Examination of Witnesses (Questions 160
- 179)
WEDNESDAY 7 FEBRUARY 2001
DR HUGO
CROMBIE, MS
LUCY HAMER,
MR LEN
ALMOND, MR
TERRY ROBINSON
AND MR
PETER ASHCROFT
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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