Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 80 - 99)



  80. Would you like to quantify what it is again for us?
  (Sir Michael Bichard) The entitlement which the Prime Minister has committed the Government to is two hours a week.

  81. I do not know how fast you can do a marathon, but I do not think I could do it in two hours and that is a week. If you will excuse the pun, this is the most heavyweight group of Permanent Secretaries we have seen in front of this Committee for quite some months. We have three Permanent Secretaries, a brace of Chief Executives. You are a pretty high powered committee, which I presume reflects the importance that Government places on this issue. I need no persuasion of it. Anything which is costing 18 million working days a year and £2 billion in lost production is pretty serious stuff. What I cannot accept is that our school programme only incorporating an aspiration of two hours a week is anywhere near enough to get children into a pattern of sporting and physical recreation which is going to make any difference in their lives whatsoever.
  (Sir Michael Bichard) You have to remember that children actually spend a relatively short period of time in school every week and there are clearly great pressures on the curriculum time they are spending in the school. The Government has made this commitment to increase the time spent in the curriculum and outside the curriculum but within the school setting on physical education. The Government has introduced into the curriculum for the first time personal social and health education which is about encouraging people of the importance of exercise, amongst other things, in their life generally. The Government is also trying to increase the amount of time which people are spending in travelling to schools by foot or by bike. The number of things being done cannot all be done within the curriculum.

  82. I understand that. May I then press you on that point? It is a fair point you make that you can only get so much into the hours which are provided in school each week. Is that not a very good reason to look at the curriculum, to look at the hours per week which are spent in school, to see whether it can be changed in some way—this is a major change we are talking about, but it is a fundamentally important issue—so that sport assumes a central role in the lives of students. Yes, it may mean a longer working day in the school. It may mean that you actually break up the time of study and intersperse into the middle of that day time for sporting activity. That also may mean that school becomes a lot more family friendly, with parents who need to work, with parents who have to pick up their children at the end of the day. Do you not think that if you are actually going to achieve anything, you need to look at that, to try to get sports activities central into the school curriculum?
  (Sir Michael Bichard) We do keep the national curriculum under review. We have recently had a review. As a result we introduced the PSHE framework for the first time onto the curriculum. A lot of teachers felt that this was a burden which they could not cope with because of the other pressures on the curriculum. One of the reasons we did that was because we think it important to educate children on the use of all of their time, not just this small pocket of time they spend in school every week. I still believe that is probably the right way forward. There is a limit to how much we can squeeze in for this very short period of time. Our task should be to try to educate young people about choices and about lifestyles which will make them healthier and also, amongst other things, encourage them to be good citizens.

Mr Leigh

  83. I should like to adopt a lot of the questioning of Mr Gardiner. I too noticed this paragraph about the fact that we would have to run a marathon a week in order to make up what we have lost over the last 50 years in terms of physical activity, which is a fairly shocking indictment of our present lifestyle. I limited myself to watching my son run the mini marathon yesterday; that was my exercise. Have you done any comparison with the private sector education and the public sector? I happened to be looking only a couple of weekends ago at a timetable for a public school and it was very apparent there that every single day, in the middle of the day or the early afternoon, or some time, time was set aside for sport. Obviously, to be fair to you, that was a boarding school. Much easier for them. However, I do think Mr Gardiner has a point that if the cost to the nation is of the magnitude we are talking about today, then we may have to look at a fundamental re-appraisal of sport in schools and the timetable in schools.
  (Sir Michael Bichard) I do not have the figures about private schools, although I was going to ask whether it was a boarding school. Although time spent on PE in the school has reduced over the last five years, children involved in school exercise outside the curriculum has actually increased in the same period of time. Seventy-four per cent of children were involved in after-school exercise in 1994, 79 per cent in 1999. The number of children involved in lunchtime exercise has similarly gone up by five per cent over that period of time. It is a mixed picture. There is a reduction in school, there is an increase out of school. Most children spend most of their time out of school and we need to educate them and encourage them to participate particularly outside school.

  84. That is a fair point. I have a child myself at a comprehensive school in London and it is a very good comprehensive school which has very effective after-school provision. Is the pattern very mixed around the country in terms of making sure that all these kids, if they wanted to stay behind, could do some sports?
  (Sir Michael Bichard) It is mixed. I do not have the figures for all sports, but if you look at swimming for example, there is quite a wide range in terms of the number of children at the end of Key Stage 2 who can swim 25 metres and some of it does depend upon where they are going to school. Some of the poorer neighbourhoods, because they are under such pressure, are not providing the same opportunities. That is one of the things we do need to look at. As far as swimming is concerned, there is a focus group which will be looking at that amongst other things. You are right that we do need to be aware of the range of opportunities.

  85. You are putting more resources, more pressure, particularly in less favoured neighbourhoods in trying to help the school provide sports clubs at four o'clock in the afternoon.
  (Sir Michael Bichard) Quite a lot of the education initiatives have been focused on disadvantaged areas. If you look at some of the particular initiatives we have funded in recent years from education action zones, excellence in cities, right the way through to cooking for kids which is a rather good summertime scheme to help children to understand some of the choices we have been talking about. A lot of that has been focused on the poorer neighbourhoods, yes.

  86. We have had a submission from TOAST which is pretty damning about the levels of service given by GPs[10]. Ninety per cent of obese people thought that their GPs did not or only occasionally provided the right kind of support. That is on the second page of the TOAST letter and attachment which we have received. They reported that management of obesity in the NHS was patchy, there was widespread uncertainty of the referral options available as well as the efficacy of the treatments available. Do you think you have made enough effort to equip your GPs with adequate resources and information on such a serious issue?

  (Mr Crisp) May I first of all say that I have not seen the TOAST letter? The general point in this report shows that we have not. If you look at page 27, it shows what GPs are specifically asking for in terms of better information about active interventions and improved access to people like trained exercise specialists and so on. There is a whole series of things which GPs are asking for in order to provide the sort of support required.

  87. Have you initiated best practice guidelines for GPs and other health care professionals?
  (Mr Crisp) I shall not repeat what I said earlier about the fact that we are now, as of this April, bringing people into having local plans for tackling overweight people and obesity. In terms of guidelines, we have a number of things which are available which we have promoted, not actually provided by the Department of Health. We shall be considering with NICE, the National Institute for Clinical Excellence, whether we should get them to provide some guidelines for this. One of the difficulties around this is that there is not that much research yet of what is really properly effective. The short answer is that there are some guidelines available. They are not fully comprehensive, we shall be looking with the National Institute of Clinical Excellence at whether to provide something more comprehensive.

  88. Like my colleagues, I am very impressed that we have three Permanent Secretaries here. In the past there would have been some huge issue of peace or war at stake to get three Permanent Secretaries in front of a House of Commons Committee. We did a bit of research in my office today. We found out that there were 261,000 registered cancer sufferers in 1994, the NHS spent approximately £1.5 billion on treating them. There are eight million adults in the UK who are obese and we only spend £½ billion on their treatment. Do we really take the subject seriously?
  (Mr Crisp) I am not quite sure where those figures come from specifically but we tackle obesity as part of a bigger issue. The deaths which are recorded in this document are people dying from diseases to which obesity has contributed. I suspect that the amount of money we are putting into obesity, as this document again says, is under-calculated. We suspect that it is more but it is put in in association with other treatments.

  89. Why were there only 12 obesity clinics in the whole of England in 1998 and they were only open for half a day per week or fortnight?
  (Mr Crisp) It is the same point, which is that the way to tackle obesity appears to be much more to tackle it as part of tackling other issues. In a way it goes back to Mr Rendel's point that actually obesity may be a symptom of something else and that we need to be tackling the underlying issues rather than tackling obesity as a single issue. There are certain things where it is reasonable to tackle obesity on a basis entirely by itself, but a lot of that is not yet proven.

  90. According to this dial I would have to be seriously overweight to be obese, yet apparently 21 per cent of women in this country, 7 per cent of men[11], are obese but only 12 clinics. You are saying it is part of a bigger problem, but if this is really such a huge issue, it does not look to me as though you are taking it terribly seriously.

  (Mr Crisp) We are taking it seriously. Part of the problem is the problem which both you and Mr Steinberg alluded to, which is that people sometimes find it difficult to take it seriously and therefore it does not perhaps appear to be. If you actually look at what we are saying, it is that every health authority now has to have an action plan.

  91. Oh, an action plan. That is all right then.
  (Mr Crisp) This report says we should treat it as a first order priority, alongside other plans, and that we should be looking at how we handle this, then it is now considerably raised up the priorities from where it was before.

  92. A more detailed question. I happen to know somebody who is very seriously obese and they had this surgery on their stomach, which did not seem to do very much good. Paragraph 3.64 of the NAO report does refer to this and say that it often only has a short-term effect and the benefit is rarely sustained in the long term. Can you tell me whether you have done a detailed analysis of the effectiveness of this sort of treatment?
  (Mr Crisp) Further evaluation needs to be done on the specialist treatments. There is this treatment but there are also drug treatments. Guidance on the first drug treatment has now been produced by the National Institute of Clinical Excellence. There is further evaluation to be done on whether or not the surgical method you talked about is effective.

  93. So you cannot give an answer at the moment.
  (Mr Crisp) No.

  94. It is all down to what the TOAST submission tells us. It is really down to psychology, is it not?
  (Mr Crisp) Part of it is to do with lifestyle, if that is what you are meaning by psychology.

  95. No, it is the psychology of the people who are fat.
  (Mr Crisp) There is a whole set of issues which are underlying this and reasons for why people may be obese. Those need to be tackled rather than just assuming that we can deal with it by people being strong minded.

Mr Griffiths

  96. I should like to ask each of you in turn what your budget is for advertising healthy living and healthy lifestyles.
  (Mr Crisp) I am sorry, I do not have that information here if you mean the total spend.

  97. Any ballpark figure of what has been spent each year?
  (Mr Crisp) I should really have to check on that[12].

  98. You may get a note from behind. Mr Young?
  (Mr Young) I would say we have nothing for advertising healthy lifestyles in particular, but the whole of our sport policy is about enhancing people's opportunity for a healthy life through sport.
  (Sir Michael Bichard) It is not part of our statutory responsibility but the money we are spending on providing the personal social and health education, the money we are spending on sport in schools, the money we are spending on swimming in schools, all of this.

  99. I am quite keen on promotion.
  (Sir Michael Bichard) There are different forms of promotion and I would say the personal social and health education is actually a very important form of promotion. What we are trying to do is promote and market a healthy lifestyle to children.

10   Note: See Evidence (PAC 00-01/148), page 1. Back

11   Note by Witness: The percentage of men who are obese is 17 per cent, not 7 per cent. Back

12   Note: See Evidence, Appendix 3, page 27 (PAC 00-01/168). Back

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