Health Promotion Guidance: Nutritional Guidance for Children and Young People in Residential Care Settings

Section 1 Introduction

"Why you should read this document"

"…At first, like, when I came in it was, like, different but the thing is you just get used to the food and, if you get used to it, you just like it and it becomes normal… They cook different food and different veg. I like it. At first, I didn't like it but now I get used to it. We just have to get used because it's completely different from what you eat…" (Female, children's unit)

Why is this guidance needed?

Food is an important part of everyone's lives. Improvements to the diet of children and young people can positively influence their current and future health, playing an important role in the prevention of diet-related diseases. The consultation report carried out by Who Cares? Scotland - "It's no like one of those café places where you can order anything you want", highlighted that children and young people have strong views on the food they like to eat. However, we know from research that children and young people in Scotland, and elsewhere, are not eating enough fruit and vegetables and are eating too much food high in fat, saturated fat, salt and sugar.

For the purpose of this document references to child, children and young people and young people have the same meaning and are interchangeable. This guidance covers residential establishments not included specifically in the Schools (Health Promotion and Nutrition) (Scotland) Act 2007 (the 2007 Act) and includes:

• Residential Care Homes (Children and Young People)
• School Care Accommodation Services (special residential schools and mainstream boarding schools)
• Secure Accommodation

Please note that school hostels are covered by the 2007 Act and associated Nutritional Requirements for Food and Drink in Schools (Scotland) Regulations 2008. While the information in this document may be helpful or of interest, those managing school hostels must continue to meet their statutory duties set out in the above legislation.

The 2007 Act places a number of duties on local authority educational establishments in relation to the health and wellbeing of children and young people. In particular, it sets out the nutritional requirements for all food and drink in schools through the Nutritional Requirements for Food and Drink in Schools (Scotland) Regulations 2008 and places health promotion at the heart of schools' activities.

Much of the information contained within the 2007 Act and associated Regulations is relevant to residential establishments and can be used as a model on which to base a nutritional plan. The general health and wellbeing approach outlined in the 2007 Act can help residential establishments to ensure that children and young people are provided with an environment that will prepare them for future years, allowing them to learn skills for independence, how to eat well and how to take care of their wider health and wellbeing.

The bulletin Food and Nutrition for Children and Young People in Residential Care: Are services meeting the standards? (Care Commission, 2008) found that overall, residential care services are supporting children and young people to eat healthily, with meals that are varied and nutritious; while taking account of food preferences and special dietary needs. Eating well also means food which is well prepared and presented. But, in respect of the questions asked by the Care Commission, it was found that a number of services need to improve.

This guidance adopts a holistic approach to health and wellbeing and acknowledges the concept of a 'health promoting environment' similar to that established within health promoting schools. It seeks to support the nutritional requirements within the 2007 Act as they are applied at evenings and weekends in residential care settings and recognises the sensitivity in providing this type of support within what is essentially the home of children and young people. The guidance will help care providers to plan and provide food and drink that meets the dietary needs of the children and young people in their care. It will also ensure they respond to their needs and preferences by involving them in food-related decisions.

This guidance has been developed using the information contained within Healthy Eating in Schools - A guide to implementing the nutritional requirements for food and drink in schools (Scotland) Regulations 2008 and the current Scottish Dietary targets set out in Scottish Dietary Action Plan. It aims to assist residential care providers in planning food provision to meet the dietary needs of children and young people in their care. The publications Eating well for looked after children and young people (Caroline Walker Trust, 2001) and Caring About Health: Improving the health of looked after and accommodated children in Scotland have also been drawn upon to recognise and take account of the unique circumstances of children and young people living in residential care settings. They provide nutritional and practical guidance along with information and advice that will assist practitioners to support the children and young people in their care.

Residential care services are regularly inspected by the Care Commission and those providing education are jointly inspected by the Care Commission and HMIE. The Care Commission endorses the guidelines in this document and commends their use to regulated services. All services are required to self assess using Quality Themes and Statements based upon the National Care Standards ( NCS). This guidance will help residential care services meet these requirements by enabling them to demonstrate, for example, how they involve service users, plan appropriate menus and have suitably trained staff to address health and nutritional needs.

By following this guidance, residential establishments will be supported in meeting their duties under legislation and the National Care Standards. It will also assist them in meeting other relevant health and wellbeing and nutrition legislation or requirements referenced in this document.

Who is this guidance for?

This guidance is relevant to anyone who has a part to play in the health and wellbeing of children and young people living in residential care.

This includes:

• Those working with children and young people in residential care settings
• Managers
• Care staff
• Health professionals
• Catering staff
• Social workers
• Educational staff
• Commissioning bodies

Policy context

This guidance takes its lead from a number of key policy areas. It reflects the principles detailed within the UN Convention on the Rights of the Child, in particular, article 24 of the Convention specifies the rights children have to enjoy the highest attainable standard of health. This includes the provision of adequate nutritious foods, education about health and nutrition, and how to use that knowledge. The core principles of the Convention include respect for the views of the child. It protects children's rights by setting standards in health care, education, and legal, civil and social services. The Convention sets minimum standards to be achieved in Scotland through key policy documents which include For Scotland's Children and The Early Years Framework. Getting it Right for Every Child is a key policy which seeks to improve the wellbeing of all children and young people in Scotland. It promotes positive action to support children and young people to reach their full potential and become successful learners, confident individuals, effective contributors and responsible citizens. The approach outlines eight indicators of wellbeing, calling on all agencies involved to make sure children and young people are: healthy, achieving, nurtured, active, respected, responsible, included and safe.

Improving the health and diet of the Scottish population is a priority for the Scottish Government. The actions identified within Healthy Eating, Active Living: An action plan to improve diet, increase physical activity and tackle obesity (2008-2011) supports people to make healthier choices in what they eat, to build more physical activity into their everyday lives and to maintain or achieve a healthy weight.

"I would like to know what's in it [the food]… you canny watch what you're taking in, you could be taking in double what you should be." (Male, secure unit)

In a debate following the publication of the Healthy Eating, Active Living action plan, the Scottish Government reaffirmed its commitment to developing a longer-term strategy to tackle obesity. It was acknowledged that individual initiatives would not in themselves solve Scotland's obesity problem. In February 2010, the Scottish Government, in partnership with COSLA, fulfilled that commitment and published Preventing Overweight and Obesity in Scotland: A Route Map Towards Healthy Weight. The report has identified four main areas in which concerted action is likely to have the greatest effect:

• Reducing demand for, and consumption of, excessive amounts of high-calorie foods and drinks;
• Increasing opportunities for the uptake of walking, cycling and other physical activity;
• Establishing lifelong healthy habits in children;
• Increasing the responsibility of organisations for the health and wellbeing of their employees.

In conclusion, this guidance has been designed to achieve two outcomes:

• Support children and young people in residential care to develop the practical skills and knowledge to allow them to take responsibility for their lifelong health and wellbeing;
• Assist managers and staff in meeting the relevant aspects within the National Care Standards in relation to health and wellbeing at the same time as supporting the needs of each child in their care.

It also recognises the important part that residential establishments have in supporting the Scottish Government's vision that we will live longer, healthier lives. Our children and young people deserve no less.