Select Committee on Environment, Transport and Regional Affairs Minutes of Evidence

Examination of Witnesses (Questions 160 - 179)



  160. Like 0.00001 per cent.
  (Dr Crombie) I would need more figures to be able to answer that, I am afraid.

  161. Thank you.
  (Ms Hamer) Just to make a point about that, there is a bigger issue here in the fact that the NHS has traditionally tended to encourage people to drive to its facilities, including the staff, and it actually requires something of a culture shift to encourage health facilities to be much more green in their thinking about transport. That is something that is now required of them but they are going to need some quite substantial support from local authorities and others to help them think about doing that. Only when they do green transport plans for health facilities will it be easier for individual staff not to drive.

  162. You do not think they would be inclined to say, "Fine, I will do that, except of course with the sort of hours I work, I will not be able to do it"?
  (Ms Hamer) This is being debated all over the country in NHS facilities at the moment, there are big scraps going on where people are trying to introduce these plans, to negotiate just these sort of problems.

  Mrs Dunwoody: Yes, I rather thought human beings might get in the way.

Mr O'Brien

  163. What about targets? Do you agree with the BMA that local authorities should adopt health derived targets for increasing the amount of walking?
  (Mr Almond) My understanding of the BMA recommendations is that they are personal targets aimed at individuals in terms of increasing walking, and I would support that notion. If it is a personal target, we need something to measure it and what the British Heart Foundation and the Countryside Agency have done is start to use pedometers, which are extremely useful in terms of your question because they allow us to identify how many steps the person has taken, so we can realistically provide targets for individuals to meet and can have records of when that target is achieved. It is something worth pursuing because the evidence so far is that people are very interested and when they recognise just how few steps they take, they take efforts to increase their activity during the day, and very often they put in a good 30 minute walk every day when they recognise how few steps they take.

  164. Do you agree with the BMA that local authorities should adopt targets?
  (Mr Almond) I think local authorities should recommend personal targets so people are aware of what is in their own interests.

  165. Do you agree that local authorities should set targets for their area?
  (Mr Almond) If they are going to be personal targets, I find that very difficult, because what I do not want to say—

  166. So you do not agree with the BMA then?
  (Mr Almond) No, I do not.

  167. Dr Crombie, do you agree with the BMA?
  (Dr Crombie) I am afraid I am not familiar enough with their recommendations.

Mrs Dunwoody

  168. No, you are not going to get away with that!
  (Mr Ashcroft) The BMA have suggested two sorts of different targets, targets for individuals related to their age, and targets for local authorities to measure in transport surveys. Both are very different elements. My own view is that all targets are useful because they can help to measure progress towards a certain aim and objective, and if local authorities had their own targets they could measure in their own traffic surveys, they would know if more people were walking to school or work, so I think an operational target helps to measure if you are making progress.
  (Ms Hamer) In local transport plans across the country, local authorities are setting or trying to set local targets, and a number of them are trying to do that around walking. Obviously, the more they can share good practice and be encouraged to do that, the easier it is for them. The most important thing about the targets is that they are worked out with the local communities in their areas on what is going to be meaningful to achieve and something they can measure. So there are some important principles about target setting, and they should not be blindly set across the country at a set level.

Mr O'Brien

  169. Do you agree with the BMA? We know the programmes are in place and we know the targets set by the Government, what I was asking was, do you agree with the BMA?
  (Ms Hamer) Certainly I agree that local authorities should develop their own local targets to support their work on walking.

  170. If that is correct, why is it the HDA in their evidence do not touch on children specifically, or indeed any particular age group? To what extent is it necessary for them to target particular groups?
  (Dr Crombie) It was necessary to restrict our evidence and there was a limit to the amount we could supply to the Committee. Certainly addressing children is an important issue. The HDA currently works through the National Health Schools Standard to promote physical activity in schools, and that takes a whole community approach, not looking just at PE lessons but including activities in the wider community and things like walking to school as part of that.

  171. So you do agree that we should be targeting children to try and change their habits?
  (Dr Crombie) Yes, to increase children's activity.
  (Mr Robinson) Certainly the Countryside Agency's experience is that it is very important to target old people and children as an age group. We work with SusTrans, which runs the Safe Routes to Schools initiative, and Kia Cars, which is a joint sponsor of the Walking the Way to Health Initiative, runs an initiative called Walking Bus which is about taking children to school, and it encourages children to get used to walking and gets cars off the road and encourages other people to use the streets when there are not so many cars around.

  172. How do you intend to get the message over to the health bodies and other organisations about walking?
  (Mr Almond) That is a real problem because if you take GPs, only 11 per cent of GPs actually recognise what the public health message is, so the Royal College of Physicians, the National Heart Forum and the British Heart Foundation are launching on March 18th a national promotion to reach every GP in the country, to alert them to the value of exercise and demonstrate how it can be done. The answer at the moment in terms of GPs is a very small number, but we are investing in that and that will be done very shortly.

  173. How effective do you think it will be?
  (Mr Almond) I think GPs value exercise but they are very busy people and do not adequately understand the messages we want to get over to people. The motion by the British Heart Foundation and the Royal College of Physicians will answer that problem and I think within a year that 11 per cent will rapidly increase.

  174. Will that need training for GPs?
  (Mr Almond) We have produced a training pack for GPs and practice nurses and that is a 30 minute training programme on physical activity. We are producing that to go on the internet as well.

  175. So you think it should be done through a pack given to the GP and no training in the form of people demonstrating or a help line on the need for exercise?
  (Mr Almond) With time constraints, we are devising strategies to deal with that problem, and our strategy is to reach every single GP in the country with the strategy and make them available and, if they want additional advice, we will provide it.
  (Dr Crombie) Some of the local HDAs have already done work. I mentioned the guidance on preventative aspects on the National Service Framework for Coronary Heart Disease. Although that is not specifically targeted at GPs, it has gone round to health professionals across the country and also to local authorities. We are also looking at how we can develop the guidance we put in there to be specifically relevant to primary care and how we can fit it into the sort of systems which primary care already use. They are increasingly, as you are probably aware, using internet technologies and that kind of thing and there are a lot of systems developing which provide them with information and guidance, generally speaking about clinical matters and about pharmaceuticals and that sort of thing. We are making sure that that includes the health promotion messages we want to add about physical activity and walking and the benefits and how to implement change and that kind of thing, which will be a very useful step forward.

Mr Olner

  176. Given that casualty rates for pedestrians for distance travelled are 16 times higher than for car users, how can promoting walking instead of car use be justified in terms of health benefits?
  (Dr Crombie) A lot of the measures we need to implement to get changes are going to be changes that address things like road danger or danger from strangers or whatever. There are a number of places which have made widescale changes to make it easier for people to walk, to be active, particularly places like York where widescale changes in the city have increased levels of walking and at the same time have decreased accidents overall, not just decreased accident rates.

  177. But has that increase in walking been done because York has had more tourists going through and it is nice and attractive to walk around York anyway? Have you any evidence that people are walking to shops and walking to work in York? Has that increased?
  (Dr Crombie) Walking to work has certainly increased.

  178. In York?
  (Dr Crombie) Yes.

  179. What about other cities?
  (Dr Crombie) I think generally speaking, no. Places which have put a lot of effort into changing their environment so it is supportive, do show changes and increases in walking rates.

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