Dietitian Jo Hulks explains the standards for school food and how school nurses can encourage uptake among parents and pupils
Jo Hulks BSc RD Food in Schools Dietitian Kent County Council, Maidstone/Eastern and Coastal Kent PCT
_ School lunches and other foods provided by State schools in England are currently required to meet stringent nutritional standards to ensure they are healthy and of good quality. Independent schools are encouraged to follow suit. Similar standards apply in Scotland,Wales and Northern Ireland
_ There is growing evidence that healthier school food is associated with better outcomes for pupils in attainment, health and behavior
_ School nurses can raise awareness among parents and young people of the benefit of school meals and help to promote uptake of the service
_ School nurses can alert parents and young people to the criteria for free school meals and support eligible families in their applications
_ They can participate in the Healthy Schools Programme to ensure a whole-school approach which combines education about nutrition and the provision of healthy food at school
The Government has a clear aim to tackle the rising tide of obesity and overweight in the population.The Department of Heath is responsible for overall policy on obesity and is jointly responsible with the Department for Education (until May 2010, the Department for Children, Schools and Families) for tackling child obesity. One method of assessing the increase in healthy eating among children and young people is to measure the uptake of school lunches, particularly among those entitled to a free school meal. All school lunches are currently required to meet tough nutritional standards that ensure that all the food provided by schools and local authorities in a school lunch is healthy and of good quality. This article sets out the current standards and highlights the role that school nurses can play in promoting and supporting the school meal agenda. School Health 2010; 6(4): 44-47
Good health for children and young people is crucial because it enables them to make the best of their opportunities in education and in developing healthy lifestyles. Lifestyles and habits established during childhood, adolescence and young adulthood influence a person's health throughout their life.
Combating obesity and overweight
Obesity and being overweight represent a profound public health challenge. If no action is taken the Foresight Report1 has identified that by the year 2050 two-thirds of children and nine out of 10 adults will be either overweight or obese and children who are obese in childhood are likely to remain obese into adulthood. While it is vital to work with parents and to take a whole-family approach, schools also have a responsibility to combat obesity. The Healthy Weight Healthy Lives: A Cross Government Strategy for England2 set out the goal of reversing the rising tide of obesity.
"Our ambition is to be the first major nation to reverse the rising tide of obesity and overweight in the population by ensuring that everyone is able to achieve and maintain a healthy weight. Our initial focus will be on children: by 2020, we aim to reduce the proportion of overweight and obese children to 2000 levels."2 Announced in October 2007, this ambition formed part of the then Government's commitment to child health and well-being (for children under 11). Tackling child obesity is also a national priority for the NHS and local health care and delivery providers3. Healthy eating is a key part of healthy weight. Healthy food provided at school sets children a good example in healthy eating patterns and makes a contribution to combating obesity.
Improving child health and well-being
A number of Public Service Agreements (PSAs) have been established for improving the health and wellbeing of children - specifically the indicators for breast-feeding, obesity prevention and improving emotional health and well-being4. This has been a crucial part of the Every Child Matters programme5 which set out the Government's aims for every child, whatever their background or their circumstances, to have the support they need to:
_ Be healthy
_ Stay safe
_ Enjoy and achieve
_ Make a positive contribution
_ Achieve economic well-being.
The Healthy Child Programme 20096 is an evidence-based programme which sets out a good practice framework for prevention and early interventions for children and young people aged 5-19. It recommends how health, education and other partners working together can significantly enhance a child's or young person's life chances. This highlights existing statutory guidance and refers to the need for schools to meet food and nutrient standards. "All schools should follow statutory nutritional standards and schools should be providing goodquality, healthy food that children want to eat, in pleasant dining areas."6
School meals: part of promoting healthy eating messages
The school environment should be a place where children and their families receive clear and consistent messages about food, healthy weight and healthy lifestyles. Indeed, schools across the country have been supporting and promoting a wide range of healthy eating initiatives for many years. The National Healthy Schools Programme7 funded by the then DCSF and the Department of Health has Healthy Eating as one of its four core themes. School nurses are in a valuable position to be able to work with families and to support initiatives within schools and act as part of the Schools Nutrition Action Group (SNAG), a group set up to address healthy eating in each school.
In October 2005 The School Meals Review Panel published the report Turning the Tables: Transforming School Food8 and the School Food Trust was established to take forward the Panel's recommendation to transform school food and food skills to improve health and education for school-age children and young people. By 2011, £650 million will have been invested to improve the quality of school food and new standards for the provision of food across the school day.
School food standards
School lunch standards were revised in 2001. However, since that time there has been growing evidence that children are not making healthy choices across the school day including break times and lunchtime, and that school meals do not meet their nutritional requirements. New standards were therefore developed to increase the intake of healthier foods, to restrict foods high in fat, sugar and salt, to improve the quality of food and set minimum levels for the nutritional content of school meals.
The standards described below apply to England but similar standards and similar requirements have been introduced in Scotland9,10, Wales11 and Northern Ireland12.
Since 2006 the new standards have been gradually introduced. First came food-based standards for school lunch. These were enhanced with the addition of food based standards for school food other than lunch (e.g. breakfast clubs, snack bars, vending outlets, afterschool clubs) from September 2007. Nutrient-based and final food-based standards for school lunch have been a requirement for primary schools since September 2008 and for secondary schools, special schools and pupil referral units (PRUs) since September 200913. The recommendation from the original School Meals Review Panel was that a combination of both food based and nutrient-based standards would be the way forward.
_ Nutrient-based standards are clear and objective and can help to reduce intakes of fat, sugar and salt, but may not increase intakes of fruit, vegetables and food containing other essential nutrients.
_ Food-based standards are simple and transparent.
They can help to increase intakes of fruit, vegetables and oily fish but may not be sufficiently comprehensive to impact on fat, salt and sugar intakes.
What are the nutrient-based standards?
The nutrient-based standards aim to make the food offered healthier by promoting those nutrients beneficial for health and restricting those that are detrimental. The overall aim is therefore to:
_ Increase the vitamin and mineral content
_ Decrease the total fat, saturated fat, non-milk extrinsic (NME) sugars and sodium content.
The standards do not give a specific figure for each nutrient but rather a maximum (for those where too much is harmful) or minimum (for those where too little is harmful) amount allowed. In total there are 13 nutrient-based standards plus an average value for energy and they are derived from the UK dietary reference values. For details, see Table 1. These are applied to an average school lunch and refer to the food provided over a 5-20-day menu cycle as opposed to that actually consumed. There is some variance for single sex secondary schools14.
What are the food-based standards?
The final food-based standards (see Table 2) apply not only to school lunches but to food provided at all breakfast clubs, mid-morning break services, vending facilities, tuck shops and after-school food and need to be met along with the nutrient-based standards.
What do the standards apply to?
_ All local authority maintained primary, secondary, special and boarding schools, and pupil referral units (PRUs) in England
_ Sixth forms on the premises of secondary schools
_ All food and drink provided by local authorities or school governing bodies to pupils on and off the premises, during an extended school day (up to 6pm), including school trips. The only exception is for food provided on a residential trip where the provider of the accommodation (not the local authority or governing body) also provides the food
_ Academies are expected to comply with the terms and conditions written into their funding agreements
_ Independent schools are not specifically covered by the regulations but are encouraged to comply13.
_ Parties or celebrations to mark religious or cultural occasions
_ Occasional fund raising events
_ Rewards for achievement, good behaviour or effort (although it is good practice to reinforce a whole school approach by using healthier foods or non-food items to rewards behaviour and academic performance)
_ Food used in teaching food preparation and cookery skills, provided that any food prepared is not served to pupils as part of a school lunch13.
Are the standards working?
The School Food Trust has documented the outcome of a number of initiatives through case studies published on their website. Early indications were that pupils were responding to healthier food choices and meal numbers are currently increasing15. The Million Meals Campaign aims to increase this further and schools can be encouraged to sign up for access to information and resources via the School Food Trust (see Resources) (www.schoolfoodtrust.org.uk). Extended services and out-of-schools providers need to work closely with school meal providers to ensure the standards are met. While this has been a challenge for some, it has also opened up the opportunity for these partners to work more closely together. Studies are also now able to link healthier food choices with better outcomes at school16. Children themselves report that they feel better and look better when they eat more healthily. A recent Ofsted Report17 identified that the schools that were most successful in meeting the food standards were those where they worked in partnership (particularly with Primary Care Trusts), shared a vision for improvement and had developed welldefined strategies.
"The most successful provision resulted from effective planning by local authorities and their partners and close collaboration between schools and a range of agencies locally."17
National evaluation of the Healthy Schools Programme has shown it to have a positive link to school achievement as well as school effectiveness. The White Paper on 21st Century Schools18 identified the Government's commitment to this programme by stating that every child will be able to go to a healthy school. Healthy schools can deliver consistent messages to young people and their families by adopting a wholeschool approach. This ensures that all the key partners are involved in audit and consultation to develop wholeschool food policies, resulting in a clear and consistent approach to food education and provision.
Free school meals
A survey19 in 2008 suggested that one in five children do not take up their entitlement to a free school meal. This can be for a variety of reasons but with the improved nutritional standards in schools it is imperative to tackle this issue. Parents may not be aware of their entitlement to free school meals or may feel that their child will be stigmatised if identified as in receipt of free meals. Many schools now have policies in place to ensure this is not the case and it is important to raise awareness of the criteria as well as the nutritional value of school meals. Children are entitled to a free school meal if their family meets the criteria20,21; they become eligible for a free school meal once their parent's application has been accepted by their local authority. School nurses can work with families who may be entitled and support their application.
Criteria for free school meals
From 6 April 2009, children whose parents receive the following may be eligible for free school meals:
_ Income Support
_ income-based Jobseekers'Allowance
_ an income-related employment and support allowance (this benefit was introduced 27 October 2008)
_ support under part VI of the Immigration and Asylum Act 1999
_ Child Tax Credit (provided they are not entitled to Working Tax Credit) and have an annual income that does not exceed £16,040 (as assessed by Her Majesty's Revenue and Customs) Note: From 1 May 2009 where a parent is entitled to Working Tax Credit during the four-week period immediately after their employment ceases, or after they start to work less than 16 hours per week, their children are entitled to free school lunches._ The Guarantee element of State Pension Credit More information is available at http://www.teachernet.gov.uk/educationoverview/ currentstrategy/freemealsandtrips/ Information about local policies and arrangements for free school meals in England, Scotland, Wales and Northern Ireland can be obtained from schools and local authorities. The Government has included the take-up of school meals as an indicator of healthy eating among children of school age (National Indicator Set: NI 52 - Take up of School Lunches).
From April 2009, local authorities have been required to provide information not only for their own catering or contracted services but for all schools across the local authority. Currently the uptake of school meals nationally stands at 41.4% for primary schools and 35.8% for secondary schools15. A large proportion of pupils are therefore providing their own food, predominantly as packed lunches. The nutritional standards do not apply to food brought in from home. There is a key role for health professionals such as school nurses to be involved in supporting schools to develop robust whole-school food policies that address local issues around packed lunches. These should be drawn up through audit and wide consultation with pupils, parents, staff as well as the wider community and will vary from school to school.
Healthy eating is particularly important as children grow up. There is increasing evidence to support the fact that children who eat healthily feel and look better, behave better and potentially achieve better at school. In the longer term there are significant health benefits in the prevention of disease and overall dietrelated health outcomes.
The ultimate goal is for children to enjoy eating healthy and nutritious food. The introduction of standards aims to assist food choices and ensure a good balance of food is available at school. School nurses can be involved through the education of children and families, by raising awareness of how school meals can help meet children's nutritional requirements and by supporting and promoting the school meals service to encourage uptake. They can also be part of the Healthy Schools Programme by contributing to school audits and consultation, ensuring a whole-school approach is promoted and clear messages delivered. Since September 2009, all schools have been encouraged to raise their status in the enhanced Healthy Schools Programme by developing an outcomes-based model that is universal and targeted on those children and young people who are most at risk. While primary responsibility for school food sits with the schools, there has never been a better time for school nurses to support this area of work.
The School Food Trust
The School Food Trust (SFT) is a Non-Departmental Public Body established in 2005. Sponsored by the then Department for Education and Skills and subsequently by the DCSF and Department for Education (DfE), it is responsible for taking forward the nutritional standards for school meals and school food. It became a charity in 2007. SFT produces reports and key documents on school meals and school food policy, and resources and information for schools, parents, children and young people, and school cooks and caterers. Its website also publicises examples of good practice. View UK Government Web Archive here:
Caroline Walker Trust
A charity founded in memory of the nutritionist and campaigner Caroline Walker, the Trust produces nutritional and practical guidelines for both young and old. Its work is particularly targeted towards vulnerable groups and people who need special help.The Trust has recently launched a new website called CHEW (Children Eating Well) www.cwt-chew.org.uk. http://www.cwt.org.uk/
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http://www.direct.gov.uk/en/Parents/Schoolslearninganddevelopme nt/SchoolLife/DG_4016089 (accessed 6 Jul 2010)21.The Scottish Government website.School Meals.Improving
Food in Schools (no date given).
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