Healthy Weight: Healthy Wales delivery plan 2021 to 2022

The Covid-19 pandemic has significantly impacted upon the progress we have been able to make on our Healthy Weight: Healthy Wales 2020-2022 Delivery Plan. Services, funding and capacity across government and with key partners were shifted to meet urgent needs elsewhere and, therefore, many of the commitments set out in the plan were paused.

In October 2020, we published our Renewed Priorities for 2020-21 which focused upon five key areas. This reflected the progress which could be made during the pandemic and aimed to establish delivery ahead of a renewed and re-energised focus in 2021-22.

We strongly believe that the priority areas set out in the initial 2020-22 delivery plan are the right ones to deliver. However, the impact of the pandemic has provided new challenges for us all in relation to both our physical and mental health. We have therefore amended delivery to take account of changes and challenges, in particular across health inequalities.

In 2021-2022, we will progress many of the paused actions from our delivery plan, with a focus on providing better support for those adversely affected  lockdown restrictions or economic impacts of the pandemic. People and families across Wales will have lost incomes, found it more difficult to eat healthy food and seen a decline in their physical activity. This will have impacted upon their mental health, which is strongly linked to obesity, and a focus on wellbeing is an absolute priority in the 2021-22 plan.

The pandemic has shown the potential for a widening inequality gap. It is now, more than ever, crucial for us to try to address this. Overweight and obesity emerged early on as a possible risk factors for Covid-19, however, there is a complex range of inter-related factors including disadvantage, ethnicity, pre-existing chronic disease and body mass which play a role. There is evidence that individuals living with overweight or obesity are more likely to be hospitalised, are progressively more likely to be admitted to intensive care and to require advanced treatment. As body mass index (BMI) increases above the healthy range there is an association with testing positive.

In light of this information, we will continue to engage in research, insight and evaluation of the virus to better understand the risk factors and promote healthier lifestyles.

Our renewed focus will look at how we can provide support with our partners, who remain committed to improving access to services, and ensuring that the healthy choice is the easy choice across settings in all parts of our lives.

This plan supports our aims of prevention and early intervention, set out within ‘A Healthier Wales’ our 10-year strategy for the NHS. We want to see a model for people and communities to feel empowered and supported to enable change. However, we know that these aims, and our delivery with partners against them, must reflect the challenges of the pandemic.  

Over the next year, we will continue to develop policy and legislation, and deliver new funding of £6.5m to achieve the eight national priority areas. However, there will be some areas which need to be deferred for delivery from 2022 onwards. 

A National Implementation Board (NIB) was created to oversee and monitor delivery of the 2020-22 delivery plan for the Healthy Weight: Healthy Wales Strategy. The board has provided advice and recommendations to inform the implementation of the plan thus far and will continue to do so through the appropriate milestones for the remaining 2021-22 period.

A number of sub-groups were set up through the National Implementation Board to ensure that the actions within Healthy Weight: Healthy Wales were taken forward within the two-year delivery time frame. The pandemic delayed these groups but both the Communications, Engagement and Campaigns sub-group and the Evaluation, Research and Outcomes sub-group have met to begin work.

The Healthy Weight: Healthy Wales Eight National Priority Actions remain in place:

1. Shifting the food and drink environment towards healthier options
2. Creating active environments and spaces to enable us to move more
3. Unlocking the potential within our natural environment
4. Developing our learning environments to be healthy, active and to promote emotional wellbeing
5. Ensuring that our children get the best start in life and are a healthy weight starting school
6. Tackling barriers to making healthy choices and reducing health inequalities
7. Delivering equitable support services for people to become or maintain a healthy weight
8.  Building a system of prevention which enables leadership at every level

By 2022 we will have in place:

• a co-ordinated approach to our new environment, where we will begin to see visible changes start to influence our weight, learning from the world changes over the past 12 months;
• the foundations of a system which is delivering tangible programmes and support for people; and
• a stronger Welsh identity for future policies and legislation which will bring about change in the medium to long term.

For many people, the pandemic has changed their eating habits. Some have taken the opportunity to learn new cooking skills and develop their taste for a range of healthier options. Others have found it more difficult to access food or be able to provide nutritious and healthy meals. Evidence has shown an increase in snacking and the pandemic impacting on takeaway provision and how we shop.

We have undertaken consultation, in partnership with UK Government and other devolved nations, on front-of-pack labelling, which ended in early November 2020. We will continue to work with the UK Government and to consider cross-UK approaches. We have also launched a four-nation consultation on alcohol calorie labelling.

We cannot ignore the importance the food environment has on our weight. We will launch a detailed consultation setting out how we can improve the balance between the price promotions and healthier items in shops, and considering where hot food takeaway stores are located in communities and near schools. This consultation has been delayed but we drive this forward at pace in 2021-22.

In 2021-22 we will:

• consult on a set of detailed proposals in the Healthy Food Environment, including regulating price promotion and discounting practices, and mandating calorie labelling for food purchased and eaten outside of the home. We will then publish the findings and set out a timetable for delivery and introducing legislation;

• work with the UK Government to seek views on how we can improve the marketing and labelling of infant food and drink, alcohol calorie labelling and take forward actions for Wales, following the consultation on Front of Pack Labelling which ran in 2020-21;
• introduce a consultation on limiting the sale of energy and high caffeinated drinks to children;
• work with Transport for Wales, as an exemplar, to adopt approaches for a healthier catering offer in commercial settings and publicly owned premises;
• continue work with key stakeholders and partners to promote postive marketing, and find ways to restrict the advertising of products high in fat, sugar and salt (HFSS), redressing the imbalance in the advertising of healthier and less healthy foods in public space.

The pandemic has provided an opportunity to consider behavioural change with many of us having to adapt our usual way of life.

It has driven changes in travel habits, with many more of us walking and cycling to work and shops and for recreation than before. We will look at the positive impacts of this opportunity for change and make sure people are able to continue to choose cycling or walking into 2021-22 and beyond. We have invested £33million into active travel schemes alone and £16.2million on short-term measures in response to the pandemic. Legislation allowing the implementation of 20mph restrictions was passed with overwhelming majority in the Senedd.  We will implement these restrictions and measure the impact they have on feelings of safety in the community, and whether active travel has increased as a result.

Many sport and physical activity initiatives and programmes have been challenged by the pandemic. For much of 2020, leisure centres, gyms and swimming pools were closed or had to operate at limited capacity to adhere to social/physical distancing measures. It is more important than ever to ensure that children and young people have the opportunities to participate in sport and physical activity, not just for their physical health but also their mental wellbeing.  We will continue to invest, through Sport Wales, effort and resources where it is needed most, where there are significant variations in participation and where there is a lack of opportunity or aspiration to be active.  Those resources will include a capital investment of £5m in 2021-22 to maintain our commitment to support the modernisation and accessibility of sports facilities in communities across Wales.

Public Health Wales have developed a healthy weight planning resource which was published in 2021-22 and will support increased working across planning, highlighting the importance of accessible green space and a renewed focus on active travel opportunities. We are committed to ensure a green recovery from the pandemic and will align with the commitments in the Clean Air Plan for Wales; Healthy Air, Healthy Wales to ensure that climate change and positive environmental impacts can be brought about.

In 2021-22 we will:

• continue investment into active travel infrastructure to develop safe walking routes to school and within communities, connect infrastructure and work with Transport for Wales to improve active travel opportunities within the public transport network;
• implement 20mph default speed limits in residential areas and encourage ideas to promote spaces for travel or play;
• take forward infrastructure proposals through housing, parks and countryside services, transport hubs, sport facilities and school community hubs. Sport Wales will be investing £5m in 2021-2, through its Places 4 Sport initiative, aimed at improving sport facilities;
• Encourage collaboration between local authorities and their partners through the Play Sufficiency Assessment to secure play opportunities and wider benefits which meet the needs of families locally;
• Continue to highlight the crucial role that playing has for a healthy and happy childhood by encouraging collaborative working between local authorities, Local Service Boards and Local Health Boards;
• continue to support schools, Childcare settings and the wider education community to realise the benefits of learning and play in the natural environment, utilising new opportunities within the Curriculum for Wales framework.

Our ability to work collaboratively with communities to develop targeted approaches to encourage and motivate people to move more has been significantly affected by the pandemic. However, we have seen evidence of those who regularly exercise, taking advantage of the outdoor spaces within their local communities; we need to do more to motivate individuals to take or continue to take regular physical activity, while presenting the potential to achieve the recommended target volume of physical activity as defined by the World Health Organisation and UK Chief Medical Officers. We want to take advantage of the renewed connections people have made to the outdoors and to highlight the importance of utilising green spaces close to home to increase physical activity and exercise.

We have seen greater community cohesion through initiatives such as Let’s Get Moving North Wales. Initiatives like these can go a long way towards tackling social isolation, and provide an opportunity to explore how we encourage people, families and children in areas of higher deprivation to utilise outdoor spaces for play, learning and physical activity.

We need to use the clear opportunities for people to access outdoor spaces and  consider behaviour-change approaches which encourage physical activity, learning and play in a safe space. There have been continued links made with social prescribing and taking advantage of Wales’ natural landscape - through the Healthy and Active Fund and Natural Resources Wales Grants for example.

Despite some delays relating to the pandemic, work has been ongoing with the Enabling Natural Resources and Well-being (ENRaW) Grant. An investment of £16.8m to improve local environment quality is creating resilient ecological networks and broadening access to sustainable green infrastructure. These grants, along with a number of supporting grants, will make a difference, not only to the environment and biodiversity of the land around us, but also the wellbeing and mental health of the communities and businesses who utilise and enjoy them. These projects will also bring a broad range of environmental, economic, social and cultural benefits by supporting new collaborative developments. 

The Valley’s Regional Park has strong links to active travel as well as the principles of sustainability and green recovery. Evidence has shown that these spaces have become more important to local communities in light of recent events. People are accessing these spaces to improve their physical and mental health and taking part in exercise that they had not previously. Through the Rural Development Plan (RDP) funded Valleys Regional Park Guardians project, individuals and organisations across the Valleys can take part in outdoor projects to improve physical and mental health, reduce social isolation and learn new skills related to food growing and practical conservation.

We have seen an increase in the number of people interested in developing more sustainable eating habits. Funding has been made available through Sustainable Food Places and Natural Resources Wales to support the establishment of local cross-sector food partnerships within communities that aim to create healthy, more sustainable and more equitable local food systems. 

In 2021-22 we will:

• continue investment of Enabling Natural Resources and Wellbeing grant and Green Infrastructure capital grants;
• continue to develop proposals for access reform to increase opportunities to access the outdoors, as well as funding improvements to the Welsh rights of way network to improve paths and help maintain the increase in local use  during lockdown;
• work with partners to implement pilot schemes across Wales to improve access to lakes and reservoirs for a range of water-based activities;
• improve allotment provision and increase support for community growing schemes, which help to enhance social inclusion and provide opportunities for people to exercise outdoors whilst growing their own healthy produce;
• deliver twelve Discovery Gateways through the Valleys Regional Park that will use green spaces and the rich cultural and industrial heritage to encourage people to be more active, explore the Valleys landscapes and take part in local food growing opportunities;
• focus on proposals for outdoor recreation, learning and play to ensure that funding and proposals continue to be brought forward;
• continue to deliver and learn from the Healthy and Active Fund;
• work with partners to develop emergent green social prescribing approaches which encourage physical activity, improve mental and social health.

The pandemic has caused much disruption to education. Return children and young people to school and keeping them and staff safe has always been our priority.  .

Despite the disruption, positive work has been ongoing to create safer environments, especially nearer schools, which impact on health, activity and mental wellbeing. The Welsh Network of Healthy Schools programme has been supporting continuation of physical activity and Public Health Wales have published guidance to support schools. Natural Resources Wales have also delivered on-line educator training programmes across Wales to support use of the outdoors.

The Safe Routes in Communities grant of £4.14 million has supported 22 schemes, specifically focused on creating safe walking and cycling routes to schools across 17 local authorities.  The funding has enabled local authorities to improve active travel networks and road safety across Wales. Sustrans Cymru will continue to operate ‘Active Journeys’ through the Active Travel Promotion in Schools programme to empower and enable positive change.

The plans set out for 2021-22 will enable us to catch up in developing learning environments which are healthy, active and promote emotional wellbeing. Supporting schools and understanding the impact upon children’s physical and mental health will be a specified focus in this period. More work is required to support the introduction of the Curriculum for Wales and to continue to develop environmental and behavioural change approaches supporting children, families and teachers to live healthy and active lives.

In 2021-22 we will:

• support the role out of Curriculum for Wales and realise the opportunities it provides.  This will facilitate professional learning and provide schools with a range of options to support the health and wellbeing area of the learning experience so increasing physical activity and encouraging active behaviours. It will include:

• cooking, food, nutrition and hydration to enable pupils to critically assess the impacts of healthy decisions and choices and broaden food education.
• alignment of our Welsh Network of Healthy Schools Scheme, Eco Schools programme and school sport to support and encourage the potential to achieve the recommended physical activity target volume in line with UK Chief Medical Officer’s Physical Activity Guidelines.
• Working with the Welsh Physical Activity Partnership (WPAP) we will develop a suite of professional learning approaches which can be tailored into bespoke, professional learning pathways to support the new Curriculum for Wales;

• Work with Sport Wales to develop a pathfinder scheme to explore how we enhance the daily physical activity opportunities available to learners and the wider community within school settings
• recommence work to inform revisions to the Healthy Eating in Schools (Nutritional Standards and Requirements) (Wales) Regulations 2013;
• promote walking and cycling to school through the Active Journeys Programme and conduct a “Hands up” survey in September 2021 which will listen to pupil’s views on active travel;
• work with the School Health Research Network (SHRN) to maximise the longitudinal data provided by the biennial Student Health and Well–being Survey.  Subject to funding being agreed, we will work with DECIPHer to develop and deliver the 2021-22 wave of the survey and use this data to monitor the short and longer-term effects of Covid-19 on young people’s health and wellbeing;
• review the national quality award through the Welsh Network of Healthy Schools Scheme and develop a set of proposals for future delivery with outcomes linked to Healthy Weight: Healthy Wales. 

A number of health and care professionals have been redeployed to respond to the pandemic response which has affected our ability to take forward some commitments in the short-term. However, we have seen a number of positive actions to support children to get the best start in life and start school a healthy weight.

We have piloted the ‘Baby Bundle’ scheme of essential items for new-borns which aims to provide help and guidance for parents and their babies. The guidance is designed to promote the health and wellbeing of newborns and help parents in the first days and weeks of their baby’s life. The first baby bundles were delivered in Swansea Bay University Health Board in September 2020.

We have also made a commitment to increase payments for the Healthy Start scheme from £3.10 to £4.25 a week from April 2021 to ensure that we can provide nutritional support to low-income pregnant women, mothers with children under the age of one and for children under the age of four, in families in receipt of certain benefits.

Work on the obesity pathway was halted during Covid but health boards were allocated £2.9m to support its delivery in the short term based on the previous pathway for 2020-21. The revised pathway was published in March 2021 and a further £2.9m was made available to support its delivery in 2021-22. There will need to be a continued focus on the promotion of healthy diets in the early years and a number of approaches through Obesity Pathways will be able to consider support for parents.

In 2021-22 we will:

• publish an independent evaluation of the ‘Baby Bundle’ pilot in Swansea Bay University Health Board, to help advise on a longer term decision for the scheme;
• work with local health boards to deliver resources with a focus on maintain a healthy weight in pregnancy, such as the digitalisation of Nutrition Skills for Life™ to embed relevant training in early years settings. The Foodwise in Pregnancy app that is currently being developed will support delivery of this priority across Wales;
• ensure that those most in need benefit from the Healthy Start Scheme by prompting wider awareness raising amongst professionals and the public. We will also review the scheme across Wales to consider the impact;
• continue delivery of All Wales Breastfeeding plan to encourage and support more mothers to breastfeed and reduce inequalities in breastfeeding rates.

We have seen widening inequalities as a result of the pandemic, with many people and families struggling to put food on the table as a result of salary reductions or redundancies. Since the start of the pandemic, the Welsh Government has allocated over £52million additional funding to ensure that eligible pupils receive provision in lieu of their usual free school meal whilst they are not able to attend school. This has included provision during school holidays up to and including Easter 2021.  In addition, funding has been allocated in the draft Welsh Government budget for 21/22 in order to make provision in lieu of free school meals available throughout the school holidays during the next financial year.   

The Welsh Government’s budget for 2021/22 includes £4.85million for the School Holiday Enrichment Programme (SHEP). This represents a £2.15million increase on previous years and will pay for up to 14,000 places.  Although SHEP was not able to run during the summer of 2020, because of the pandemic, we provided £1m of funding to deliver engaging and enriching activities which helped participating children and young people from economically deprived areas to re-engage with education provision.

The Big Bocs Bwyd (BBB) project in the Valleys Taskforce area has been established to help children develop an early understanding of healthy food choices while providing affordable priced food to families in the community who may be in need of support.

Access to physical activity has also been harder for many. With restrictions on leaving home, how often and for how long during the early stages of the pandemic, and a caution around social contact with others, we have seen a reduction in physical activity in a large number of the population. This is why we invested £500,000 for Sport Wales to develop a 60plus Active Leisure Scheme offer. We know that the needs will differ across age groups and demographics. The Healthy and Active Fund projects have provided a diverse geographical representation across Wales. They seek to reduce inequalities in outcomes and remove barriers to participation in one or more key demographics. The impact of the pandemic has meant projects have had to adapt delivery to their participants which helps them to embed physical activity into their daily routines. We will continue to support delivery of the £5.4m Healthy and Active Fund and focus on getting more people to move by utilising local assets, community knowledge and strengths.

Despite the hardship experienced at this time, there are opportunities through the pandemic to drive behavioural change interventions. It is more important than ever for us to understand some of the specific barriers and issues faced by our communities and we are determined to work together to understand and break down local obstacles.

In 2021-22 we will:

• continue to support families on lower incomes through the Pupil Development Grant and make a further investment of up to £0.6m into trialling three children and family intervention programmes;
• provide £100,000 to establish a further five Big Bocs Bwyd shipping containers in schools across the Valleys, working in partnership with the Valleys Regional Park;
• recommence delivery of the School Holiday Enrichment Programme (SHEP) in summer 2021, and continue supporting the reduction of health inequalities;
• continue to support delivery of a £5.4m Healthy and Active Fund which will focus on getting more people to move, utilising local assets and strengths;
• invest £100,000 with the National Governing Bodies of Sport to develop pilots through a collaborative delivery plan that tests innovative ways to broaden physical activity opportunities;
• continue to work with Sport Wales on delivering targeted provision of physical activity opportunities to contribute to the reduction of health inequalities. We will invest £500,000 into a 60plus Active Leisure Scheme offer in 2021-22 and evaluate delivery for future planning.

The delivery of services has been impacted significantly through the pandemic response. Health services felt the biggest pressure on their resilience and ability to focus resources on obesity. We have worked with health boards in Wales to develop obesity pathways through £2.9m funding and there will be a continued focus to develop LHB pathway plans within 2021-22.

A new pathway with national minimum standards was published in March 2021 and set out approaches for health boards to develop their own Pathway Plans. We provided £2.9m in 2020-21 for health boards to support the delivery of their pathway, and have committed the same for 2021-22. There has been a shift and a refocus with many services being delivered digitally and there will be a need to explore how services can be delivered moving forwards.

The All Wales Obesity Pathway provides guidelines for support services both for adults and for children, young people and families. We know that it will take some time to evolve this service to the ideal pathway. However, there is growing support for what we have achieved to date including the digitalisation of Nutrition Skills for Life which supports self-help within level one of the obesity pathway.

Wales currently has the highest diabetes rates across all of the UK nations and there have been significant links between Covid-19 and diabetes which have led to poorer outcomes. There are significant links to obesity with some studies suggesting that around 90% of adults with type two (T2) diabetes are overweight or obese. Following a successful pilot in the Afan Valley and Ceredigion, a pre-diabetes prevention programme will be trialled across Wales, which will help to support the delivery of Healthy Weight: Healthy Wales.

The National Exercise Referral Scheme has had to pause the acceptance of new participants and a review of the scheme has been undertaken. We will continue to review timing for future delivery and any adaptations to the delivery model.

In 2021-22 we will:

• begin to deliver the revised obesity pathway with a continued £2.9m investment in services, with each health board in Wales to publish Pathway Plans which will be monitored for delivery;
• develop an NHS digital offer for Wales which will promote self-help and a range of tools for people to access;
• publish the review of the National Exercise Referral Scheme (NERS) and use the findings to ensure it continues to provide targeted support for people with existing chronic conditions, including to provide lifestyle and diet advice;
• work with health boards to roll out a pre-diabetes trial through an investment of £1m, building on an initial pilot in Afan Valley and Ceredigion.
• Develop an options appraisal for a consistent, high quality, all-Wales approach to social prescribing, which will in turn help increase the numbers of people directed to weight management services through the delivery of the All Wales Obesity Pathway.

There will be a renewed focus to support and drive leadership in the system across Wales. This includes at a community level, where we will continue to share good practice in delivery of the strategy.

The 2020-2022 delivery plan has been supported by three Healthy Weight Ambassadors with a role to promote Healthy Weight: Healthy Wales. They also offer a feedback mechanism on how the strategy is developing and being received by the public. During the pandemic they have supported materials and the development of Healthy Weight Cymru social media pages. These messages and support will continue during 2021-22.

In order to have the desired impact, we require sustained local actions that will bring together a diverse range of stakeholders and will draw upon strengths and opportunities locally. We will use the success of initiatives such as the Cardiff and Vale strategic plan “Move More-Eat Well” to encourage partnership working across Wales.

The need for good intelligence and a clear evaluation approach based on behavioural change will continue to be a focus for 2021-22. We will continue to consider alignment between Healthy Weight: Healthy Wales and other plans such as the Mental Health Action Plan to ensure that we take a whole, person-centred approach.

In 2021-22 we will:

• fund seven regional co-ordinator teams to support local health boards, Regional Partnership and Public Service Boards to facilitate systems-based approaches to prevention;
• develop a national team at Public Health Wales to support systems delivery;
• publish a national and local evaluation approach and monitor delivery;
• continue to develop a clear approach on intelligence and surveillance to inform policy and practice decisions;
• publish a national communications plan and develop communications across partners to champion the work being delivered through the strategy.