Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 20 - 39)



  20. Last June I did a publicity stunt here and was told by the nurse to see my doctor immediately because I had a high cholesterol. I went to the doctor who told me I had very high cholesterol and that I would have to lose weight. I lost one and a half stone. If I had not lost that one and a half stone this dial would have made me obese. I am not obese. Am I obese?
  (Sir Michael Bichard) There are some questions we surely do not have to answer.

  21. What I am trying to say is that I suspect the so-called categories of people who are overweight and obese are not really as bad as we are making them out to be. I was advised to change my diet and I took the advice of the doctor. I changed my diet, lost one and a half stone and frankly found no difficulty in doing that. What annoys me about it all is that there is so much going on. For example, there are five of you here this afternoon, all on huge salaries, when it would be far better if you were back where you are supposed to be doing your individual departmental jobs. Here you are this afternoon, giving evidence to us on the basis of trying to get people to lose weight and do some exercise. Sometimes we do go over the top a little bit. Let us move on to Part 3 of the report which is probably the most important part of the report in my view, from paragraph 3.15 onwards. I was advised by my doctor what to do, but should this not be the automatic function of every general practitioner? We are told they only have five minutes now to see a patient but in that five minutes should they not be telling people in their surgeries that they are overweight and perhaps the best thing to do is diet to lose weight and do some physical exercise? Should that not be the role of the doctor?
  (Mr Crisp) The evidence presented here suggests that that is precisely what very many general practices do do.

  22. The evidence clearly shows that a lot of them do not; something like 60 per cent actually do not.
  (Mr Crisp) I take that point. You were maybe more fortunate in that you were able to lose weight relatively easily by the sound of it.

  23. It is not very easy, it is hard, but you have to change your diet and change your lifestyle, do you not?
  (Mr Crisp) Yes, but there are some methods of persuading people to do that which are perhaps more effective than others. If we are interested in making sure that we do reduce the burden on the NHS for obesity, we need to make sure that we are giving high quality advice and that it is advice which is followed.

  24. That is the point. Given the statistics in the report, only 40 per cent of GPs actually identified those patients at risk of being fat, two per cent did not even bother to do anything, so they saw a big, fat, obese person coming into their medical centre and they did not even comment on it, they just let them walk out. Seventy-five per cent thought they could not do anything about it and referred it to somebody else. That seems to me to be passing the buck and just not doing their jobs properly.
  (Mr Crisp) The new arrangements under the National Health Service Framework do require each health authority to have plans for tackling overweight and obesity issues and those will be primarily managed, in Health Service terms, through primary care. We have the plans coming in now; they were due to be in place at the beginning of April and that will no doubt require more and more GPs to be doing things in a routine way as you have described.

  25. It is not difficult, is it, when you see somebody come into the surgery who is overweight to tell them they should lose weight and how to do it? I can do that. I was going to be a doctor, but I did not have the patience.
  (Mr Crisp) I am sure identifying the problem is not the issue. The issue is how you deal with it. It describes pretty well in this report the fact that GPs say they could do with some guidance here. GPs are telling people to change their lifestyle. In the case of a strong-willed person like yourself, maybe you have been able to do it, but that has not always applied.

  26. For a doctor to say he needs some guidance on how to do it leaves me a bit astounded. The section clearly shows me that GPs are failing to do this. Are you saying this afternoon that health authorities are going to be instructed to inform GP practitioners and family care groups that they must take this much more seriously and they must give advice to their patients? Or are you just going to leave it to the doctors?
  (Mr Crisp) In effect that has already happened because health authorities have been charged with providing plans and those plans will primarily be around GPs, but not entirely, because they also link in with the departments represented by other colleagues here because the other side of this is more activity and more opportunities for activity and so on. We do now have a process which will involve all primary care trusts, all primary care groups and therefore through them all GPs, in a process of tackling these issues. It needs to be done professionally and well.

  27. The most important thing is to target children, is it not? It seems to me that to target adults and parents does not really work. There are those adults who are sensible enough to do what they are told but the vast majority say that they do not. Basically what you have to do is target children.
  (Mr Crisp) It is a twin-track approach but that is a very significant part of it.

  28. Recently we saw in the newspapers and on the news the most ridiculous case—perhaps you do not want to comment on it—where a head teacher sent a note home to a child's parents because the little girl was obese and the parents were immediately up in arms, called the press and said it was a violation of human rights and all this rubbish. How do you change people's views and lifestyles who have attitudes like that?
  (Sir Michael Bichard) One of the things you do is to encourage head teachers to have the courage to do that if they really feel there is a problem. I feel that head teachers should do that.

  29. You feel they should step in.
  (Sir Michael Bichard) Absolutely; yes. It is something which has to be done sensitively and carefully, but it does need to be done in certain situations. The head teacher or teacher does have a pastoral responsibility towards the children in their care and if they become so concerned about a child that they believe it is affecting their quality of life or their ability to be educated, then they should quietly and sensibly mention it to the parent.

  30. We really have to educate children so when their parents say they are going to take them for a treat to McDonald's the child is intelligent enough to say it is not a treat to be taken there and in fact it is somewhere which could eventually kill them if they have enough over the years. What is the Food Standards Agency doing about this when it is clearly bad for health to go to these fast food places?
  (Mr Podger) We should be careful about saying that it is always bad for health to go to fast food places.

  31. It is.
  (Mr Podger) No, with respect, it is not good for your health to continually eat in fast food places and there is a distinction which is very important for this debate. Individual food is not actually harmful, it is the balance of the diet you have, both in childhood and later, which matters. You are absolutely right though, and I agree with you, that one of the issues the Agency is very carefully looking at, which is very relevant to what you just said, is the issue of advertising aimed at children in relation to food and whether in fact that conveys a proper picture of the results derived from eating that food or not. It is worth making the point that 99 per cent of advertising aimed at children on Saturday morning, which is obviously a peak TV viewing time, appears to relate to foods which are high in fat, in sugar and in salt. That indicates there is a problem there and it is partly about feeding into the education programme where steps are being taken. It is partly undoubtedly about educating parents and it is also about trying to persuade the food industry, which we are also seeking to do, to adopt slightly more responsible approaches.

  32. That was the question I was going to ask next. What action are you taking against these food manufacturers who do supply this sort of food? How are you encouraging other food manufacturers to provide food which is healthy, less fat, less salt, less starch, whatever it is? Are you doing things to encourage that?
  (Mr Podger) We are. The first point I would make, which if I may say so is relevant to your previous question, is that we should not underestimate the extent to which people actually want to change their diet. With respect, I do not think they have all been as successful as you have been, but you only have to look at the extent to which people engage in particular diets, buy supplements and so on, to show the extent to which people would like to change. What follows from that very clearly is that we need to persuade the food industry—and we have been doing this—that there are real market opportunities and real public demand for products which are reformulated so they do not have the adverse effects you are pointing to. There is some evidence for example in Scandinavia that you can change products from being high in saturated fats to low in saturated fats whilst actually retaining their appeal to consumers. We do have discussions which we have initiated with the industry on salt and fat and sugar precisely with a view to trying to persuade the industry to make further changes.

  33. Why does the DfEE not also take some sort of tough measures? Why do you not, for example, ban companies or organisations which get into our schools to sponsor things such a Walker's crisps and these sorts of people? Why are they not banned? Why for example do you give local authorities and schools the choice and not suggest what sort of foods they provide? Why do you not say they cannot serve this in school meals, they have to serve so and so and so and so which are healthy foods?
  (Sir Michael Bichard) One thing we need to remember is that there are very few bad foods: it is a bad diet we are concerned about, it is the balance of the diet. Therefore we should be reluctant to ban, in those terms, a particular food, crisps or whatever. What we are trying to do is educate children on the choices which are available and the implications of having a badly balanced diet on their health. We are trying to educate parents at a much earlier stage, through things like the Sure Start programme, to understand the importance of these choices and we are trying to ensure that in the schools there are nutritional standards which are applied. On 1 April we just introduced nutritional standards for the very first time in 20 years in this country, minimum standards which we expect to see applied in schools and which we will randomly monitor. We are doing quite a lot to educate people but not banning particular foods.

Mr Burns

  34. Sir Michael, may I just pick up an area slightly at a slant to what Mr Steinberg was just raising and draw your attention to an earlier answer you gave where you said that head teachers rightly have a responsibility, if they are concerned about a child being obese and their performance and health being affected at school, to draw it to the attention of parents. I suspect no-one would disagree with that view. Is there not a slight conflict of interest in that more and more schools in this country are gaining sponsorship and other benefits from crisp manufacturers and soft drinks vendors installing vending machines in schools? Is that not a conflict?
  (Sir Michael Bichard) The decision as to what sponsorship schools accept is a matter for schools. Guidance has been produced by the National Consumer Council which is now being updated by the NCC and the Consumers' Association with our help. One of the things that asks schools to reflect upon before they accept any sponsorship or allow the sale of products in their school is whether or not the governors are happy for those things to be consumed, whether they are happy for the product to be consumed. At the end of the day it is a matter for schools.

  35. It is certainly a matter for schools if you are talking about the narrow legal definition, of course it is. However, is the principle not contradictory if one is encouraging on the one hand products to be readily available in schools in return for sponsorship in whatever shape or form that conceivably have an adverse health effect and encourage obesity amongst children consuming the product?
  (Sir Michael Bichard) I go back to the point Mr Podger was making and I was underlining: if all you ever eat are crisps then you would have a problem, but crisps are not by definition a bad food. What we should be targeting are bad diets and we should be educating people to understand the importance of a good diet. That is what we are trying to do. It is for individual governors, individual schools, to take a view on whether they are doing that effectively and whether or not they are content for particular products to be sold in the school to their children or content to accept particular forms of sponsorship. People would be pretty concerned if we were to dictate from the centre on an issue like that to every school in the country.

  36. I do not know whether you have had an opportunity to see the Health Select Committee report recently published on public health which in some way overlaps this report because it deals with sport and the role that sport has to play in enhancing the health of the nation both amongst children at school and also adults. Is there not a slight anomaly that the Government involvement in sport and encouraging sport is placed in the Department for Culture, Media and Sport and not in the Department of Health? Surely if you see a key role of sport as to enhance a healthy lifestyle, then surely the Department of Health is the better Department to sponsor and spearhead that than the DCMS?
  (Mr Crisp) An enormous amount of cross-governmental work is going on around sport. We are engaged with the Department for Culture, Media and Sport on a whole set of issues to do with sport, dealing with sport strategy, the Government plans for sport, so we are working across anyway and you always end up with boundaries somewhere.

  37. Have you read that report?
  (Mr Crisp) Yes, I have looked at it.

  38. And the section on sport?
  (Mr Crisp) Yes, I have read it.

  39. We were a bit surprised by the evidence from the Minister for Sport who seemed to suggest that she did not have much liaison with the Department of Health.
  (Mr Crisp) There is a considerable number of areas where we do work very closely together and instances are given in this report as to where we do that. I am not sure that the placing of where the particular departmental responsibility lies particularly affects that.
  (Mr Young) On the issue of which Department is responsible, sport in this country has moved around between ministries. Some years ago it was in the Department of the Environment, it moved at the end of the last Government[1] to the Department for Education and then to the Department of National Heritage as it then was and is now DCMS. Just as a matter of interest I have checked, having seen the Health Committee's report, with the other EU countries. Only two of them, the Netherlands and Belgium, have accommodated sport within their Health Ministry.

1   Note by Witness: The move happened in 1990, not at the end of the last Parliament. Back

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