children in poverty in Blackpool was one in four: 26%.
Nicky Dennison: Yes, that is correct.
The Chair: Do you have any further breakdown? For Brighton, Katie gave us one in five of the population as a whole, but one in three for people with a health problem or a disability. Do you have any comparable breakdown?
Nicky Dennison: I do not have it with me, but if it is something you want I could find out.
The Chair: That would be helpful, just so that we have two sets of figures that we can compare. Thank you both very much. Those were extremely helpful introductions.
Q55 Baroness Sanderson of Welton: In both cities, you have partnerships and networks with different private and third sector organisations. It would be interesting for us to hear a bit about how important those networks are and what the challenges are of working with the different organisations, which will have a slightly different focus in each city with each relationship.
Dr Katie Cuming: In Brighton & Hove, there are two key partnerships that I would like to highlight, the first being the Brighton & Hove food partnership and the second being our healthy weight programme board.
We see huge benefits from working in partnership on this agenda. Citywide, the Brighton & Hove food partnership, brings together over 100 organisations, including 30 different council teams. The Spade to Spoon strategy, which was the first citywide food strategy, was launched in 2006 and refreshed in 2012 and 2019. Over the last five years, there has been a specific stream of work around food poverty that, in the last strategy developed last year, has been mainstreamed in all our food work.
Many colleagues who work on this agenda agree that the fact that a very broad view of food is taken is a great advantage. It is food and health. It is considering sustainability work, and ranges from waste to food growing, with a real focus on food poverty. The fact that all sorts of organisations work together on the agenda does not remove, but certainly reduces, the risk of silo working in specific areas without good communication. That said, challenges include good communication and the funding of an organisation such as a food partnership.
The healthy weight programme board is a group of stakeholders who are working on the challenge of healthy weight and preventing and treating obesity in the city. Obviously, part of that agenda is food related and part is physical activity. It is about the whole system that helps support a healthier weight for people in the city throughout their life course. We work with colleagues on healthier catering and a healthier and broader food environment. Planning colleagues sit on the group. We work with transport and travel. We work with sports and physical activity colleagues, including leisure providers. We work with colleagues in schools and with health colleagues. We are trying, year on year, to build a broader group or coalition of colleagues who work on this challenging agenda.
We see huge benefits of working with such a broad and sometimes unconventional mix of people. Some of the more innovative examples of work, which I can illustrate during this session, such as our Sugar Smart work, have emerged from that. They have sometimes included partnerships with voluntary organisations and the private sector. We have recently done some work with Lidl on vegetables. We worked with the Jamie Oliver Food Foundation and our local football club. There are all sorts of partners, sometimes conventional and sometimes less conventional, on this agenda, and that certainly brings strength to the work.
Nicky Dennison: We have a range of partnerships in Blackpool. Among the key ones I want to pull out is a more recent partnership that was pulled together between the third sector and the public sector around developing the holiday activity scheme that we ran in 2019. It is quite challenging for the third sector when funding suddenly becomes available; everybody wants a piece of the pie or they feel that they want to deliver everything. Working with the third sector can be very challenging, especially when there is a pot of funds; it is about how it is shared equally at a time when third sector organisations may be struggling. It is how you strengthen them by working together. If you work together, you have a better chance of bidding together and pulling in the finances.
Everyone working together delivers something better for the town than lots of pockets of things happening. Quite often when funding is parachuted in and there is only one organisation dealing with it, it only deals with one specific area, whereas the partnership we have now works across the whole of the town. It is pulling everybody together to work together.
We have just brought Business in the Community around that table and that allows us to approach it. There are not five different organisations going to Business in the Community; it is one partnership. Hopefully, we are going to get better gains as we move forward as a partnership to develop a holiday activity scheme that will run every single school holiday rather than just in the summer. The challenge is probably finding the funding to keep the programme sustainable and running over every single holiday. We can pull on and rely on the different strengths of the different people in the partnership to help deliver what we hope to achieve within Blackpool over the next 12 months.
Like Brighton & Hove, we have developed a partnership around healthy weight across the town that is led and directed by our health and well-being board. We have brought all partners—private, third sector and business—to look at the weight agenda in the town. Blackpool was one of the first local authorities to sign the local authority declaration on healthy weight. That holds our partners to account and challenges them to make commitments and to make changes in their own organisations. We work with different sectors to try to shape and influence what is happening around healthy weight.
For example, when the council signed, we got our local NHS trust to sign up to a declaration on healthy weight, saying that it was going to improve for its staff and its patients. We also got 20 organisations, including the police, local businesses and our third sector to sign up and start to make simple and small changes and steps. Keeping the momentum going is challenging. We have had the scheme since January 2016, and as you get pulled on to different agendas the question is how, as a lead, you keep the momentum going. We do, but it is challenging. You want it to improve. Hopefully, we will touch on some of the things that have come out of that, such as the healthy choices awards going on in the town, which get our local businesses to think about the food they deliver to our population. It presents challenges.
Baroness Sanderson of Welton: Is it now delivering stats on the effects since you started in 2016?
Nicky Dennison: We found it very hard to measure, because our key measure is the national child measurement programme. We saw a slight dip in 2016-17 which we were delighted with. We went down, but unfortunately we have gone up again on that data, but it is not as bad as it was in 2016. The difficulty with obesity is that it is a long-term measure, and it is difficult to monitor.
The other partnership I would like to highlight is a strength that we have in the north-west. Our directors of public health in the north-west commissioned Food Act!ve to create a partnership. We work as a team of commissioners across the north-west and across our local authorities to learn best practice from each other and share what is working in our local authority and what is working in other local authorities, so that we are sharing practice and not reinventing the wheel. We are also sharing the burden and learning what else can be achieved.
I know that 17 local authorities in the north-west have signed a declaration on healthy weight. In Yorkshire and the Humber they were very interested, and they are driving and working for every local authority in Yorkshire and the Humber to be signed up to that. In the south-west, they are also interested, but they are taking a different approach and looking at what an NHS declaration on healthy weight would be.
Q56 Baroness Janke: How can local areas successfully embed sustainability into food and public health policies?
Dr Katie Cuming: It can be done in a number of ways. Our Brighton & Hove food strategy and action plan has health and sustainability very much interwoven throughout all the key aims and outcomes. They are quite wide-ranging, from championing healthy and sustainable food at every opportunity, to preventing food poverty and trying to transform catering and food procurement on both those agendas. It is about becoming a food use rather than a food waste city and trying to work with policy and planning to embed healthy and sustainable fair food at every possible opportunity.
The city is working towards becoming the first sustainable gold food city and is submitting its bid later this year. The food partnership generally feels that having a cross-sector food strategy and partnership allows us to work on a number of different areas where there are food and health outcomes, to benefit alongside each other.
As a health and public health professional, I think we still have some way to go before we have sustainability fully embedded alongside lots of our health and public health-related work, but there are a few key areas of work that we have been focusing on in the last few years where it completely makes sense. For instance, there is our work on Peas Please, a national initiative championed by the Food Foundation. We have been doing some work locally in Brighton & Hove on that. The general aim is to increase the amount of veg that ends up on the plate, with our work around food growing and around improving the amount of veg that children eat in the school food environment. We are working with Lidl and it feels as though there are very clear dual benefits for both health and the environment in encouraging a more plant-based diet.
A second good example would be our work on water over the last few years. We are trying to encourage local tap water provision and consumption, steering children and young people—everyone really—away from sugary drinks. We championed that as part of our Sugar Smart work. There is a very clear co-benefit of reducing single-use plastic. We have a local UNESCO biosphere site, which we are championing in that work.
Thirdly, more broadly, there is our healthy weight programme. Some of the areas are outside food but very relevant for healthy weight. Active travel is the key to action on healthy weight in the city. In encouraging people to cycle and walk more, you could not get a clearer sustainability benefit to the health benefits that we will see across a whole range of health outcomes, not just weight, if we can get our city moving.
There has been an extra impetus to that as part of the recent climate agenda. The city is working to introduce more school street closure days and exploring the options for a car-free city centre. That was announced in the last few weeks. There are a number of ways in which health and sustainability feel as though they are firmly alongside each other in the ideal state that we would like to move towards.
Nicky Dennison: In Blackpool, we have been looking at a whole systems approach. Fairly recently, Public Health England did a whole piece of work around a whole systems approach to obesity. It is not looking at one specific thing but actually looking at all the interconnections and relations around what impacts on a healthy environment. It is not just looking at the food environment; it is looking at every element.
When we are trying to shape and influence policy in the council, it frames the conversation around the impacts it has on other strategies—for example, on green and blue infrastructure. Like Brighton & Hove, in our healthy choices award we encourage every premises to offer free tap water, so that when you take your bottle in it can be refilled, even if you are not buying anything.
It is key across all our departments that we really look at health in all policies to ensure that health is featured in them, even down to our procurement. When we are looking at our procurement process, especially when procuring catering facilities for our care homes, there should be something around health, the food agenda and supporting the whole systems approach to tackle healthy eating and the obesogenic environment.
We have a series of programmes. We have worked with Living Streets. We have funding from the Department for Transport at the moment to encourage children to walk to school—the WOW project. We have schools signed up. We are trying to discourage cars from parking outside schools. That has been in since 2012. It is very well embedded and the schools love it. It is about having those conversations and encouraging families to walk to school rather than dropping children outside the school gate.
We are working around getting people active in the workplace as a part of the Living Streets work. We are trying to encourage that in our secondary education provision, talking about the transition from primary to secondary and how children are going to get to school in a sustainable way, whether cycling, walking or even accessing public transport. It is building and strengthening those things to embed them, and then they become part of everyone’s everyday practice.
The Chair: You have talked about some things that you measure; for example, you mentioned, Nicky, that the child weight measurement programme gives you some trends or blips in the obesity trends. More generally around the sustainability agenda, do you have measures that you can track to see whether, in either Brighton or Blackpool, things are in some measurable way becoming more sustainable? You mentioned transport, but we are also particularly interested in the carbon footprint of the food that is being consumed or the sourcing of it. Do you have anything by way of measurement?
Dr Katie Cuming: On general sustainability measures and the active travel bit, there is data that we regularly collect and monitor. We get some really useful data from our Safe and Well at School survey data on a whole range of healthy lifestyle issues. That includes active travel to school. We also work very closely with our transport colleagues in the local authority and look at the surveys that they do on children and active travel to work. There is data that is collected nationally around work journeys. We know that in Brighton & Hove we have a high proportion of residents who walk to work every day.
The food bit is in development. We have a range of metrics that we collect on the food front. We have good detailed data on healthy weight. Quite a lot of the detailed metrics on sustainability are in development, and, as far as I understand, that is nationally as well as locally. I would certainly be able to share with you after this Committee the bits that food partnership colleagues have been working on.
The Chair: It would be helpful if you could send in whatever you have, even if it is just an indication of the direction of travel.
Dr Katie Cuming: Yes.
Nicky Dennison: We do not particularly have anything in place for monitoring the food and sustainability side, but I can go back to our food partnership and have a look at what they have. I can feed that back to the Committee.
There are some other things that we are able to monitor. Obviously there is the walk to school. There is what we call a travel tracker, and we can monitor what the children are doing. We can supply that. I can give you that information.
Another thing we do with our schoolchildren is what we call a shoe survey. It looks at a raft of healthy lifestyles around their sport, their activity, their walking to school, whether they cycle, what type of fruit and veg they eat and how much sugar they eat. We do that every two years. They are very standard-format questions so that we can monitor each year whether the position is getting worse or better, depending on what the subject area is.
Baroness Boycott: Do we have that measure? It would be interesting to know how much it might have changed, and how much fruit and veg they are eating.
Nicky Dennison: A number of local authorities do a shoe survey, but we can track back. We have done it for a number of years, so we would be able to track back. What you have to be mindful of is that it is a different cohort of children.
Baroness Boycott: Can you send it to us?
The Chair: It would be very helpful.
Nicky Dennison: I can send it, yes.
Q57 Baroness Ritchie of Downpatrick: You may have already referred to this issue, but do you in your separate locations have any examples of innovations or initiatives that have been successful in tackling food poverty and diet-related ill health? In relation to that, how do you determine whether those interventions have been successful, and what metrics do you use?
Dr Katie Cuming: First, on success and the metrics we use, for us the two key forms of ongoing monitoring are our national childhood measurement programme data and the data just mentioned that we get from our Safe and Well at School survey.
As regards our national childhood measurement programme data, we are pleased that over a number of years we have seen a significant increase in the proportion of children in the city achieving a healthy weight by year six. We have seen a trend since 2007-08, when 67.5% were achieving that, through to 73% in 2017-18. That is a drop in obesity from 17.7% to 13.1%. When compared with the south-east and national data, we are certainly bucking the trend in a significant way.
We also know, as I am sure do all other cities around the country, that there is a significant relationship with deprivation and ethnicity, where we see very different rates. Some of our schools have 56% of children achieving a healthy weight, compared with others where 82% achieve a healthy weight. We are doing all sorts of things in the city towards supporting an environment where achieving a healthy weight is easier. We do not always know which bits make the biggest difference.
One of the areas of innovation that we developed and launched in the last few years was our Sugar Smart work back in 2015. It started off as a very low-budget, local debate when the Scientific Advisory Committee on Nutrition report on carbohydrates and health came out in 2015. We thought it would be good to discuss that with residents and ask people throughout the city, particularly children, families, schools and food businesses, what they thought about it and whether we should be taking action as a city; and, if so, what sorts of actions we should be taking for them and for the food environment.
As part of that work, we managed to engage our local residents as well as a much wider audience. We teamed up with the Brighton & Hove food partnership and the Jamie Oliver Food Foundation, which was starting to campaign for a sugar tax. That was timely. We also worked with our local football club. We ended up over the next couple of years engaging dentists and early years settings, and doing all sorts of different things with schools, kids and their parents. Public Health England developed a large range of resources around Sugar Smart and became a national branding around sugar, and lots of other local authorities have taken it up. It started as a small idea with an incredibly small budget and grew into a much bigger and interesting piece of work.
Initially, it did not set out as an initiative to address food poverty as such. However, given the relationship between deprivation and a lot of diet-related ill-health—not just unhealthy weight but a lot of the disease and health issues related to sugar, not least dental decay—as it is addressing sugar and trying in a more systematic way to reduce the amount of sugar in our diet, it feels as though it is an important way to start working towards that issue.
Peas Please and the veg work is another more recent initiative. It is still early days, but as part of that work we teamed up with the University of Brighton and with Lidl, which has a supermarket in one of the more deprived areas of the city, where one in three children lives in a household in poverty. As part of that, we did some focus groups and a survey looking at the various factors that influence families’ habits and ability to purchase and prepare vegetables. That again has been a really interesting and different piece of work. As I say, it was more recently started.
Our colleagues working in the food partnership want to flag up that we have a surplus food network, which I gather is fairly innovative and unusual around the country. It comprises an alliance of five organisations that work on tackling food waste. They work with suppliers on trying to distribute surplus to people in need in Brighton & Hove and the surrounding area. On the broader agenda, that is also an innovative initiative.
Nicky Dennison: Over in Blackpool, there are a number of key initiatives that I want to highlight. The first is a campaign that we called GULP, developed in the north-west with our Food Act!ve partner. We developed the campaign jointly, and it is used in different local authority settings, adapted to the local area.
GULP is “Give Up Loving Pop”, and it is a 21-day challenge to children to stop drinking fizzy drinks and only drink water or milk. We started it on a small scale in the town. We started with our year four in primary, and over the years we have built it, so that it is now offered to years four, five and six. It reiterates the message each year about trying to give up fizzy drinks.
We are in our fourth year of delivering that campaign. It goes down well with the children. We do it on a school basis, and it is a great craic because schools like competition between themselves. Each year, we offer the winning school, with the most fizzy-free drink days, a trip to the Blackpool High Ropes as a reward. Obviously it is physical activity as well, so that is really good.
We offer to supervise teeth brushing in our nursery settings. After a lot of hard work, we now offer fluoride milk to every primary schoolchild in every school in every year, from reception through to year six. That has been a positive introduction. It has taken some time. We had a lot of campaigners who were against us putting fluoride in milk, but we have worked through that. In Blackpool, we are able to demonstrate an improvement in dental caries through the work we have done, which is really positive. I do not have the percentages now, but I will supply them. We are still above the national average but we are moving in the right direction. We have undertaken a valuable piece of work.
The other programme I want to highlight is our Fit2Go programme, run by our local football trust. It is a fantastic partnership. It is funded three ways, through the local authority, the CCG—the clinical commissioning group—and the Premier League. It is a six-week healthy lifestyle programme that goes to every year four child, and they go through physical activity and healthy lifestyle. There is the Eatwell plate, and all the different types of food are discussed.
We survey at the beginning to understand what children know about healthy eating, healthy food and healthy lifestyles. Then at the end we monitor it. Generally, there is a move and a shift to children wanting to eat more fruit and veg and having a better understanding of what is healthy. That is one of the programmes. We also do a Fit2Go for families and there is a Fit2Go for our nought to fours now, which is funded through our A Better Start programme. They are all based on healthy lifestyles and getting those messages across to families.
Another key programme is the healthier choices award that we have in the town. This is where we work with our local businesses trying to get them to do swaps around what they offer. Instead of full fat sauces, can they use light mayo? Can they offer brown bread instead of white bread and offer smaller portions? Since that has been in place, we have 142 businesses signed up—lots of local, small businesses rather than large national companies.
At the back end of last year, we introduced our junior healthier choices award. That is around encouraging our businesses to be breastfeeding friendly, and to support weaning and complementary feeding, and being much more open and supportive to mums and dads. Rather than offering a children’s menu, they offer the child a small portion of what they are doing. We also ask that restaurants or cafés give free water to mums who are breastfeeding and that every child gets free water or milk rather than having to pay for it. At the moment, we have 37 businesses signed up to that, but we have an ambition to get 150 signed up to that award by the end of this year. We offer some small incentives. If the café does not have a high chair, we will put in a high chair. They are little things so that we can make small changes.
Baroness Boycott: I know that we are running out of time, but this will be my last question. You are both super-impressive. I have obviously been watching Brighton & Hove for years. I know Vic Borrell and Jo O’Reilly. You have lots of people there. Is there a way, not necessarily now, that you can encapsulate what it is particularly about Brighton & Hove and what you have done that could be replicated?
You have staggeringly good figures compared with everywhere else and you are bucking a trend. I am keen to know how we copy you. I do not expect an answer now because I think it would be too long, but it is very interesting. Is it a combination of all those people, the length of time you have been doing it, the fact that you have a Green MP or that you have a different kind of priority on the council? I would like to know how we can use that as part of the example of what you have to do. I will leave it at that. I would like the information.
The Chair: Bearing in mind the time, it would be good if you could write in about that and any lessons from Blackpool.
Baroness Boycott: Especially the stuff about teeth. It is incredibly important that you are taking measures. Scotland has done a lot in relationship with the Government. Do we need government intervention to stop dental caries?
Lord Empey: You are both running a lot of initiatives. What relationship do you have with central Government on support, guidance, two-way traffic or whatever?
Dr Katie Cuming: From a public health point of view, we have reasonably close relationships with Public Health England and many of the policies come out to us. We have some support from PHE. A number of the initiatives that I have highlighted as part of the discussion so far this morning have been things that we have thought up, working with our great partners on the ground, as Baroness Boycott mentioned. A lot of the ideas come from that, and we ask for support and back-up from Public Health England as it comes. I would say that we have good working relationships.
We always try, as part of our south-east healthy weight network, to share ideas, initiatives and the different kinds of work that we are developing. There are other aspects, but that is our main link.
Lord Empey: Obviously local authorities have links with central government departments. A lot of what you are doing is locally based with local groups. What is the interrelationship? The question I am asking you is: why is everybody else not doing it? If there is central guidance, you would think there would be a broader amount of activity right across the country, but there obviously is not.
Nicky Dennison: We work very closely with Public Health England. I suppose that, perhaps, where there is discord, it is over the manpower we have at local authority level. It is what you have in the way of resources in your own local authority to champion topic areas and drive the agendas forward.
Our relationships link with national ones where we have funding—for example, from the Department for Transport for access funds, so that we can run the partnership we have with Living Streets. You have a relationship with a department when you have a funding stream because it is very clear on how it wants that funding spent, measured and fed back to it to make sure that you are delivering against what it wants to achieve.
The only other way we link is through the Department of Health. For example, we have the Making Changes programme, which concerns family weight management. We follow NICE guidance and we have to achieve what the guidance tells us in relation to delivering that service.
Q58 The Earl of Caithness: What other options do local authorities or boards have to encourage a healthy food environment and alleviate poverty and food insecurity? If they have those options, why are they not using them?
Nicky Dennison: The key option is probably around planning. We have the National Planning Policy Framework, which local authorities need to work towards. Under that, we have the core strategy. In Blackpool, we have a very health-focused core strategy. Currently, in Blackpool we are working on part two of that strategy, which is developing what we want to do locally from a planning perspective.
In the food environment, we are looking at food density. A lot of local authorities are taking a 400-metre radius around schools. We have not taken that approach, in my opinion, because of where our schools are located; 33 are primary schools so the children do not leave the school, and we only have seven secondary schools. Around those are convenience stores; the large supermarkets and most of the fast-food takeaways are closed, so that perspective would not work for us.
We have looked at density. That is what we are moving towards. We are looking at ward level data, our obesity levels and saturation. We are looking at saturation of fast-food takeaways and what the obesity levels are. We are moving towards embedding in our local plan that we will, hopefully, restrict fast-food takeaways in areas with high levels of obesity and density of fast-food takeaways. Just to give you an idea, we have 2.54 per thousand population of fast-food takeaways in the town. We have something like 358 fast-food takeaways and over 2,000 eateries.
Planning is very complex. For a hot-food takeaway you need A5 planning. That basically means that you do not have any chairs or tables in the vicinity. A3 planning is for restaurants. All you need is five tables and chairs to class yourself as a restaurant and serve food. A1 is retail. Once a retail unit has that, it can serve food. It is a really complex approach.
At national level, I would love A5 planning to be looked at, because once a property has A5 planning it stays with the property and does not go. If one fast-food outlet goes away, the next landlord or owner can come in and open as a fast-food takeaway. I would love us to look at how we can make changes to that. It should probably be a bit like alcohol licensing, in that it goes with the name of the person who owns the business rather than the property itself. That is probably one of my asks from the Committee. Is that something that could be looked at?
Dessert bars are opening that serve 3,000-calorie puddings and desserts. They look lovely but are obviously very sickly and are 3,000 calories in one hit. They only need A3 planning.
Baroness Boycott: I thought you said they do not need any planning.
Nicky Dennison: They do not need A5. They can open as an A3 or A1 as a retail, depending on the approach they take.
Dr Katie Cuming: In Brighton & Hove, we started looking at the issue of planning and A5 outlets back in 2012. We started off with a bit of mapping with our planning department. We found that, although Brighton & Hove had one of the highest numbers of food outlets per head of population, when we looked at where the secondary schools were situated, which was further round the outskirts of the city, the number and density of fast-food outlets within 400 metres was very low. Even within 800 metres, which a bit of observational work showed us that our secondary kids did—they walked for 10 minutes to go 800 metres rather than the standard 400 metres—the numbers were still quite low.
We did a bit more work looking at the types of food outlets they went to. A few years later, we did some interesting qualitative work and interviews with those fast-food outlet owners. We found that secondary school-aged kids with a small amount of money to pay for their lunch ended up going to two or three different food businesses. One of them might be the classic fish and chip shop or fast-food outlet, but the others were often convenience stores. They might be garage shops, newsagents, a café or a hot-food takeaway, which certainly would not come under the A5 restriction.
As a local authority, the decision was taken to focus on promoting healthier choices rather than trying to restrict an outlet that certainly did not feel as though it would capture for us, as a city, the main risks that children are exposed to. We also realised that it is not just about lunchtimes; it is the route to and from school. Restrictions probably need to be a bit more comprehensive than just talking about A5 outlets at lunchtime.
The Earl of Caithness: Sustainable Food Cities tells us that it has given local authorities a list of 30 possible levers that they can use to improve the situation. Are your two local authorities using all those levers? If not, why not? Is there a blockage from central government to local government that prevents you using those levers?
Nicky Dennison: I can give you an example, not for Blackpool but for me as a resident of my area. A large national food chain, McDonald’s, wanted to open in our area. The residents did not want it. It was declined at local level. It went to the Government and it was overruled, and that McDonald’s is now being built in a car park. We talk about localism and doing things at local level, yet actually it can go up to government level and be overruled. From a regulation point of view, that is frustrating. We tried to do something at local level, yet it was overturned at national level. It is hard to implement some of the levers that we are required to implement.
Dr Katie Cuming: From the point of view of Brighton & Hove, I am not sure that we are trying to implement all 30 levers that might be advocated. We work in a very positive way, similar to Blackpool, with a healthy choice award. It is not just a healthy choice award where a food business has to comply with all sorts of different things. There is a healthy choice commitment, so that businesses can start making small changes and be recognised for them.
We have a healthy nutrition project officer who sits in our regulatory services team. She has great access to work with all the food businesses across the city. We are a town that people visit and we have huge numbers of food outlets. However much great work she does with committed businesses, and lots of businesses want to make their offer healthier, it is a drop in the ocean when there are thousands of food businesses. Many change hands quite quickly.
The qualitative work we did with some of the businesses a few years ago showed that they were committed and wanted a healthier offer, particularly for children who come to their businesses. What is difficult for them, particularly if their business is running on a very small margin, is that, if they improve or change the quality of the food they are selling and they have to increase their prices even by a small amount, their customers, particularly if they are schoolchildren with very little money to buy their lunch, go elsewhere. That is bad for business.
From their point of view, they would very much advocate a level playing field, so any changes that can be brought in that mean that everybody is really playing by the same rules will be much more effective than individual businesses making small changes, or, although they do it, trying to influence their customers through nudges and building on all the behavioural insights that we hear about.
The Chair: We are running out of time quite rapidly. I would like to turn to Baroness Boycott. If you could keep the answers to this question very brief, it will give us time to finish off.
Q59 Baroness Boycott: I can wrap my point into the next question. Basically this is about the challenges of administering things that come from the Government, such as Healthy Start, free school meals and funding holiday programmes. My little supplementary about planning, which always used to frustrate me, is that shops such as Topshop and garage forecourts can sell food apparently without having to do much more than download a form online from their local authority. I would like to hear from you about that. Topshop can sell milkshakes, sweets and things. You can get those licences. Can I ask you about that? Then there is the other question. I am sorry, it is a lot of questions and you have frightfully little time.
The Chair: A couple of minutes each.
Nicky Dennison: I can pick up on that quickly. Next does it too. Those businesses have A1 planning. Once they have A1 planning, they can sell sweets, chocolate and confectionery without difficulty.
Baroness Boycott: Kids go into a clothes shop or a shoe shop and they can get sweet drinks.
Nicky Dennison: Yes, absolutely.
Baroness Boycott: Thank you. Carry on with the next one.
Nicky Dennison: The other one was on initiatives.
Baroness Boycott: And what the Government do to support them.
Nicky Dennison: I have experience of the Healthy Start and Healthy Vitamin ones in Blackpool. The uptake is quite poor because of the bureaucracy that clients and our population have to go through. They have to complete forms and show proof, which they do not always have with them when they come.
We have taken a pragmatic approach in Blackpool. We have health connectors who work in all our health clinics with our health visitors and midwives. They know the clients because they are health connectors who live in the community. They see that people need vitamins and they will give out the vitamins, regardless of the form filling, but uptake is still extremely low.
I would like to pick up on the school food standards—the school food plan. We recently looked at that across Blackpool, across our 33 primaries; 11 schools meet the school food standard and the others do not.
Baroness Boycott: Eleven out of how many?
Nicky Dennison: Thirty-three. Those 11 are run by our own catering team in the local authority. The others are private contractors in the schools. There is no regulation to monitor the schools doing that.
Baroness Boycott: Do you mean no regulation from anyone?
Nicky Dennison: For example, it would be great if Ofsted monitored that as part of its process, but there is no regulation.
Baroness Boycott: Your recommendation would be that Ofsted included the level of the school meal in its ratings.
Nicky Dennison: Yes. It is very clear that treats and things should not be given to children, yet, as I have experienced with my son, they offer chocolate bingo. They do sweet tombolas and bottle tombolas and all sorts at school summer fairs. The school food plan says you should not do that sort of thing, yet only the other day a head teacher said they were having a non-uniform day and asked everyone to bring in a bar of chocolate. It is frustrating that we cannot regulate that.
Dr Katie Cuming: I briefly echo what Nicky says. We have done quite a bit of work in the last couple of years campaigning to raise awareness of Healthy Start; 44% of families that are eligible locally do not get their vouchers. It is nearly always the logistics of getting the health professional to sign the form and the fact that the vouchers arrive by post. I understand that Scotland may be looking at different models or systems. As a local authority, we would be very open to having a system that was easier to administer. It feels as though it is the clunkiness of—
Baroness Boycott: Do you have recommendations as to how that system could be better administered?
Dr Katie Cuming: It feels as though the need to get the health professional’s signature and the fact that paper vouchers arrive, particularly in buildings or houses that are communal, is a very difficult way for families to do it.
Baroness Boycott: Would it be better on the phone?
Dr Katie Cuming: Exactly. Any of those barriers being removed would be great. It is in a fairly narrow window that families can apply, so we echo the issues that have been raised elsewhere about the barriers to children receiving the vouchers.
Similarly, it is really important to encourage uptake of free school meals. Local authority colleagues in our family, children and learning team say that they have challenges in trying to provide food for holiday programmes and for families in need when children attend early years settings. Unless they have two sessions on the same day, where they have lunch in the middle, they are not eligible for free food as part of attending that setting.
Baroness Boycott: It is outrageous.
Dr Katie Cuming: Those were issues that they flagged up as real needs and pressures on their budgets.
Baroness Boycott: Thank you very much indeed.
The Chair: Do you have any figures or analysis comparable to Nicky’s on the uptake of the school food standards?
Dr Katie Cuming: I do not have anything. I can ask colleagues and we can send the information.
The Chair: If you could, that would be useful. Nicky’s figures were particularly compelling and interesting. Very briefly, a final question from Baroness Sater.
Q60 Baroness Sater: What would be your policy ask from the Government?
Dr Katie Cuming: For me, it would be that any child in the city, regardless of the home that he, she or they come from would have access to an affordable, healthy, sustainable meal at least once a day throughout the year. That is bearing in mind not just school days, and early years, not just primary schools. I am thinking about holiday clubs and eating out in a city. We know that the trends are going up for families eating outside the home. If all those businesses provided an affordable, sustainable meal for a child eating at that place, it would be fantastic, with universal standards that that is a requirement.
Nicky Dennison: I have touched on A5 planning and regulation on school food. It is an ideal opportunity to give children a healthy, balanced meal during their school day. Our plea is for things to be funded appropriately in order for us to be able to deliver initiatives and keep them sustainable. Under the current climate we are working in, we work it out on a 12-month basis because we do not know where the funding is coming from. We do not even know about public health grants. It is only annually that we know what is coming in, so it makes it really hard to plan what we want to do.
We need to enforce at local level, but our enforcement team is so small that when things pop up, such as illegal takeaways, we do not have the manpower to do it. That would be my ask.
The Chair: I thank both of our witnesses very warmly. You have given us some fascinating and very useful evidence.
As I mentioned at the beginning, you will have an opportunity to read the transcript and make any editorial corrections that you wish to make. You have both kindly agreed to write in with some supplementary information. If there are any points that you wish you had been asked that you have not been asked, please feel free to make them to us in writing. Meanwhile, thank you very much indeed.
