NHS England announces proposed action to cut sales of sugary drinks on NHS premises

NHS England’s Chief Executive Simon Stevens has today announced details of proposed new action to cut obesity and reduce the sales and consumption of sugary drinks sold in hospitals.

England would become the first country in the world to take action across its health service in this way. A formal consultation launched today gives details of a proposed new fee to be paid by vendors, or alternatively seeks views on an outright ban.

As Europe’s largest employer, with over 1.3 million staff, the NHS committed in its overall strategy, the Five Year Forward View, to improve the health of its workforce.

A recent survey found obesity to be the most significant self-reported health problem amongst NHS staff, with nearly 700,000 NHS staff estimated to be overweight or obese.

Rising rates of obesity amongst NHS staff are not only bad for their personal health, but also affect sickness absence and the NHS’s ability to give patients credible and effective advice about their health.

NHS premises also receive heavy footfall from the communities of which they are a part, with over 1 million patients every 24 hours, 22 million A&E attendances and 85 million outpatient appointments each year. The food sold in these locations can send a powerful message to the public about healthy food and drink consumption.

Addressing the ukactive National Summit, Simon Stevens said: “Confronted by rising obesity, type 2 diabetes and child dental decay, it’s time for the NHS to practice what we preach. Nurses, visitors and patients all tell us they increasingly want healthy, tasty and affordable food and drink options. So like a number of other countries we’re now calling time on hospitals as marketing outlets for junk food and fizzy drinks. By ploughing the proceeds of any vendor fees back into staff health and patient charities these proposals are a genuine win/win opportunity to both improve health and cut future illness cost burdens for the NHS.”

Today’s formal consultation proposes levying a fee for any vendor of sugar-sweetened beverages (SSB) on NHS premises. It is complementary to the government’s proposed sugar tax, but would begin sooner – in 2017 – and based on best evidence would cover the full range of sugar sweetened drinks. Subject to consultation the drinks affected would be any drink with added sugar including fruit juices, sweetened milk-based drinks and sweetened coffees.

Proceeds from the fee would be used directly to fund expanded local staff health and wellbeing programmes and/or the trust’s patient charities. It also seeks views on an outright ban on certain products being sold on NHS premises, an approach now beginning to be taken by hospitals in several other countries.

The consultation will ask for the views of patients, carers, NHS staff, the public and suppliers and will close on January 18 when feedback will be considered and a decision taken about how this should be taken forward into the NHS standard contract.

A recent two month NHS pilot of different types of sugar policies at four hospitals has already taken place and showed positive results. For example, one site reported that although no sugary drinks were sold during the trial, the overall total number of drinks sold did not decrease and they were financially unaffected.

A year ago NHS England introduced a number of initiatives to improve staff and patient health and well-being including the following which are now delivering real benefits for staff and patients:

Staff Health and Wellbeing CQUIN: This included the introduction of a new staff health and well-being financial incentive (Commissioning for Quality and Innovation), which NHS England is now announcing will be extended for at least the next two years.

To receive some of the fund hospitals and providers have had to introduce staff health and well-being programmes and healthier food choices. The wellbeing initiatives include mental health programmes, physical activity schemes and fast track access to physiotherapy for staff with back and other MSK problems.

The healthier food choice scheme includes incentives for hospitals and trusts that end price promotions on high fat, salt, saturates, sugar foods; that stop advertising of unhealthy foods on NHS premises; and that end the sale of unhealthy foods at checkouts, while ensuring healthier meals are available out of hours.

The Healthy Workforce Programme: In addition, 75,000 staff across 10 Trusts, one CCG and NHS England have taken part in a pilot scheme to improve health and well-being focusing also on mental health, physical health, improving the food environment, culture and leadership.

To increase physical activity and help staff manage their weight they have trialled a variety of schemes  including appointing health trainers and dieticians to give staff tailored advice on diet and exercise, as well as discounts with local gyms. All sites used a Weight Watchers discount, negotiated by NHS England.

Examples of successes include West Midlands Ambulance Service which in partnership with Slimming World has helped nine per cent of its staff (392) lose over 3350lbs – the equivalent of 18 adult men.

Bradford District Care have set up a Couch to 5K group, appointed an onsite chef who prepares healthy food daily, have reduced portion sizes of meals and implemented a price premium on unhealthy foods.

The Walton Centre participated in the NHS Games in 2015, which included a 5k run and other sports competitions and they opened their specialist physiotherapy gym to staff after 5pm.

Support for General Practice: The £19.5m ‘NHS GP Health service’ launching in January 2017: it is a free, confidential service provided by health professionals specialising in mental health support to doctors, accessible via a confidential national self-referral phone line, website and App, enabling GPs and GP trainees to seek information about services available, access self-help tools, and access clinical support. An occupational health specification has also been developed to ensure there is a consistent level of occupational health support for staff working in primary care across the country.

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  1. Gina Eades-Richards says:

    Health workers should be healthy lifestyle ambassadors and promote healthy behaviour in every given opportunity by setting a good example. What was provided before these machines? We survived pre-sugar and fizz and were healthier for it. Education is key – good idea to invest in preventative services, before the government cuts take them away completely.

  2. Lisa says:

    I believe our role is to educate the public to make informed choices not to dictate what they can and cant eat or drink. When patients or relatives are under stress making healthy choices is not always a priority. A total ban may affect those who may need the additional calories or who will only drink sugary drinks. Education is the answer not a ban.

  3. Anonymous says:

    I think an outright ban would be an excellent way of making people think about their habits. When a sugary drink is not available some thought must be given to the alternatives. This has potential for a knock on effect outside the hospital environment and seems to me a good health promotion tactic to raise awareness. There are other ways of increasing calorie intake where it is needed and I imagine people will still have a choice to add sugar to their own tea etc. if they still wish to.

  4. Anonymous says:

    Support major clamp down but then many staff at hospitals seem to have obesity issues themselves and should also be promoting a healthier image? Hard to preach to others if not practised from within.

  5. John S says:

    You need to consider that a high calorie diet is a healthy diet for some patients on chemotherapy, etc. who are at risk of becoming underweight, dehydrated, etc. Therefore, care should be taken not to introduce a blanket ban which could harm certain specific groups of patients.

  6. Clare says:

    I completely agree with a total ban on any sugary drinks in NHS vending machines. Even many flavoured waters have sweeteners in them now and these too should be included. The NHS has a real opportunity to use its size to spread a valuable message and practise what it preaches. We wouldn’t sell alcohol or cigarettes so why sugary drinks now that we know just how bad they are for us. Many premises have Costa or M&S on site now, we have to think about how this is tackled too.

  7. Anonymous says:

    I think we need to have an outright ban. Schools and children’s centres are doing their best to make healthy eating/drinking the norm and I think it is so important for hospitals to do the same. It is so important to get the message across that people need to take some responsibility for their and their children’s health. All hospitals should have a stock of products to give/sell to hypoglycaemic patients when necessary.

  8. KIM says:

    Diabetics on insulin do at times use sugary drinks to overcome hypoglycaemia.
    Might be worth seeking the view of Diabetes experts, Diabetes UK as part of consultation on ban on sugary drinks for sale in NHS premises

  9. I totally agree with the suggestion of banning sugar fuelled drinks in hospitals.
    I would like to see this extended to the unhealthy drinks pedalled by coffee chains. They are expensive , generally unhealthy and often exploit patients/ carers and visitors .

  10. Jill says:

    Whilst I agree with a national wide initiative to reduce the dietary intake of added sugars, I am not sure about totally banning the sale of sugar sweetened drinks, and replacing them with drinks sweetened artificially. There are some people, such as those having inherited PKU for whom artificial sweeteners are actively harmful, but who lead productive working lives. I feel the way forward is education. A total ban is discriminatory. [ Not to mention those who do not like the taste of artificial sweeteners but are quite capable of moderating their sugar intake to healthy levels.]

  11. Richard Kerr says:

    A hospital’s role is not simply to treat disease but to prevent it.

    Clearly selling sugary drinks providing carbohydrate, vastly in excess of the body’s needs is unforgiveable.

    As well as contributing to Diabetes risk and other obesity related problems, it also causes dental decay. Hospitals have daycase general anaesthetic lists filled with young children having multiple decayed teeth extracted due to excess sugar in their diets.
    Surely we should not be contributing to the problem.

    I must say that the reasons for banning these drinks in hospitals is so blatantly obvious that I am unsure as to why you are requesting opinions regarding it.

  12. michael says:

    I am a dentist who has been asking for this for many years both for patients and staff.
    I would be extracting multiple teeth on young children under general anaesthetic at a local hospital. When I went to see them post op often parents would be buying sugary drinks from machines in the children’s ward.
    I remember challenging them and staff said there was “no safe water”
    Please ban them from hospitals as has been done with smoking.

  13. Lynette Anear says:

    Simply making the drinks more expensive will not stop people from buying them, we need education and good alternatives. The NHS must model healthy eating habits.

  14. Tracey G says:

    The NHS is supposed to be promoting good health,sugery drinks are not healthy – Ban them and anything else that is bad for your health. Its like a gym selling cookies or companies adding more salt in their goods than the recommended daily amount. Bottom line its about making money and in the long run, it will cost the NHS promoting rubbish as you’ll get more ‘customers’, which actually you strive not to have !!

  15. Annoyed person with a brain says:

    Stop wasting money on overpaid “consultants” to investigate yet more pointless nanny state regulation.
    People know which food and drink is bad for them, restricting access WILL NOT STOP THEM consuming it elsewhere. This proposal is about as useful as the “sugar tax”. Idiotic.

  16. Gail says:

    Diet drinks are not healthy – they are full of chemicals – are you going to ban them?
    Education is needed to help tackle obesity not a can of coke in a hospital.

  17. samantha cowee says:

    We certainly should be leading by example.It sends the wrong message. I would ban them completely, starting at the hospitals, then gyms(no need for energy drinks with majority of sport done at a gym!) and then followed by everywhere else!! what is wrong with water!

  18. Guy Bradley-Smith says:

    Of course a ‘tax’ is nonsense as it requires management intervention. Just ban sugary drinks completely in health facilities (except for hypoglycaemic diabetics!!) and be done with it. That will send a powerful countermessage and immediately add to the likelihood of reducing our burgeoning obese population.

  19. Giselle Taylor says:

    I’m unsure why the government is so focused on obesity rates when the highest number of hospital admissions for children is for the extraction of multiple teeth (sometimes every tooth in their mouths) under General Anaesthetic. This is well documented and entirely preventable, if those children didn’t consume sugar. Its a huge drain on NHS resources and has lifelong repercussions with dental phobic patients with lifelong NHS dental treatment needs.

  20. Mandlebrot says:

    Foodstuffs available in hospitals should demonstrate what a healthy balanced diet is. Therefore each “meal” should represent an appropriate fraction of a normal daily intake for the ideal BMI of a normal healthy individual (on a diet without heavily “processed” foods). An individual wanting to purchase any “meal” that exceeds that fraction should be disincentivised, either financially, or socially, whichever is the more effective. For practical purposes, normative averages can be calculated.
    Failing to overtly demonstrate what a healthy diet is, in a place that is supposed to bring health to those who lack it, is hypocrisy. Legal limits on the proximity of food outlets that fail to adhere to these rules should be brought in (e.g. no junk food within 2 miles of an inpatient facility).

  21. JULIE says:

    When I first took a job in the hospital canteen I was amazed that a trolley went round the wards selling crisps, chocolate and fizzy drinks although this was mainly for the staff there are vending machines selling the same sort of thing and it is almost impossible to get a proper meal or something healthy in some hospitals, especially after 4pm.

  22. Anonymous says:

    I agree 100% with the thinking behind this but it is also important that some form of rapid acting carbohydrates are available for those with Type 1 Diabetes should they need them to deal with low blood glucose levels.

  23. Anonymous says:

    I think it’s a little unfair to presume that all obesity and diabetes is caused by sugary drinks in vending machines in hospital. We’re all aware of the size and nature of the problem and, having worked in the NHS for well over twenty years, I’ve seen my fair share of campaigns to tackle these issues. Being selective about what options are available, I believe, and therefore an outright ban isn’t necessary. This defeats the object of the NHS personalisation and choice agenda and it isn’t quite right to treat people like naughty schoolchildren who spent their last few pennies on sweets.

    I understand the view that vending machines offering these drinks do not help the issues of obesity and diabetes among others, but we need to be looking at the root cause. Exchanging some monster munch for a banana isn’t going to stop people from eating and drinking the wrong things. Think closer to home, and you’ll crack what I’ve been working on for 15+ years.

  24. Lucinda Adams says:

    My daughter is Type 1 Diabetic. Sugary drinks are a life saving treatment for her hypos and other like her. Provision needs to be made for diabetic hypo treatments if buyable sugary drinks are banned from hospitals. Lucinda Adams

  25. Anonymous says:

    Not before time! I am a retired diabetologist and it was very frustrating to see the “coke” dispensing machine right next to the entrance to the Diabetes Unit! An outright ban is the only sensible option. Selling any sort of high sugar drink in a hospital setting implies to the general public that it must be OK to drink it, both from there AND from the local supermarket. Ban them!

  26. Pella Erskine-Tulloch says:

    About time. I have been complaining about the prominence of the vending machine in the hospital where I work – it’s right by the desk where patients check in – it’s a specialist Children’s Hospital and I believe has a dedicated Obesity Clinic. It just doesn’t make sense. There should be an outright ban – not an extra charge for vendors – people will keep on buying if the products are accessible, even if more expensive.

  27. Fiona says:

    Fantastic – very much agree with these proposals. I think the NHS should lead the way in creating a healthy environment to work in and for patients. One of my biggest bug bears used to be the sales push at the till at our hospital’s small shop to sell you cheap chocolate bars on offer even when you’d only gone in to buy an apple. That kind of thing is the opposite of what should be done on NHS premises.

  28. Julia says:

    Agree with the comment below 100%. Let’s have some alternatives to the unholy trinity of Costa, Starbucks and ‘supermarket outlet’. It is total hypocrisy to preach healthy eating and then provide your own staff/visitors/patients with easy access to high-sugar snacks and drinks and other unhealthy foods.

  29. Angela Moody says:

    Well done Simon, AT LAST some common sense and leadership from the NHS. You are currently failing to get your message across on the crippling effect of obesity and type 2 diabetes on our NHS service – a complete ban on confectionery and sugary drinks in vending machines and people may begin to wake up and take this health issue seriously. I hope you also explore the provision of healthy alternatives, waiting times can be long, otherwise patients will simply turn to Starbucks, Costa and supermarket outlets which are now prevalent in hospitals who also supply high sugar and carbohydrate food and drink. Stop the mixed messages and lead from the front !