Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 1 - 19)




  1. Today the Committee is taking evidence on the Comptroller and Auditor General's report on tackling obesity in England. It is a unique occasion, the first time, certainly since I have been Chairman, that we have had five departments appearing before us together. It shows the importance of cross-sectoral or joined-up government to address the issue we are dealing with this afternoon. We welcome Mr Crisp, Permanent Secretary at the Department of Health and Chief Executive of the NHS which takes the lead in formulating the policy on this considerable public health risk. I should also like to welcome the Accounting Officers of the four other major players across government, Sir Michael Bichard in his appearance after his valedictory, Mr Young, Department for Culture, Media and Sport, Mr Podger, Foods Standards Agency and Mr William Rickett from the Department of the Environment, Transport and the Regions. Welcome to all of you gentlemen. Let me start with Mr Crisp. The report tells us that there has been a doubling of the number of obese people in this country at the time when in Europe there has been an increase of between 10 and 40 per cent. Why are we so much worse than the rest of Europe?

  (Mr Crisp) The first point is that this is a worldwide issue and is really a very significant worldwide issue and no country yet has an approach to dealing with it which seems to be delivering.

  2. But we are the worst by the look of it.
  (Mr Crisp) No, if you look at the figures here it also relates to where the starting point was. If you look at the figures in one of the appendices you will see that even if we have come up, we are still behind Germany in terms of the prevalence of obesity and considerably behind the United States. This is a problem, particularly for the more affluent societies, though it is also in the developing world. We have seen a big increase: we are now more in line with some other countries. We seem to be following the same process as the States and that is why we need a very active set of measures to tackle it.

  3. You have not really given me a cause for this.
  (Mr Crisp) The cause of obesity is very much about change in lifestyle, it is about the over-mechanisation of modern life, people being much more sedentary, a diet much more rich in energy dense foods, changes in the way in which food is eaten away from the home, far more snacks and soft drinks and indeed alcohol. There is a whole series of things to do primarily with affluence and changes in lifestyle which are affecting us as they are affecting other countries. We may have started from a lower base than some of our European neighbours, but we certainly have a significant issue.

  4. That will be pertinent to the methods you adopt to deal with it. The C&AG estimates that it costs the National Health Service at least £½ billion to treat the consequences of obesity every year. Paragraphs 2.26-2.27 suggest that figure is actually conservative and that it is probably more than that. To what extent does this encourage you to give greater priority to the issue of obesity than perhaps you have in the past?
  (Mr Crisp) Obesity is implicated in a whole series of very major diseases and you pull out the cost there. It is partly the cost but also the effects on people's health which are also brought out in this report, both of which mean that we do need to give it a significant priority and, as the report also says, that is happening now. We have it within the NHS Plan, probably most significantly and in a most developed way in our National Health Service Framework for coronary heart disease which has moved on a bit since the time the research for this report was done but we do have within that a requirement that by April 2001, in other words now, every health authority should have a strategy for plans for dealing with being overweight and obesity alongside some of their other plans for health. We are tackling it in the same way as we are tackling smoking and other issues which cause ill health.

  5. You say that the target is for now. Has it been achieved?
  (Mr Crisp) We do not yet know. We do have an evaluation which is being started by the Health Development Agency to look at what health authorities have put in place and we shall be able to look at that over the summer. It is not a question of ticking a box and saying you have a strategy.

  6. Others may press you a little harder on that but let me move on to some specifics. The report identifies wide divergences in the way GPs deal with this problem. What action do you propose to take to ensure a more consistent and evidence-based approach by them?
  (Mr Crisp) There are three elements there. You mentioned the evidence-based approach. Firstly, we do need more research. It is not yet clear absolutely what works or what combination of factors works, so more research is needed and that is happening. The second thing which is happening is that we need to do more work on providing guidelines and advice for people as we know what works; there is some work going on around that. The third and most significant point is what I have already alluded to, which is that health authorities need to have plans in place for tackling being overweight and obese and that the main people who will be delivering that part of the strategy will be through primary care. It is a two-part approach: one part is the approach to prevention which is primarily with schoolchildren and fit adults; then the approach to people who are having problems or who are already obese needs to be led in the first place through primary care.

  7. Paragraph 18 of the Executive Summary notes that much of the cross-government work to promote physical activity is targeted at schoolchildren, which is very evident from Part 4 of the report. What are you doing to promote the health benefits of physical activity across the whole population? Adults really rather than just schoolchildren.
  (Mr Crisp) We have an inter-ministerial group working specifically on physical activity for children. We are waiting for some of the information to come from that group before we make a definitive decision as to how we would move forward with the recommendation which is in here about providing a strategy for all ages around physical activity. There is some learning to do from the children's activity but perhaps at this point I could bring in colleagues to flesh that out.
  (Mr Young) Certainly from the sport point of view we have deliberately focused on schoolchildren, not least because it is there that we can have most control because how they spend their time is less voluntary. Whereas in the twenty-first century you cannot tell adults what to do and how much exercise to take, with schoolchildren you can have a try at least at doing that. We have deliberately focused our attention on improving sport opportunities and exercise opportunities for young people in schools. The Government's sports policy as a whole goes much wider and deals with the enhancement of sporting facilities for use by all ages. We focused new additional money and attention on sport in schools but for example in previous sessions here I explained the Sports Council and Lottery funding scene and the huge improvement in sports facilities throughout the country that has caused. We are not restricted on adults but Ministers have definitely focused quite deliberately on schoolchildren.
  (Mr Rickett) There are strategies for encouraging walking and cycling across all ages; they are not targeted just at schoolchildren though some measures are targeted at schoolchildren. It is worth noting that the General Household Survey shows that walking is by far the most popular leisure activity for adults. There is scope.

  8. Paragraph 2.15 raises the question of barriers to participation of some groups and they talk about poverty and fears about personal safety. What are you doing to deal with that in some of these areas?
  (Mr Young) From the DCMS point of view—not that this is an unjoined-up answer—we ask the Sports Council in particular to monitor use of sports facilities by a number of groups who hitherto have considered themselves shut out or discouraged, including women's and ethnic minority groups, the poorer members of society, who hitherto have made less use of public sports facilities than other groups. We have set them a particular task of monitoring use of our new facilities and all facilities by those groups which will unfold as they report back.
  (Mr Rickett) Our strategy is to ask local authorities to bring forward local walking strategies and cycling strategies, taking account of personal security issues like good lighting on pedestrian routes and so on. We have issued guidance on "Personal Security Issues in Pedestrian Journeys" to help local authorities and guide their activities.

  9. Let me move on to the question of youngsters at school. What progress has been made, Sir Michael, by your Department to meet the stated aspiration of at least two hours physical exercise a week for youngsters?
  (Sir Michael Bichard) The statistics show that the time spent within the curriculum on PE has probably reduced a bit, but the time spent outside the curriculum has increased a bit. Earlier this year the Prime Minister committed the Government to an entitlement for every child to have two hours a week. That covers time spent in the curriculum and outside the curriculum. We are working with other departments on how that can best be achieved. There has been a very substantial investment in initiatives like schools sport coordinators where we expect to have 1,000 in place by 2004. One hundred and twenty million pounds are going into that. There is another substantial investment in sport, Champions, which is well-known sports people going to schools not to preach excellence but to encourage people to participate and raise the level of participation up to two hours a week. We are also investing with DCMS in a very substantial programme of multi-purpose arts and sports facilities across the country. A good deal of work is going into it but I accept that we have yet some way to go.

  10. Do you have figures on how far and how fast?
  (Sir Michael Bichard) We do have figures on how much time children are spending within the curriculum on PE. At Key Stage 1 it is one hour and 20 minutes, at Key Stage 2 it is one hour and 35 minutes, at Key Stage 3 we are up to two hours and at Key Stage 4 it drops down. One of the problems at Key Stage 4 is that some of the older children have not been keen to be involved in the rather more traditional team events. We are therefore giving schools and teachers a bit more flexibility as to the kind of provision they make available for older children.

  11. I am sure others will pursue that further. Let me move on to the DETR. How successful do you think the Department has been in ensuring that local authorities participate fully in making it easier to walk and cycle? You mentioned this briefly earlier but how successful do you think you have been with local authorities?
  (Mr Rickett) It is a requirement of the Local Transport Plan process that local authorities should produce local cycling strategies, local walking strategies, in partnership with other agencies and with bodies like schools, health authorities and so on. The local transport plans that they have produced all include these strategies and there is evidence of partnership working. There has been a history of increasing partnership working, starting perhaps with road safety and air quality, now moving more into physical activity. The Department collaborated in the publication of a document called "Making T.H.E Links", the transport, health and education links, to try to bring home to local authorities the importance of bringing these activities together.

  12. Do you have any quantitative measure of how much has been done by local authorities?
  (Mr Rickett) It would be quite hard to produce a single quantitative measure. We have done surveys of how far their strategies refer to joint working and it is a requirement of the guidance that they report annually on what they are doing and that should give us more information about how far they are actually working in collaboration.

  13. We may ask for data later but I shall come back to you on that one. Mr Podger, the point was made very well by Mr Crisp at the beginning that a lot of this comes down to the sort of food people eat today, high energy food basically. What is your agency doing with respect to the way food is marketed and labelled?
  (Mr Podger) The point you raised earlier about adults is particularly relevant. Adults who want to choose may in fact find themselves potentially defeated by labelling in actually exercising that choice. For that reason the Foods Standards Agency has a variety of initiatives which are currently ongoing which are designed to promote on a voluntary basis more helpful labelling for consumers in this country, but also to feed in to the revision of the European Community law which governs this area in the hope that will actually allow consumers to have access to labels which are more meaningful to them. I doubt it will have escaped the notice of any of the Committee that if you look at something which is currently labelled according to European regulations, unless you are a nutritional expert it is extraordinarily difficult to understand what is being said. I should say—and they should be praised for this—that UK retailers in particular have already introduced simple diagrammatic indications, for example of what proportion of your daily fat intake is contained in a particular product. We have encouraged the retailers to do this. We have a working party looking at clarity of labelling which will be reaching its conclusions this year, but also we are very much in touch with the European Commission who are in general sympathetic about the need to reform the nutritional labelling rules at the Community level so they are actually meaningful to ordinary people.

  14. Just as an ordinary consumer I notice that advertising things as 80 per cent fat free is a euphemism for 20 per cent fat. Can you discourage that?
  (Mr Podger) Yes. We do have voluntary guidance with the industry and we do specifically discourage exactly that kind of labelling which is worse than meaningless and in our view is actually positively misleading. We strongly deprecate that. Frankly, it is an issue of perpetual vigilance. Let me say that the food industry are not unresponsive, but inevitably from time to time they see commercial opportunities arising. It also worth making the point which is very relevant to this, that the Agency is also very concerned about the labelling of products which may be high in fat or sugar, but which are alleged to have some additional health advantage because they are fortified with vitamins and which we would perceive as being very misleading to consumers.

Mr Steinberg

  15. May I say that I have read a lot of reports over the last three years on this Committee but I think when I read this report I was more cynical about it than any other I have read? I do not deny that the Government have a role to play in this: obviously they have. Those who are fat and obese, other than some who are actually ill, mentally perhaps, I do not know, are really to blame because they indulge, they do no exercise, they sit on their backsides and just get bigger. Why is there such a movement to do something about it other than the fact that it costs such a lot of money? I suspect that if it did not cost such a lot of money, I would say let them get on with it.
  (Mr Crisp) From the health point of view it is the money, but if you take a single example, which is Type 2 diabetes, we think 70 per cent of that would be preventable if it were not for the levels of people being overweight and obese. That is a very considerable issue in health terms, let alone just economic terms. That is for people who are already obese.

  16. We have half the population overweight and one in five obese. That is their fault, is it not?
  (Sir Michael Bichard) If we believe that the education system, for example, is there to help people to a position where they can enjoy life, a healthy life and a decent quality of life, then at least in their school years we have a responsibility to help them to understand and the choices which will assist them in that and that really is what the problem is.

  17. Is it not a fact that the vast majority of people eat too much, they indulge, they do not do any exercise and basically it is their own fault?
  (Mr Rickett) That does not mean that the Government should not take any interest in that as a public policy issue. In terms of transport, clearly people have been driving their cars more. As car ownership rises we have seen an increase in people travelling by car and less by bicycle, foot or bus and it fits with our transport objectives to try to do something about that. It also fits with our objectives of trying to create better places for people to live.

  18. Is it not up to people to do something about it?
  (Mr Rickett) Absolutely; yes. The public policy issue is about providing people with choices and information so that they can make sensible choices.

  19. We will continue this theme. I am very suspicious about this dial as well; very suspicious. If I am reading it correctly, I am 28 BMI, which is two from obese. If this is the formula which is being used to calculate who is fat and obese, then frankly it seems to me that the vast majority of people who are talked about as being fat and obese are not actually fat and obese in the first place.
  (Mr Crisp) May I suggest that on page 15 the bit which is more worrying than that dial is chart 6 which actually shows that at round about 28 your relative risk of dying prematurely goes up sharply. That is the bit which worries me rather more than that chart. That is the issue for us in the Health Service.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2001
Prepared 20 August 2001