Select Committee on Health Minutes of Evidence


Examination of Witnesses (Questions 40-59)

12 JUNE 2003

MR MIKE ASH, MS DANILA ARMSTRONG, MS IMOGEN SHARP, MS PATRICIA HAYES, MR ALEC MCGIVAN AND MS MELA WATTS

  Q40  Dr Naysmith: We are going to embark now on a series of questions about to what extent the National Health Service and the department take this subject of obesity seriously. You have already heard this morning that it can be quite difficult with a cross-cutting issue like that to get departments to meet and talk about things and devise a common strategy. But even with the Department of Health there are different subject departments and sections. I wonder if you think it is the case that it is taken seriously enough by the Department of Health.

  Ms Sharp: I think, in terms of the Department of Health, yes, ministers certainly do take this issue seriously. It is something that the Public Health Minister in particular is concerned about and has stated publicly her concerns about rising levels of obesity—which, I would stress, are not just in this country but are a global phenomenon and a global epidemic. I think we recognise, therefore, that it is not an easy problem to tackle, but it is certainly one that has health consequences and NHS cost consequences. So, yes, it is taken seriously. I think it would be fair to say that our work internally comprises of, I suppose, two strands. One is the prevention, beginning in childhood and focusing on diet and physical activity, which obviously is a cross-government activity but, certainly from the Department of Health's point of view, I suppose, the first focus on that has been on diet, with the national 5 A DAY Programme, the National Fruit Scheme and a range of initiatives there. In terms of exercise, now we are doing a similar approach to that. We have recently set up nine link pilots which follow the same sort of model as the 5 A DAY local community initiatives programme, where they are evaluating work by primary care trusts and giving money to them. In terms of the NHS, yes, I think it is increasingly taking it seriously and we have put in place a series of structures, including a new Priorities and Planning Framework, which has a target for registers, which guides them. They have to deliver priorities in the next three years.

  Q41  Dr Naysmith: I am glad you mentioned primary care trusts. That is the area I want to ask you about specifically doing something about this. Implementing, for instance, the National Service Framework on Coronary Heart Disease, one aspect which would seem to be useful would be looking at body mass index and monitoring it and controlling it and seeing to what extent it was happening in a particular area and with a series of patients. How do you know whether that is happening or not with primary care trusts?

  Ms Armstrong: It is obviously the responsibility of primary care trusts to set their own local priorities in partnership with other commissioners and also to look at how they are going to be monitoring that. As Ms Sharp has already mentioned, there is the requirement of primary care to set up diabetic and CHD registers and on those registers there will be a recording of things like body mass index.

  Q42  Dr Naysmith: How is this monitored back at headquarters? I know we are trying to get them to move things away but, if you are setting this up on a National Service Framework, you have to make sure this is happening.

  Ms Armstrong: The responsibility for the performance management of primary care trusts rests with strategic health authorities. Strategic health authorities are accountable to the Department of Health in delivering local delivery plans and also in delivering the local delivery plans returns, and in delivering obviously the priorities and planning targets as set out for 2003 to 2006. In addition to that, there is also CHI (Commission for Health Improvement) who are undertaking a review particularly of the NSF for coronary heart disease. It is an implementation at local level. That process is starting now and will be reporting on how that is being taken forward at the local level.

  Q43  Dr Naysmith: So you do not have any figures for us yet. It is too early.

  Ms Armstrong: We do not have any figures.

  Q44  Dr Naysmith: You do not know what proportion of primary care trusts are implementing this.

  Ms Armstrong: Implementing in terms of recording BMI, no, we do not have that information at the moment, but, following the Commission for Health Improvement review, we will be better informed what proportion of primary care in PCTs are actually gathering that kind of information and how effective they are in implementing NSF for CHD.

  Q45  John Austin: You have said the responsibility rests with the PCTs. If we go back to the White Paper The Health of the Nation, that did identify targets for obesity reduction. They were not present in the public health White Paper Saving Lives. Does that send the right message to PCTs about the importance the Government attaches to tackling obesity?

  Ms Sharp: As you acknowledge, I think that is a question for ministers, but the ministers chose to reduce the number of targets. They had concerns about the amount of targets that were being set and very deliberately focused on outcome targets of heart disease, cancer and an inequalities target, which is also reflected in the local planning at the Priorities and Planning Framework, so they took that decision. However, that does not stop us monitoring trends and having indicators of progress towards those, and obviously we recognise that obesity, diet, exercise all contribute to the heart disease target as well as smoking and other things and are monitoring that through indicators at a national level.

  Q46  John Austin: Also not just heart disease but also cancer rates as well.

  Ms Sharp: Yes.

  Q47  John Austin: You have said it is the PCTs' and then it is the strategic health authorities' responsibility to monitor that. Doug Naysmith asked a specific question about the Coronary Heart Disease Framework. Do you have any idea of how many PCTs actually have an identified lead member for obesity issues?

  Ms Armstrong: I do not have the answer to that question. We know that in each of the strategic health authorities there will be lead people who have responsibility for coronary heart disease.

  Q48  John Austin: Will there be an expectation that each PCT would have a strategy?

  Ms Armstrong: There is an expectation that each PCT will have a local delivery plan which then feeds into the strategic health authority's local delivery plan which then is the one that gets reported back to the Department of Health.

  Q49  John Austin: If we want to know how many PCTs have a strategic plan and a lead person, we would need to ask one of the SHA.

  Ms Armstrong: At the moment, yes, that is correct.

  Q50  Dr Taylor: I am going to ask the Department of Health some more rather awkward questions which, if it cannot answer, I think we ought to have—just as I think we ought to have the answer to the question how many PCTs do have a lead officer for obesity. NICE Guidelines, which are pretty well the law these days, when they are talking about the drugs for obesity, do say "arrangements should exist for primary care staff, mostly practice nurses, supported by community dieticians, to offer specific advice, support and counselling on diet, physical activity and behavioural strategies." You probably do not know but could we find out how many PCTs do have practice nurses who are actually trained in this sort of advice? How many have access to community dieticians who again are trained in this sort of work. Could you give us a rough idea of the training GPs actually get these days in handling obesity. That is something you might be able to answer now, I do not know.

  Ms Sharp: If I take your first point about how many of us are doing that in how many PCTs, I would say that is something that we are actively looking at at the moment. It is something about which I have some concern. In the context of this three years' plan, we have identified the need for workforce development as being a priority over those three years. There we are working with the workforce development confederations, etc. We are essentially doing some work around that which will involve, we have agreed, some form of survey or something to find out levels of understanding and knowledge, etc, and therefore what training guidance might be needed.

  Q51  Dr Taylor: It would be very helpful if we could have some sort of rough idea of the numbers of PCTs that do have these sort of people available to them. That is impossible, is it?

  Ms Sharp: I think we would need to look at, I suppose, the burden that that would give. We are intending to do some analysis or some survey of exactly that area.

  Q52  Dr Taylor: Is it not something strategic health authorities should have at their fingertips?

  Ms Sharp: Yes.

  Q53  Dr Taylor: It should not, to me, require that amount of work.

  Ms Sharp: But it is something that we can undertake to ask the directors of public health and the strategic health authorities, if that would be helpful.

  Dr Taylor: I think it would.

  Q54  Sandra Gidley: As an add on to that, does the department have any idea how many doctors surgeries are offering exercise on prescription as an incentive?

  Ms Sharp: The department's position on that is we have produced the guidance on the Quality Assurance Framework for Exercise Referral. We also have an understanding that there are about 500 but, no, we have not collected that data. We, I suppose, keep an informal check on it but we have not undertaken to collect—

  Q55  Sandra Gidley: That is 500 out of . . . Can you turn that into a percentage?

  Ms Sharp: May I come back on that?

  Q56  Chairman: You can come back to us with the answer.

  Ms Sharp: Okay. Could we come back to you on that? Thank you.

  Q57  Julia Drown: You talked there about workforce development. Are there any thoughts about whether there needs to be some new type of worker in this field, somebody who knows about family counselling, about diet and physical activity? Is there any work being done on that?

  Ms Sharp: The things we have in place, particularly in terms of workforce development. The Health Development Agency, the remit of which is specifically to review the evidence and also to do guidance and practice development, is due to be publishing fairly shortly guidance on obesity. There is also—

  Q58  Julia Drown: That would not be about a new type of staff.

  Ms Sharp: No, that is about evidence of effectiveness. They are also setting up a number of collaboratives, in terms of workforce development and working with the workforce development confederations and others, about what would be needed. I think this would need to be considered in the case of that.

  Ms Armstrong: There are also various programmes in place. For example, there are life skill escalator courses for enabling people who perhaps are not necessarily professionally qualified but can get some sort of supervision to deliver some of this work, particularly out in the community. For example, in the case of dieticians I am aware that there are schemes in place to take this sort of broader approach.

  Q59  Julia Drown: So we might be seeing these roles emerging.

  Ms Armstrong: Yes. Because of the limit on the number of our specialist staffs that can deliver this work.


 
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