Healthy weight - local health systems support for pregnant women and young children: research

7. Key findings and issues for consideration for policy and practice

This final chapter provides a recap of the main findings before ending with a series of issues for consideration for future system design and implementation. These issues for consideration are firmly grounded in the data gathered from participants, which has been synthesised and situated in the context of existing guidelines and recommendations.

Key findings

This research has shown that there are many elements of child healthy weight systems that appear to be working well. On the whole, systems were being implemented as intended (albeit with some inconsistency) and professionals felt largely confident in their roles. The strong relationships built up between families and health professionals via the UHVP (and to an even greater extent, the FNP), which can help to facilitate open and honest conversations and build trust, appeared to be a particular strength.

It was also clear, however, that there is considerable variation in provision from pregnancy to Primary 1 between health boards. In relation to the early years specifically there is some way to go before all boards meet the Standards for this stage. Boards recognised that improvements were required and displayed a commitment to doing so. Indeed, they were all in the process of developing and/or rolling out new services – albeit often delayed due to the COVID-19 pandemic.

In saying this, professionals were very aware of the challenging circumstances of many of the families they worked with (for example, poverty and mental health conditions), particularly those in the most deprived areas. While they felt their efforts could go some way to supporting and engaging them, there was a consensus that improvements to health systems alone were unlikely to make a considerable difference to rates of overweight and obesity, given it is such a complex and multifaceted issue. Relatedly, there was support for a whole systems approach, as well as a view that change should be conceptualised as a longer term, preventative spend, which might not show results for many years.

Issues for consideration

Notwithstanding the wider societal challenges, the research identified a number of issues for consideration for the provision of healthy weight support in pregnancy and the early years which can be influenced by health systems. These have been discussed in previous chapters and are summarised here under local and national headings.

Local health board level

• Increased focus on prevention at the preconception stage – and on prevention among pregnant women more generally (Chapter 2).
• Improved pathways/co-ordination of services from preconception to Primary 1 - greater strategic oversight of child healthy weight across the system as well as practical improvements e.g., handovers between professionals (midwife to health visitor, and health visitor to school nurse) (Chapter 5).
• Increased capacity for treatment services to accommodate those who are eligible (Chapter 6).
• Increased focus on deprived areas, including greater time available for health professionals to work with families with more challenging circumstances (Chapter 6).
• Maximising the potential of the strong existing relationships health visitors have built with families (Chapters 2, 3 and 6).
• Work with families to understand better what might engage them to work with health professionals and services, and to sustain this engagement (Chapter 6).
• Better auditing and evaluation of service engagement and effectiveness (Chapter 6).
• Greater knowledge sharing, both within and between health boards, on service engagement and effectiveness. The PHS Healthy Weight Leads Network, which was considered a useful means of sharing learning, may offer one way of facilitating this (Chapter 6).
• Increased join up with other parts of the system – for example, local authorities, third sector organisations (Chapter 6).
• Facilitating healthcare professionals to refer directly to exercise facilities (rather than having to go via a weight management service) (Chapter 4).
• Further consideration of the training needs of midwifery and health visiting workforces. For example: ensure health visitors are using BMI centiles and have a means of calculating BMI while out on visits; increase the prominence of the role of sleep hygiene and screen time in childhood obesity; and ensure healthcare professionals are aware of the current guidance on healthy weight gain in pregnancy and kept informed of any subsequent changes to this (Chapters 2, 4 and 6).

National level

• Establish whether increased and longer term funding could be provided for child healthy weight activities (Chapter 6).
• Explore whether factors that limit the work school nurses are able to do on child healthy weight (e.g. workload, few existing relationships with families) could be addressed to allow them to take on a greater role in this.
• Consider whether health visitor caseloads can be reduced, allowing them to spend more time on healthy weight, particularly with families who would require more intensive support (Chapter 6).

Further research

To further understanding of how healthy weight is supported in pregnancy and the early years, future research should incorporate the views of other relevant groups that it was not possible to include in the current study. This includes: pregnant women and families with young children; professionals working in early learning and childcare settings; third sector organisations working in partnership with health and education sectors to enhance provision.

Furthermore, as discussed throughout, the research took place at a time when a number of health boards were in the process of implementing improvement plans, many of which had been delayed due to the COVID-19 pandemic. Further research to revisit these plans with boards in the future should also therefore be considered. This could include an understanding of the effect of the COVID-19 pandemic on any planned activities.