1. Royal Bolton Hospital Changing the whole food environment

2. Hospitals Significant reach and influence within local community. staff, patients and visitors. large workplace employing thousands of people. daily interaction with thousands of patients & visitors Requirement to tackle staff ill health and promote good health (Boorman) Desire for good nutrition as part of treatment goals & food for convenience. – trusted brand (hospitals perhaps more so?)

3. Obesity Products high in fat, salt & sugar (HFSS) contributes significantly to obesity - If hospitals provide then fair to say ARE contributing to obesity by: 1. Increasing access to them 2. Giving credibility to HFSS food & drink products 3. Neutralising public health messages about potential harm

4. Malnutrition Eating energy-dense (ED) and/or high fat salt & sugar (HFSS) food/drink with little or no nutrition. Patients – may refuse, miss or only partially eat prepared nutritionally balanced meals if full on ED HFSS products Staff - facilitating short term energy boost intakes - weight gain - low nutrition Visitors – normalisation/promotion of HFSS products – may validate & encourage further consumption?

9. Removed salt from tables. Removed high-sugar drinks & high-fat crisps from sale*. Restricted size of chocolate bars (max 60g), flapjacks, muffins and large packets of biscuits (includes WRVS shops) Established weekly fruit & veg market & mobile fruit & veg van for staff & visitors Traffic light labelling on restaurant menu. Prohibiting multi-buy deals e.g. buy one get one free or 3 for price of 2 Developed the Less campaign to support physical changes Redesigned children's menu encouraging healthier meal choices Established a Food and Nutrition Working Group Developed a trust food policy Working with Council Leisure Services to mirror improvements Weve made a start....

10. Traffic light labelling

11. Less campaign

12. Weekly fruit & veg market

13. Weekly mobile fruit & veg van on site

14. After the changes

15. WRVS shop

16. Trust owned cafe

17. Trusts vending machines

18. WRVS shop

20. Next steps...remove multi-buys

21. OK with this multi-buy

22. What is acceptable trade within a hospital/NHS environment?

23. Electronic cigarette shops - A known public health problem?

24. Betting shops - public health problem?

25. Fruit machines – Public health problem?

26. ....Public health problem?

27. Brand stretching.....

28. Target audience......

29. If put to a public vote?…….. IS IT ACCEPTABLE FOR HOSPITALS TO PROMOTE & SELL PRODUCTS HIGH IN FAT, SALT AND SUGAR? Yes No

30. Take home messages.....

31. Dont have too much sugar!

32. ALL hospitals need to run similar campaigns – it CAN & MUST be done! Individual hospitals can only make statements – a network of hospitals can start a revolution!

33. THANK YOU Gary Bickerstaffe Health Improvement Specialist (Health Settings) Room 23, Rivington Unit, Royal Bolton Hospital Tel: 390749 xt 5749 gary.bickerstaffe@boltonft.nhs.uk