THURSDAY 23 NOVEMBER 2000

MS YVE BUCKLAND, PROFESSOR RICHARD PARISH, MR ANTONY MORGAN and MS PATTI WHITE

  320. Sorry, before we get there, who does the approval of the targets which have been adopted locally?
  (Professor Parish) The health improvement programmes are all signed off through normal NHS mechanisms, so I would work on the basis that they would be signed off through the regional offices.

  321. Do you see that as very much part of the HImPs programme?
  (Professor Parish) I do indeed, yes.

  322. Which makes it slightly confusing in that some of the targets are not really HImPs but are some other initiative, are they not?
  (Professor Parish) But I think if all were to move in the direction that many of us hope would be the case, we would, over the course of the next two or three years, see some bringing together of community plans and health improvement programmes, and in more innovative parts of the country one has already seen that cross-fertilisation occurring to a very considerable extent. So that one could not then clearly decide at once between the contribution to be made by local authorities and the contribution to be made by the NHS.

  323. So yours is an informative role rather than an instructive role?
  (Professor Parish) Absolutely, it is an informative role—we do not have a mandate to instruct—based upon the best evidence that we have been able to collect from good practice around the country.

  324. Can I pick you up on that point about good practice and your R&D role, and ask you what your view is on the role of sport within public health? We have, as a Committee, agreed to invite the Minister for Sport to appear before the Committee as part of this inquiry, because we see a clear connection between sporting activity and public health. Have you had any thoughts in that area at this stage in your work, and what are your views on the role of sport?
  (Professor Parish) I think we have tried to move quickly as the HDA. In fact, we have a joint conference with Sport England in a matter of just a few weeks' time, at which we have two Ministers contributing. I think the key here is actually mass participation in physical activity that is enjoyable and easily accessible.

  325. Perhaps "sport" was the wrong word. I was conscious in the previous session when we had evidence from, I think it was, Peter Donnelly again where he talked about the involvement of a leisure centre in coronary care. So it is a wider picture rather than simply sport; it is leisure, other areas outside what might be deemed the mainstream of health provision, is it not?
  (Professor Parish) Yes, and indeed it goes beyond that. There are examples going back some 15 years ago of leisure centres which increased their opening hours and provided an all-inclusive, low-cost centre which provided people not only with the opportunity to engage in physical activity but also in, for example, a healthy breakfast. That was actually good business for the leisure centre, it turned out. So I think whether it is through leisure centres, or whether it is through schools and increasing physical participation rates within schools, or indeed using schools as a resource outside of normal school hours for the wider community, there is no doubt that this will feature on our agenda. Indeed, in the national plan that was published a few months ago the HDA is required actually to look at the whole question of physical activity and obesity.

  326. Do you see currently any real connection between what is happening in education in respect of sport, what is happening within the Ministry responsible for sport and the Department of Health in developing a strategy that actually draws all these strands together in a meaningful way?
  (Professor Parish) I think probably it is fairly early days. The fact that I cannot immediately see all of the connections does not necessarily mean they are not happening.

  327. That is a very diplomatic answer.
  (Professor Parish) It tends to be an accurate answer as well.
  (Ms Buckland) Certainly there has been inter-ministerial co-operation around the formation of this conference which I think both Chris Smith and Yvette Cooper are speaking at. It is intended that becomes the basis of further joint working, but irrespective of that, we have had very, very close working relationships with them, so did the HDA with Sport England, and are looking at the opportunity for working more directly with them, particularly through their performance work and our schools work and promoting physical activity at the local level.
  (Professor Parish) At the local level there are lots of examples of good practice where people have been working across the boundaries of local authorities and the health wing.

  328. If you do have further information about this, we would be very interested to hear from you.
  (Ms Buckland) We would be happy to provide that for you.

  329. Does the network so far include GPs who can prescribe exercise?
  (Ms Buckland) Certainly there are examples throughout, evidence based, in terms of good practice of GPs at the local level who have been very active in campaigning for exercise on prescription. I worked in Nottingham. There was one particular GP who was very active in that area and, indeed, in terms of a whole community development approach his part of the city. Sport England I think are also aware of the potential of the human primary care groups and around HImPs to look at how some of these things might be worked out. I think that is going to be part of the joint work. They would like to use us in an advisory capacity to help them engage with the primary care groups.

  330. Have you looked at whether prescribed exercise has increased or decreased as a result of primary care groups or trusts?
  (Professor Parish) We have not as yet, as the HDA.

  331. It is interesting, because I agree with Ms Buckland that there has been good research that shows that it can be extremely cost-effective, but my anecdotal evidence is that it has virtually disappeared since individual practices no longer have the resources to transfer monies from a drug budget into an exercise budget.
  (Professor Parish) I think this is probably also not unrelated to the earlier discussion about targets, because if we manage to build these things in as targets, then by definition they become priorities, and that is when resources tend to flow. So if exercise on prescription is seen as a priority against which the performance of a particular locality will be measured, it is more likely that it will be resourced to achieve the sorts of results that you are clearly hoping for.

  Mrs Gordon: Can I just say that we came across this yesterday in our visit. One of the exercises prescribed was walking and organised walks in the local park, which was definitely cost-effective.

  Chairman: If there are no further points anyone wants to raise or which our witnesses wish to make, can I thank you for your co-operation. We are very grateful to you for your attendance this morning. Thank you.