Thursday 18 December 2003

PROFESSOR IAIN BROOM, MS LOUISE MANN, MS AMANDA AVERY, MS SALLY HAYES AND MS EMMA CROFT

  Q1070 Chairman: Welcome to our second group of witnesses and thank you for your contribution to this inquiry. I want to finish this session before midday, so would be grateful if you could give concise answers to our questions. First, would you briefly introduce yourselves to the Committee.

  Ms Avery: I am Amanda Avery, a community dietician employed by Greater Derby PCT. I have been a community dietician in southern Derbyshire for the last 17 years. For part of that time, I have spent time in public health, with a remit to pull together a local obesity strategy. Following that, one of the missions was to link in with the commercial slimming sector. I have therefore been involved in a feasibility study, looking at the practicality of working in partnership.

  Ms Mann: Louise Mann, a practice nurse, working in primary care; and I have been doing so for ten years. I have recently been using the Counterweight project.

  Professor Broom: My name is Iain Broom. I am Consultant in Clinical Biochemistry and Metabolic Medicine. I have a long-standing interest in obesity. I am currently the Chairman of the Counterweight programme in the UK.

  Ms Hayes: I am Sally Hayes, Lead Nurse from the North West Leeds PCT. I am the Management Lead for CHD and Diabetes NSF implementation. We are very, very interested in the primary prevention side of the NSF really, and that is where the interest in obesity comes.

  Q1071 Chairman: Knowing Leeds fairly well, which parts of it does your PCT cover?

  Ms Hayes: We go from the university district out to Otley and the Guisely area.

  Q1072 Chairman: So you have quite a mix of population there.

  Ms Hayes: Absolutely.

  Q1073 Chairman: Ms Croft?

  Ms Croft: I am a community dietician, and I work for South Leeds PCT, but I am currently on a secondment to the Leeds North West PCT, working with Sally Hayes. I am managing a weight management project in primary care.

  Q1074 Chairman: You crossed the river. Why have you moved over? Is it just a temporary arrangement?

  Ms Croft: Yes, a temporary arrangement.

  Q1075 Mr Jones: You have heard the previous evidence, which partly touched on the need for a national service framework. I am addressing this question primarily to the representatives of the primary care trusts. Is it impossible to push the obesity issue up the primary care trust agenda without a national service framework; and, related to that, have your PCTs achieved the milestones concerning tackling obesity set out in the Coronary Heart Disease National Service Framework? Do you think other PCTs have achieved them, and would a dedicated national service framework help?

  Ms Hayes: There are lots of questions in there. The first part of your question—would an NSF in obesity help—yes, it would greatly. The issue around PCTs and their ability to push the obesity agenda is about prioritisation, and there are so many priorities out there, so how do you get obesity to register in the mindsets of all contributors to primary care? I think that inclusion within an NSF would help greatly. Whether it needed to be a national service framework on obesity—I am sure it could be part of a chronic disease national service framework. Certainly, the setting of standards and targets which are performance managed helps. It is also about the capacity to address these things, and national service frameworks do attract money and investment, which would also help greatly. The second part of question was about whether we have achieved the milestones for coronary heart disease. I can obviously only speak for my own PCT, and we are very much on track but, obesity is not specified enough within the CMD standards and milestones. There are other things based on medication, on lifestyle etc. It is not specific enough really, and the targets are not specific enough. There is more work needed to promote obesity.

  Q1076 Chairman: Ms Mann, do you broadly share those views?

  Ms Mann: In terms of the milestones within the NSFs, they are definitely not addressing them. We are addressing all the other milestones, but not obesity—definitely not.

  Q1077 Dr Naysmith: Why not obesity?

  Ms Mann: I think it has just been given the poor service really. The funding is not there to do it. We are dealing with the Counterweight within our general practice, but that is just the goodwill of the GPs. They provided the money to allow us to do the training and to do the work, but we have no extra money for it.

  Ms Avery: It is quite sad that an NSF for obesity is required. That is possibly because there is great fear in primary care about addressing obesity, possibly because of all the complexities surrounding the issue. It is an easy one for people to drop off the agenda because of that fear. We always relate it to smoking cessation, which is a much simpler concept. Although it is a behavioural lifestyle issue, fundamentally people need food to live, and eating is such an emotive issue; so there are many complexities surrounding addressing obesity that it is part of the root of the problem.

  Q1078 Mr Jones: Is there a concern that once you start going into this, you just do not have the resources?

  Ms Avery: Certainly the resources are limited. Hopefully, a good obesity strategy looks at how we make the most of all the resources that are available to primary care to take the issue forward; so looking across all life stages as to what resources are out there currently—but fundamentally resources are limited, particularly in this area.

  Q1079 Chairman: Can I move on the appropriateness of the current professional roles in respect of dealing with obesity? The longer I have been involved with the Health Committee, the more I think we need to question the traditional training and the specific roles that the professions occupy, because it affects the thinking about how we deal with a problem that is just beyond doctors and PE teachers. It involves all of us, looking at the big picture; and the narrowness of our roles sometimes means we do not do that. When we came to Leeds not long ago to look at some of the work being done there, we went to Rothwell Sports Centre. There was a support group for children who were facing weight problems. We met the lady who ran it, and I think she was a bit offended when I asked about her professional background because she had not really got one, but she was doing a brilliant job. She had been involved in the Health Service, but not as a trained nurse or dietician, as I recall. But it struck me, why should she have that background, because she was doing a great job. She was drawing in all the different areas of speciality to back up the work she was doing. Do you have any thoughts, being a dietician, on the points I raised in the previous session: do we need to look at a different person, a different profession and approach, which will encompass some of the work that all of you here as witnesses, and others, are doing?

  Ms Croft: Yes, definitely. Through the work we have been doing in Leeds as well, we are trying to work in partnership with leisure services and community groups, to link in with what they are providing, mainly in regard to physical activity. As a dietician, part of my role is is to train practice nurses and GPs . In one of my practices we do have a healthcare assistant, which is a new role in primary care, helping along with weight management sessions. That is taking another role in the NHS and training them to be able to deliver these sessions. Indeed, dieticians have a role in advising, training, and co-ordinating and should be at the heart of any weight management initiatives.