Schools (Health Promotion and Nutrition) Scotland Act: Health promotion guidance for local authorities and schools

3. Implementation

3.1 Introduction

This section is concerned with the steps that schools, local authorities and managers of grant-aided schools can take to implement the Act in each of the areas for health and wellbeing indicated in Curriculum for Excellence. The advice for each area is structured around the key characteristics of health promoting schools identified in Being Well - Doing Well and is consistent with the draft Curriculum for Excellence Health and Wellbeing Experiences and Outcomes (The following key characteristics apply generally to all of the outcomes).

• leadership and management
• ethos
• partnership working
• curriculum, learning and teaching
• focussed programmes in personal and social development/personal and social education ( PSD/ PSE) and health education programmes
• environment, resources and facilities

The general contribution which each of these makes to achieving the outcomes is indicated below and is exemplified through reference to some outcomes.

3.2 Leadership and management

Local authorities can lead through the introduction of whole-authority approaches to health promotion. Clear leadership from authorities is needed to ensure a consistent approach across the authority, for example in ensuring that healthy food is served not only in schools, but also in other authority facilities such as sport and leisure and community centres. It is important that they lead in highlighting health promotion as a key permeating aspect through supporting and challenging schools to enhance and develop their provision.

Schools, authorities and managers of grant-aided schools should provide clear and concise guidance on health promotion objectives. Some examples of these objectives include:

• fostering genuine and participative communication and building a culture of listening across the whole school community
• school lunch menu development and the uptake of school lunches;
• dealing with special dietary needs or allergic reactions to food;
• how staff and pupils can access appropriate services relating to alcohol, tobacco and drugs; and
• clear child protection procedures developed in conjunction with key partner agencies including NHS, voluntary sector and faith interests.

It is also important that schools, local authorities and managers of grant-aided schools lead in encouraging and supporting staff and volunteers to take up relevant health and wellbeing CPD opportunities.

Within individual schools positive leadership from the headteacher will encourage contributions from pupils, parents, staff and other partners. Effective leaders look after their own health and wellbeing, model a positive approach to change, and encourage and support well-judged trial and innovation.

Effective leaders ensure that school and authority improvement planning embodies commitment to health promotion. Partners and stakeholders are involved in developing health promotion policies and plans which are based on consultation, shared values and open communication.

It is important that the key lead individuals for health promotion in each school are known to all staff, partner agencies and local authority departments.

3.3 Ethos

In a health promoting school, policies and structures are based on shared values which support communication that is open, honest and practised in all aspects of a school life. This enables the development of relationships based on mutual respect and allows everyone in the school to understand and manage their own feelings and those of others.

Health is promoted through positive relationships in a climate that is inclusive, promotes equality, is conducive to learning and where pupils and staff feel safe, secure, valued and respected. Schools with such an ethos are likely to:

• have an atmosphere of emotional wellbeing, respect and caring;
• foster a positive attitude towards a healthy lifestyle;
• ensure entitlement to and participation in physically healthy activities for all, particularly those who are less active;
• make children and their families aware of the formal and informal opportunities to engage in healthy activities;
• consider the impact of all decisions, including around commercial activity, on all aspects of health and wellbeing;
• implement clear and effective procedures for child protection;
• continually foster an informed attitude towards relationships and sexual health and identify appropriate services and support;
• work with pupils, parents, special interest groups and other partners to assess and contribute to meeting the community's health and wellbeing needs;
• embed physical activity within the school development plan; and
• create opportunities to celebrate the school community's successes and achievements in promoting health and wellbeing.

3.4 Partnership working

Genuine participation of pupils, parents, staff, community representatives and partner agencies is essential to encourage, support and develop initiatives for promoting health. Local authorities, schools and managers of grant-aided schools need clear protocols for involving partners in the delivery of health promotion policies and plans and they should be clear about the outcomes they wish to achieve. Effective joint planning needs balanced representation from partners with their roles, remit and responsibilities being fully understood. Partnership working should reinforce work across transitions and cluster planning across sectors.

The benefits of partnership working have been demonstrated through many initiatives including Eco Schools Scotland and Hungry for Success which have typically included joint working among education, community organisations, catering, health and finance departments, as well as pupils, parents and staff. Good practice occurs when parents are consulted, encouraged to get involved and to see things through a health promotion perspective themselves. Effective outcomes are achieved when staff work in partnership with pupils, for example through Pupil Councils, to ensure that their views and ideas are incorporated into practice.

A key partner in delivery of health promotion is the National Health Service ( NHS). NHS boards manage local NHS resources to improve the health and wellbeing of the populations they serve. They are key partners in the development and implementation of the Act. The Boards engage in Community Planning with local authority Education Department/Children's Services partners to take forward health promotion in all schools in the Board area. The role of health boards is set out in Section 1.6

It is important that schools engage with local partners to ensure that policies and activities which promote health are inclusive and consistent, and are embedded across schools and their communities. Such local partners include Alcohol and Drug Action Teams, specialist health promotion staff, local police, and community and voluntary sector organisations such as substance misuse support services. It is essential that work undertaken by partners in schools is reinforced on an authority-wide basis by other community services and local authority provision such as sports and leisure and community centres.

3.5 Curriculum, learning and teaching

Curriculum

The main purpose of health and wellbeing within Curriculum for Excellence is to develop the knowledge and understanding, skills, capabilities and attributes necessary for mental, emotional, social and physical wellbeing now and in the future. Promoting health across the curriculum will help support children and young people's development as successful learners, confident individuals, responsible citizens and effective contributors. There should be flexibility which allows teams and individual teachers to make innovative provision which addresses current circumstances and meets pupils' changing needs.

Here are some examples of ways to use the curriculum to promote aspects of health and wellbeing in a holistic way.

• promote the development of positive mental and emotional wellbeing across all areas of the curriculum;
• build physical education into a whole-school approach to promoting health and physical activity across the curriculum, most notably in physical education, physical activity and sport but also, for example, in the sciences (beneficial effects of regular exercise, need for good personal hygiene and dental hygiene) and in mathematics ( BMI, comparing energy intake and energy expenditure);
• broaden the curriculum through outdoor learning in all curriculum areas by including activities in school grounds, urban spaces, rural or city farms, parks, gardens, woodlands, coasts and outdoor centres;
• incorporate aspects of food, nutrition and dental health in the curriculum at all stages through for example, mathematics, science (energy in various foods, the effects of good dental hygiene), home economics (healthy diet, principles of nutrition, food hygiene, safety and handling) and social studies (the importance of sustainable development and fair trade, where our food is sourced from and how it is produced);
• when preparing food and drinks as part of school enterprise projects, ensure that nutritional regulations are met;
• use outside agency programmes to enrich the health component of the curriculum;
• use all curriculum areas to exemplify the benefits of a safe and healthy environment with due regard to all aspects of child protection;
• use a range of curriculum areas to promote safe behaviour outside of school, such as road safety, safety when playing outdoors, safety at home and dealing with domestic abuse;
• view sex and relationships education as one element of health education, set within the wider context of the health promoting ethos of the school;
• build in health and wellbeing provision which reflects the cultural, ethnic and religious influences within the home, school and community, and which is sensitive to the diverse backgrounds and needs of all young people;
• include activities which develop pupils' emotional resilience and their emotional literacy.

At all stages, primary and secondary schools should aim to develop pupils as successful learners, confident individuals, responsible citizens and effective contributors to society. The promotion of health is a key component in developing these capacities. It is important that focussed programmes in personal, social and health education within health and wellbeing complement other contributions to health promotion throughout the curriculum. Effective programmes blend whole-school and special focus components and have continuity and progression from stage to stage but also take account of the changing health and wellbeing needs of individual pupils, the school and its community.

Key characteristics of programmes which effectively promote health and wellbeing are: carefully-planned coverage of all of the Curriculum for Excellence experiences and outcomes for health and wellbeing, and use of external speakers such as parents, school nurse, community health workers, dieticians, GPs, police, road safety officers, fire service and theatre groups.

Learning and teaching

Learning and teaching to promote health should involve a wide range of inputs. Pupils, staff, special interest groups, Parent Councils and other partners should be involved in a health and wellbeing needs assessment of the whole school community. Particular attention should be given to gender, disability and additional support needs to ensure inclusive learning and teaching. All staff within the school should understand that health promotion is their responsibility.

For example, effective health promoting schools maximise opportunities for pupils to be active within the classroom throughout the school day in order to improve concentration and focus for learning. They help pupils to understand that physical activity can be incorporated into all aspects of school life and beyond through such activities as walking to and from school or work, attending a dance class, playing outside with friends, rambling and cycling.

Teaching in health and wellbeing should motivate learners through drawing on their curiosity, creativity and critical thinking. Activities relating to healthy eating and safe, hygienic practices might include research on the nutritional value of the food they eat, consultation on which healthy foods should be included in school vending machines, lunches and tuckshops, and designing presentations on healthy eating as part of a peer education project. Informed discussion and research can be used to explore the links between physical activity, mental health, obesity and eating disorders.

Pupils are generally more motivated to learn through approaches which involve them directly, where their views are taken into account and which relate to aspects of their own lives and experiences. Examples include the use of role play, small group discussions and theatre group presentations which enable pupils to explore, for example, the health and social effects of drugs, alcohol and tobacco. The skilful use of questioning by a teacher or other partner, and opportunities for young people to ask their questions, leads to increased motivation and engagement of learners. Such approaches enhance the development of skills such as strategies for dealing with risk and how to say 'no', and address pupils' misconceptions about, for example, the prevalence of drug use in their own age group.

Teaching and learning in aspects of health and wellbeing should provide young people with life skills which develop their confidence and respect for themselves and others. One way of doing this is to raise pupils' awareness of sources of help and support outwith the school. An example is to encourage members of the community, members of staff, appropriate partner agencies and parents to develop skills in supporting sex and relationships education. It is important that lessons and activities to promote health and wellbeing are presented in a positive way. For example, presenting education in relationships, sexual health and parenthood through an informed, interactive and non-judgemental approach can have a lasting influence on how young people develop social, emotional and physical relationships, and who they approach for support at this time

3.6 Environment, resources and facilities

The whole school environment should be conducive to health promotion. Schools with health promoting environments provide opportunities and space for physical activity, play, eating, socialising and privacy. They make these facilities available both during and outwith normal school hours and work with local community groups to explore ways of making their provision, including drop-in, available to the wider community. In a health promoting school, members of the school community demonstrate a commitment to enhancing the quality of the immediate and wider environment. Staff and pupils adopt Eco-School Scotland principles through taking steps to minimise negative environmental impacts of the school.

Pupils are encouraged to be physically active when school grounds and facilities are clean, safe and maintained to a high standard. In promoting physical activity schools should provide cycle racks, secure lockers and appropriate areas for changing and showering. In addition they should promote active travel such as walking and cycling to school. Many School Travel Coordinators have worked with staff, pupils, parents and Road Safety Officers to promote road safety through devising school travel plans which include use of the 'Safer routes to school' initiative.

Providing physical activity opportunities through wider school and community activity allows young people to be physically active in less formal settings and gives them more choice and influence on the type of activities in which they participate.

Canteen facilities, vending machines, tuck shops and breakfast and after school clubs should give consistent messages about healthy eating and oral health. Other service providers should be expected to do likewise.

The nutritional regulations will require that pupils have access to free drinking water throughout the school and it is important that its consumption is actively promoted. Toothbrushing activities and programmes should be supported and encouraged at breakfast clubs and after lunch. Staff and pupils should have ready access to quality display points for information on such aspects as

• food and oral health;
• infection control measures;
• physical activity;
• mental health and wellbeing;
• drugs, alcohol and tobacco;
• relationships, sexual health and parenthood, and
• signpost information to relevant support services.

3.7 Continuing professional development ( CPD) and training

It is fundamental to the promotion and delivery of health and wellbeing in schools to recognise the impact of the adults who work there. A school's culture is directly influenced by its staff and supporting their needs is a vital aspect of the whole-school approach to health promotion.

Schools that do this well:

• increase staff awareness and understanding of health and wellbeing through training, development and opportunities to practise;
• provide inter-agency training which embeds health promotion within all aspects of provision;
• use a range of appropriate training providers;
• give school staff access to resources and information about services and agencies to support them in promoting health;
• ensure access to appropriate training for volunteers;
• give staff opportunities to reflect on, discuss and feed back on their health and wellbeing;
• provide clear procedures and support for staff when dealing with children and young people in difficulty;
• provide specialist support for staff delivering the physical education curriculum;
• ensure that all staff contributing to education in relationships, sexual health and parenthood attend child protection training; and
• promote pupil peer education in some aspects of health and wellbeing.

Examples of appropriate areas of training, provided with involvement of other partners, include:

• drugs, alcohol and tobacco education;
• sex and relationships education;
• links between drug and alcohol misuse and sexual ill health; and
• links between poor sexual health and social inequalities.

3.8 Monitoring and evaluation

Under the Act, strategies for health promotion must be an integral part of an Education Authority's annual statement of improvement objectives. In turn, these strategies must be reflected in school development plans. It is important that authorities and schools evaluate the effectiveness of these strategies and plans within their ongoing self-evaluation. Local authorities and managers of grant-aided schools should promote and monitor provision at school level.

Best practice in evaluating health promotion occurs when schools encourage a sense of ownership by giving young people and their families' opportunities to discuss their views and reflect on their experiences. This is particularly effective when schools have mechanisms to consult with parents including the provision of advance information on the proposed timing and content of planned programmes to develop aspects of health and wellbeing.

Internal self-evaluation by schools, local authorities and managers of grant-aided schools is complemented by external evaluation through HMIE's inspection programme. HMIE inspects a sample of schools each year and publishes a report on each one which is inspected. HMIE currently asks the school to complete a pre-inspection profile which includes a section on health and wellbeing. The information provided by the school is confirmed, or otherwise, by the inspection. HMIE collates and analyses information on health and wellbeing gleaned from inspection.

For the purposes of inspection and reporting, HMIE uses a core set of quality indicators from How good is our school? (2007 edition) to evaluate the work of a school. Two key quality indicators currently used in inspection are: Learners' experiences and Care, welfare and development. These QIs make specific reference to positive outcomes for pupils in terms of their health and the processes by which a school seeks to ensure these positive outcomes.

In a proportion of inspections, HMIE's specialist Assessors evaluate and report on a school's progress in implementing specific duties, including those in the Act related to school meals and compliance with the nutritional regulations as specified by Scottish Ministers.

HMIE ensures that inspections are 'proportionate' and does not inspect each aspect of provision in every school. School inspection work is supplemented by tasks at national level which enable HMIE to provide comment on progress nationally with the delivery and impact of aspects of provision in health and wellbeing.