Health Promotion Bill [HL]
Friday 2nd December 2022
(2 years ago)
Lords ChamberHealth Promotion Bill [HL] 2022-23 View all Health Promotion Bill [HL] 2022-23 Debates Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Addington (LD)
My Lords, this Bill is one I have come up with with an almost total lack of original thought. This is because it is taken from a combination of a good idea that the Government came up with, but then slightly back-pedalled from, and the recommendations from a committee that I served on with many of the other people here, which was chaired by my noble friend Lord Willis. It was called—let us get this right—the National Plan for Sport and Recreation Committee and it called for that national plan. The proposal here is that two ideas are combined: to have somebody who combines active public health with a national plan for sport. Why? Quite simply, it is because exercise is the wonder drug.
It is the wonder drug that does not just affect your physical health but, done correctly, usually supports your mental health. This is something we can do and something the public have already bought into on a massive scale—so much so that the Government are often let off the hook because most of our sporting establishments were made without government help, fund themselves and allow sporting activity to go on. Indeed, the national sports—football, rugby or cricket; you name it—provide quite a lot of the funding and government is a late player to this field.
I am calling for the Government to come in and take their fair share of the weight because, so far, they have not. They have allowed the old boys’ club or the old works team to provide the physical activity. Allowing them to do it means that amateur sport, which is what we are talking about solidly here, is something provided by people going into their own pockets to help others and using their own time to make sure it happens. That is one reason why I feel the Government have been let off the hook here. If you are running your local team and playing in it, giving X nights a week and your weekends to it, you are probably not interacting with a political process that keenly because there are only so many hours in the day. The same, by the way, can probably be said of the arts.
Government really should have done more; in most other places, it does. I remember the FA talking to its German counterparts and when it said, “We spend a lot of money on maintaining pitches”, the German response was apparently, “That’s a local government duty.” In France, you play at the stade municipal. I hope the Government will say, “We’ve got to get more involved here.” Now, I am sure the Minister has a brief in front of him that says, “There are lots of initiatives here. Departments will talk to each other because several committees will sit down to do this, so we’ve got lots of initiatives.” That is the answer I would have got 30 years ago. It is quite clear that, while they may have talked to each other, of decisions and cohesive action there have been little.
I could run through all the provisions in the Bill. It would not take that long but would rather try the patience of everybody here. If I can read them, I am sure we can all go through them. I would have claimed to be one of the most out dyslexics in public but I believe there is currently someone in the House of Commons challenging that position. I have two favourite provisions in the Bill: the inclusion of
“measures to promote physical access to the countryside for sports and recreation”
followed by the linkage between schools and clubs. Both depend on action across the board with local government and the departments for education, agriculture and transport all talking together.
Clause 2 has seven lines, which, as they stand, are probably more important than any other individual subsection, and say that government must work together. For instance, if we want to get the best out of our recent innovation that farmers will be helped to create footpaths, are we making sure that these footpaths are linked to traditional foot-pathing walks and that there is access to somewhere you can park a car or, better still, catch a bus to them? Would there possibly be some village where you could get a meal or a drink afterwards, and make a day out of it? That requires a huge co-ordination of government and unless you have something that drives it forward, you will not get there. We would be back to hearing, “This committee wants that”, and then there is the lobby. The less said about the planning or maintenance of a footpath, the better, because that has never been a happy story. How do you get that access out there?
On schools’ links to other bits of amateur sport, it does not matter if a headmaster has a row of trophies for various sports outside his room, because those children will be gone if they do not play the sport later on. A school should get awards for filling second and third teams in all of the local sports around it, not for winning the odd trophy, because that is where the benefits of social interaction and mental and physical health come in. We are rather too fond of saying, “Oh, we won something”. Many of us here were champions of our schools for something or were great debaters at the age of 11, 12 or 15. That does not matter; what matters is if you do something with it later on. It is just a tick along a pathway, but the pathway itself is important.
I declare an interest: I have played rugby union for probably far too long. My physiotherapist is probably quite happy about that. I advise everyone to read the House magazine for a report of the Commons’ and Lords’ most recent rugby matches. It is true that the photographs with it are from another match, but it is there. I will give a little commercial: anyone who is a passholder and has any knowledge of the game or would like to acquire a strange knowledge of it is welcome to participate. Golden oldies’ rules allow this.
Having done the commercial, I will come back to the serious matter here. Unless you co-ordinate better, you will not facilitate this. Public health starts with clean air and water, which have certainly saved more lives than penicillin, although it was pointed out to me not a few moments ago that penicillin is also a good thing. We have to have some form of co-ordination. You have something that benefits society holistically, if you allow it to happen properly. If someone is going to move a clubhouse from inside a small town to outside it because there is a wonderful development deal, make sure that there is a bus route, or at least a cycle path, to it. Why? Because you will not have an under-18s team when their parents get fed up with ferrying them around, or possibly cannot do so. If anyone wants an example of that, I can provide a list that goes on and on.
Let us get some coherent leadership from government here—not a series of diverse initiatives and schemes, but a coherent plan. You will have to upset someone and upset government a little bit, but, unless you do that, you will not get the best out of all of this. It all comes together under the heading of public health and improvement of our society. I hope that the Bill will be given a fair wind by this House.
Lord Lansley (Con)
My Lords, I am glad to follow the noble Lord and to welcome his Bill, not only because I agree with its content but because it affords us an important opportunity to discuss how we might improve public health through not only legislation but local, voluntary and community action. I declare an interest: I have a long-standing relationship with ukactive. In that context, I mention the recently retired chair of ukactive, our own noble Baroness, Lady Grey-Thompson, who participated in the debates about a national plan for sport and recreation to which the noble Lord referred. I thoroughly endorse what that committee had to say and the purposes of his Bill.
I will go a bit wider in the public health context and talk about the structure of support for the promotion of public health in this country. Noble Lords will recall that I was responsible for health in the coalition Government for two and a half years. We published the Healthy Lives, Healthy People White Paper in December 2010—exactly 12 years ago—and if anyone wants to see my prescription for public health, they still only have to look at that. It followed and reflected Sir Michael Marmot’s ground-breaking work on the social determinants of health and a “life course framework” for working on public health issues.
The Government have recently talked about the importance of preventive work through the NHS, which I thoroughly endorse. But, although preventive services are a key priority for the NHS, they are not a substitute for a government-wide and societal focus on improving public health. Inequality, poor housing, environmental quality—we discussed this on Third Reading of the clean air Bill—and, not least, economic disadvantage are the major social determinants of health. They require Governments to provide leadership, resources and structures to help us improve public health across society.
This was the originating purpose of Public Health England, which pursued both this agenda and the complementary tasks of combating the key risks associated with poor mental health: tobacco and smoking; obesity, both in terms of diet and activity; air quality; drug misuse; and sexual health. The then Government brought forward plans to address each of those causes of poor health. For example, my noble friend will, I hope, tell us that a tobacco control plan renewal will not be far off.
This was not done at the expense of the health security functions, in respect of which UK expertise was, and is, internationally recognised. For example, in the year following the White Paper, the pandemic flu preparedness plan was published. However, within two years of its establishment, Public Health England’s capacity to meet its responsibilities was progressively limited because of budget cuts and staffing limits. From 2015 onwards, local government’s public health grant was cut by £200 million, and Public Health England saw a 40% reduction in its real-terms funding, reducing its capacity by a quarter.
The classification of Public Health England as not part of the NHS was wrong at the time and a mistake in public policy terms, and in the pandemic we paid for the results of that mistake in lives and many billions of pounds. Public health policies should seek to address both communicable and non-communicable diseases. The pandemic demonstrated, not least in this country, the interaction between vulnerabilities to infection and the effects of chronic disease in the population, often as a result of smoking, poor diet or inactivity.
The resulting division of Public Health England into two organisations is therefore a mistake. The perceived reduction in the independence of the Office for Health Improvement and Disparities, compared with Public Health England—although both are in fact executive agencies directly accountable to the Secretary of State—is also a mistake and risks undermining future responses to public health challenges, not least by failing to engage and mobilise local government. During the pandemic, we saw how important this was and what might have been, had the Government engaged it more fully at an early stage.
The scapegoating of Public Health England, which in reality resulted from a lack of investment in it, should be called out in the coming public inquiry. Public health should, like tackling climate change, be a priority across government, with leadership from the top and dedicated funding. I believe that Public Health England was the right structural approach, as was the transferring of public health responsibilities to local government. We lose tens of thousands of lives prematurely every year because of smoking, alcohol abuse, poor diet and inactivity. During the pandemic, deaths in all of the older age groups were much exacerbated by obesity and diabetes.
So improving our public health, including by enhancing our environments, reducing inequalities, increasing physical activity and reducing average calorie intake—with less alcohol abuse and drug misuse, and stopping smoking—would be central to our future health security every bit as much as the investment in surveillance and the response to infectious diseases. There is a case not only for the changes proposed in the Bill, but to go further and reintegrate the public health function in an agency that leads for this purpose both across government and in society.
Lord Crisp (CB)
My Lords, I welcome this Bill and congratulate the noble Lord on promoting it. I very much support the focus on health promotion, physical activity and cross-government action. After all, the department is called the Department of Health and Social Care and not the department of health services and social care, and the noble Lord is the Minister for Health and not just health services.
Like the noble Lord, Lord Lansley, I will also be widening the debate slightly. I am particularly pleased that the Bill widens the debate on health. Too often, we talk just about health services and healthcare, and sometimes prevention, but we almost never talk about the third important area of creating health, of which health promotion is a part. All three are important and essential.
All of us understand what we mean by healthcare but it is important to distinguish prevention, which is about the causes of disease, pathogenesis and pathology, and about activities focusing on, for example, heart disease, stroke, cancer and tackling air pollution, and health creation, which is about the causes of health, salutogenesis, but not the causes of disease. I describe this as creating the conditions for people to be healthy and helping them to be so. Those causes include, for example, opportunities for social interaction; healthy working environments and development; being in touch with nature; having a meaning in life; relationships of all sorts; being well-fed and well-housed; the agency to act and decide, as opposed to alienation and anomie; and self-respect. We want healthcare, the vital services of the NHS, and the approach to prevention that this Government are moving on, but we also want the positives of actively creating health.
I have often quoted in your Lordships’ House the saying from a great Ugandan doctor:
“Health is made at home, hospitals are for repairs”.
Indeed, I know that the former Minister, the noble Lord, Lord Kamall, has quoted this back to me on occasion. It is a very valuable point. It is why I talk about a health-creating society and why I am promoting the Healthy Homes Bill. The first time I raised this in your Lordships’ House was in a Cross-Bench debate on 26 November 2015, when I moved that this House takes note of the case for building a health-creating society, where all sectors contribute to creating a healthy and resilient population. There were many powerful speeches from all sides of the House. I believe we need this even more than ever, and that we are not going to make progress on health unless and until we recognise that creating health is as important as disease prevention and healthcare. Obviously, there are links and overlaps, but let us recognise these very important distinctions.
It is also worth noting that health creation operates at four levels: the health of each of us as an individual is intimately connected to the health of the local community in which we live, to the health of wider society and to the health of the planet. I will think about this while turning specifically to the Bill and its focus on health promotion and sport. Health promotion as usually described is generally about the individual, lifestyles, activity and diet. It is also about the important point that the noble Lord, Lord Addington, made about walking, rather than physical activity in general, which has been recognised since the Greeks as being vital to health. As the noble Lord pointed out, what he is proposing is also about sociability and bringing people together, creating purpose and creativity. I am pleased to see that he has included nature in the Bill. It is also about self-respect, being successful and achievement. All these factors are for the individual as well as for communities: bringing people together, sharing and community facilities. It is also about opportunities in a wider sense, and sport has long been a driver for social mobility. As he has drafted the Bill, it is also about the planet, nature and the environment.
I commend the noble Lord for the Bill, with its focus on health promotion, sport and wider physical activity, and for promoting a national plan for sport. This is not the whole story—of course it is not; he does not present it as if it were—but it is a very important part of a health-creating society. As he said very eloquently in his speech, the public get this; this is a win-win because people will understand why the Government, in creating a health-creating society, are promoting sport in this way.
I ask the Minister whether the Government will recognise that they need to think about three distinct elements of health—health services, prevention and health creation; each distinct but linked to the others—and whether they will promote health creation. Finally, I say to the Minister that many people and groups around the country are actively involved in creating health. Would he be willing to meet representatives of the Health Creation Alliance, which brings many of these groups together?
Baroness Uddin (Non-Afl)
My Lords, it is a pleasure to follow the noble Lords, Lord Crisp and Lord Lansley. I applaud and thank the noble Lord, Lord Addington, for his leadership in pursuing this debate.
Like many noble Lords, I have spent a lifetime trying to improve health and social care in my backyard, alongside the work we do in this House. It would be remiss of me to not acknowledge the immense results we achieved back in the early and mid-1980s, which saw great improvements, particularly in perinatal and postnatal mortality rates, immunisation and breastfeeding. Most of those changes are under much stress now, adding to the improvements required in maternity services, which need urgent attention, and to the gross disparities we have talked about in this place and elsewhere on health and well-being, as well as air pollution, mental health and long Covid, particularly for those people living with disabilities and from minority communities.
Alongside this, the dissatisfaction rate among the general population for our GPs and much-beloved NHS and A&E services suggests that services have become inadequate. There is a lack of good quality maternity services, with women unable to receive adequate care during pregnancy, childbirth and postnatal care; one can see the trajectory of the health and well-being deficit in the family being set very early on. This is worsened if there are disabilities, mental health and care needs, in addition to the bullying, racism and discrimination within the system and which staff experience. If this is embedded in the services, is it any wonder we are facing this crisis? If noble Lords are minded to underestimating the effect of racism within institutional structures, I ask the Government to speak with Dr Chaand Nagpaul prior to setting up the new office proposed in the Bill to ensure that we do not just consult but involve those who have a track record of achieving changes within communities, even with restricted and constrained resources.
The Health Promotion Bill contains potential and important milestones to achieve better services. However, I would like us to pay the requisite attention to ensure that the issues of workforce balance, leadership in commissioning and senior management, and board representation are given equal attention and support. I welcome this Bill and agree that the national plan must be integrated, as has been said. What it does not explain is how we will set and benchmark standards, how implementation will be monitored, or how this will be embedded within the equality framework. This must be based on an absolute commitment from the Government to address workforce balance and leadership in commissioning and senior management. This must be a perquisite to the changes that are required.
This new office can flourish only with the determination of better collaboration which integrates sufficient resources and a commitment to achieving this, and by placing at the heart of any changes the service users and leadership which reflects all the communities in which these services are based.
Lord Kamall (Con)
My Lords, I congratulate the noble Lord, Lord Addington, on securing time to debate the Private Member’s Bill. I approach this debate with three words in mind: apathy, sympathy and empathy.
Let us start with apathy. During the debate on the then Health and Care Bill, I reassured your Lordships of the Government’s commitment to a national plan for sport and physical activity, and that it would be published later this year. I also informed noble Lords that the Government were working across departments—and I referred to the health promotion task force, led by the Health Secretary, and pledged to keep your Lordships up to date on the progress. I believe that it was this commitment that convinced my noble friend Lord Moynihan to withdraw his amendment.
Unfortunately, in response to a recent Written Question, the Department of Health and Social Care explained that the health promotion task force was not a part of an updated Cabinet committee structure. To be fair, the Answer also explained that the Government’s Our Plan for Patients would address preventable ill health through collaboration across government and the National Health Service. However, it gives the impression that the Government’s approach to health promotion now appears to be one of apathy—or, perhaps more kindly, lethargy. One of the ironies is that part of encouraging physical activity is to overcome individuals’ apathy. Whatever the true picture, I am afraid that there is now a perception that the Government cannot be bothered to take health promotion seriously. I hope my noble friend the Minister will be able to address this perception head-on.
However, this is where I also feel sympathy—indeed, sympathy for my noble friend the Minister, since none of this is his fault. These decisions were made way above his pay grade. While noble Lords can attach no blame to him I hope that, by challenging the Government in this debate, they will empower him to raise your Lordships’ concerns with his department and across government.
My disappointment at the Government’s apparent apathy and my sympathy for my noble friend the Minister leads to my empathy, since I completely understand and share the concerns of the noble Lord, Lord Addington, in bringing forward this Private Member’s Bill. I share the noble Lord’s concerns about the lack of progress, but I am afraid that I will have to respectfully disagree with some of his Bill. One reason why I welcomed the establishment of OHID is because I hope that having the word “disparities” in the name of the organisation will force it to do what it says on the tin—that is, to identify and address health disparities, as the noble Baroness, Lady Uddin, said. This reminds me in some ways of the debate when many noble Lords asked for mental health to be explicitly on the face of the then Health and Care Bill, even though health is generally understood as both physical and mental health.
Whether we term it health improvement, health promotion or health creation, I know that noble Lords agree that it is important, but I hope that we can move on from the debate around health improvement, which seems sometimes to be reduced to the question of whether you burn off calories versus reducing calorie intake. It should not be a question of either one or the other. We can argue about the data and whether reducing calorie intake is more effective than physical activity, but surely the important thing is to encourage both. Indeed, some believe that physical activity may lead to less calorie consumption. A 2019 article in the International Journal of Obesity concluded that
“15-week exercise training appeared to motivate young adults to pursue healthier dietary preferences and to regulate their food intake.”
But everyone is different. There are also studies of people with eating disorders doing excessive exercise followed by binge eating, so we really need to understand it at the level of the individual.
I think that most noble Lords would agree that we should all do more to encourage physical activity. Fortunately, a lot has changed since my youth, when it was about selecting the best and forgetting about the rest. If you did not make the first or second team, you were more likely to be discouraged and give up. Unlike the noble Lord, Lord Addington, I am unable to refer noble Lords to the register of my interests, although I really wish I could for this debate. I was still playing five-a-side football into my 50s and playing with people 30 years younger, and my wife expressed some concerns. I needed allies, so I went to see my physiotherapist, hoping that she would be my ally, and she said, “I’m afraid I agree with your wife—you should give up playing football with people 30 years younger than you.” But that does not stop one from doing physical activities. Nowadays we see more clubs in local communities encouraging people to play sport, no matter their ability. We also see an emphasis on physical activity rather than just sport, encouraging individuals to find the physical activities that they enjoy the most—or perhaps dislike the least.
During my brief time in the Department of Health and Social Care, I became interested in the idea of social prescribing, helping people with physical and mental health conditions through the power of music, the environment, arts and physical activity. I recognise that there is scepticism from some clinicians, but I have heard of so many positive stories of people for whom it worked. But with an ageing population and increased pressures on the state, we should also remember that the state cannot do this all or alone. We need to encourage more local neighbourhood civil society groups, which better understand the people in their local communities. By asking the Government to be more involved, we should be wary that they do not squeeze out civil society but better co-operate and co-ordinate cross-government initiatives in partnership with it.
To sum up, I am disappointed by the Government’s apparent apathy in promoting better health. I sympathise with my noble friend the Minister, since none of this is his fault, and I empathise with the noble Lord, Lord Addington, and his frustration at the lack of progress, even though I disagree with renaming OHID. I end with a question to my noble friend the Minister. Now that the health promotion task force no longer exists, how will the Department of Health and Social Care drive cross-government action to improve health outcomes?
Baroness Randerson (LD)
My Lords, I thank my noble friend for his work on this invaluable Bill. I concentrate on the issue of sport, and general physical activity and its importance. I want to praise the Bill’s emphasis on the importance of a cross-governmental approach.
Not surprisingly, given my remit in this House, I start with transport. It is no good encouraging people to participate in sport if they cannot access the facilities because there are poor or no public transport links. This issue applies in particular to young people. For example, at the end of the school day it is common to have sports clubs but, if you are a pupil who relies on the school bus to get home, you miss that school bus if you stay for the sports club. You then have to rely on the regular, scheduled bus service and, if it does not exist, you have no choice but to fall out of regular sport and of attending the sports club. That is one of the commonest reasons in schools why children stop participating in sport.
It is also very important that local authorities develop good, safe and active travel routes for cycling and walking. At issue is not just the existence of public transport facilities but the cost. If the bus fare is too expensive, young people and adults are not going to be able to afford it. There has to be cross-local government thinking on this.
I also emphasise the importance of location. A sports club being in the centre of a town or city is often much more important than the size of its pitches. It is where it is that is so important, rather than how big it is. I give you the example of my own home city of Cardiff which, because of a wonderful donation hundreds of years ago by the Earl of Bute, has an enormous park in the centre. There is the Sport Wales National Centre, Glamorgan Cricket Club and rugby facilities in the centre of the city, all within a short walk of the Central station and near where all the buses start and stop.
My second point relates to my time as Sports Minister for Wales from 2000 to 2003. We started work on a sports and activity strategy specifically linked to promoting good health. As part of that work, we did an analysis of grant funding from what was then called the Sports Council for Wales. On the face of it, it all looked okay. We did proper due diligence, and officials checked that the money had properly been spent, and so on. There was nothing suspect or dubious, such as VIP lanes. However, I could immediately see, at a glance, that it was badly skewed towards football, rugby and cricket—male-dominated sports—and very often to areas that were more prosperous. A proper alternative analysis showed that the vast majority of money went to men and boys’ sports clubs which were well established and had buildings, facilities and pitches of their own, and so on.
So, on equality issues, Sports Council funding failed women, girls, young people, people in poorer areas and people with disabilities. It also failed newer sports and their development—the sort of thing more likely to bring in a wider range of people. In other words, it failed the people and communities who needed it most. We therefore had to rethink the whole thing, putting equality at the centre of it and making sure that we addressed the issues of capacity to make bids and so on. We set up a small bids fund for small amounts of money, for example. I emphasise, therefore, the importance in Clause 1 of the reference to tackling discrimination. That is a key part of this Bill.
Finally, the Bill states in Clause 3 that it extends to England and Wales. I raise this question with my noble friend, because health, sport, education, transport, housing and local government are all devolved to the Welsh Government and Senedd. It is therefore important that we take into account that there is variability across Wales, and that this would need a legislative consent Motion from the Senedd if it were to become law. I will end with this thought: Wales is small enough to be a very good pilot project for this way of thinking.
Lord Moynihan (Con)
My Lords, I refer my interests as set out in the register. I congratulate my noble friend in sport, the noble Lord, Lord Addington, on securing this debate and introducing a Bill that seeks to take forward one of the main recommendations from the House of Lords National Plan for Sport and Recreation Committee. The noble Lord has made a strong case for the measures contained in his Bill, which builds on then Prime Minster Boris Johnson’s commitment that the new office for health promotion, which began work earlier this year, should tackle the causes, not just the symptoms, of poor health and improve prevention of illness and disease.
As we have heard in earlier deliberations on the subject in your Lordships’ House, the then Minister, my noble friend Lord Kamall, who did an excellent job in government, emphasised the Government’s commitment to developing a national plan for sport and physical activity, informing the House that it would be published “later this year”. As he would agree, and indeed accepted very honestly in his contribution just now, we are fast running out of time. One reason, which the committee recognised, is that, departmentally, sport lies on the fringes of the Whitehall machinery. The case for sport and recreation to be moved to the Department for Health and Social Care has once again, this year, demonstrated that we need a concerted, co-ordinated and cross-departmental effort, placing sport and recreation at the centre of a proactive health policy. The benefits are clear to your Lordships, but that has sadly withered on the political vine.
We may have hosted a great Olympic Games in 2012, yet we have not, beyond even the imaginations of the most optimistic observers, been able to deliver a sports legacy for this country. One-third of the adult population receive less than two and a half hours of moderate activity per week and schoolchildren face unprecedented levels of obesity and inactivity, with PE marginalised and woefully inadequate primary school training for teachers—less than three hours in a three-year course. That has all combined to the point where the chair of our sport and recreation committee, the noble Lord, Lord Willis of Knaresborough, concluded in this House that we have become
“one of the most lazy, inactive nations in the modern world.”—[Official Report, 4/2/22; col. 1208.]
So I would like to put a number of questions to my noble friend the Minister today. I accept that he is not responsible for enacting the outcome of these questions, but it is an opportunity for the House to hear the reasons why we continue to slip further behind countries around the world in promoting participation in sport. None of us is talking about elite sport; we are talking about participation. It is there where we need to develop measures to ensure that sport and recreation facilities operate as safe and non-discriminatory environments. We need a healthier, more proactive population, yet we have dropped the clear benefits of implementing the Prime Minister of the day’s full commitment to establishing an office for health promotion, to place prevention through an active lifestyle in all its connotations at the centre of our approach to the National Health Service.
I therefore ask the Minister: what work has been undertaken by the DfE to increase the number of schools making physical activity facilities available to communities after school, at weekends and during the school holidays through the opening of school facilities programmes? How many schools have built closer and reciprocal links with local, grass-roots sports clubs? Where is the physical activity facilities strategy, capable of improving everyone’s access to opportunities to be active? Can the Minister report on whether we have doubled the Sport England local delivery pilots this year —or can he at least indicate what progress has been made on this fund? Have the Government moved forward with the healthy schools rating scheme, strengthening the physical activity elements, improving the response rate and increasing its visibility and use among schools?
Does the Minister agree that the DfE should pursue a six-sports pledge to promote the ambition that all children experience at least six different types of sport and physical activity through curriculum PE, extracurricular and out-of-school provision? Why did the Government drop the idea of introducing a summer activity challenge, linked to schools and holiday provision, and creating a 10-week summer activity programme this year and beyond for every school child, not just the enthusiasts? What additional active travel interventions have been delivered this year to promote health and well-being in society as a whole?
What is the current status of social prescribing—admirably referred to by my noble friend—and how successful have the pilots been? Is it the intention to roll these out nationally, because they should be? What is the current level of cycling training programmes for children, which was announced over a year ago? Has Bikeability reached its objective of widening participation from its baseline of 60%? What has been done to embed active design principles into national planning guidance as part of the review of the National Planning Policy Framework?
These are just a few of the vitally important areas that my noble friend in sport—as I always refer to him—the noble Lord, Lord Addington, seeks to embed in his legislation into the office for health promotion’s activities. Can the Minister report why sport and recreation are still on the fringes of government? Why has this portfolio not been moved to a department of state, in this case the Department of Health and Social Care, and why are we destined to reflect that, despite the cross-party support in your Lordships’ House, we meet today, 10 years on from the hugely successful London Olympic and Paralympic Games, having failed to take forward a true sports legacy?
The Bill of the noble Lord, Lord Addington, is not only necessary but signals to the Government the need to act—if it is not already far too late. I wish my noble friend the Minister well in persuading his colleagues and ensuring that the current Government deliver on the undertaking that Prime Minister Boris Johnson publicly welcomed.
Baroness Bennett of Manor Castle (GP)
My Lords, I rise to make the range of cross-party and indeed non-party support for this Bill even broader. I thank the noble Lord, Lord Addington, both for bringing it and for introducing it so comprehensively.
The noble Lord, Lord Crisp, made a powerful point when he talked about prevention of ill health; he then got to the point where we really need to be when he emphasised that physical activity is absolutely crucial to well-being and a healthy society.
Ahead of today’s debate, I looked back to a speech that I gave in July 2015 to the University of Manchester’s Festival of Public Health UK, which was in fact an international event. I said then that we have in the UK
“a society that’s making … its members ill. A society that’s failing to provide clean air … adequate housing … a healthy diet … safe jobs and decent benefits … opportunities for exercise … an education that prepares pupils for life.”
Seven years on, I do not believe that there is a single measure that I set out then on which we have seen positive progress, which is extraordinarily terrible—although I note that it is not through want of the efforts of my noble friend Lady Jones of Moulsecoomb. Indeed, this House has, with broad support, just put through the Clean Air (Human Rights) Bill. I hope that that might be one area where we could see very rapid progress.
I shall concentrate in my speech on sports—appropriately, since the noble Lord, Lord Addington, is such a champion in your Lordships’ House in this area. I stress the need to change the conversation. I was on the politicians’ panel on BBC’s 5 Live this week. For reasons that my accent makes obvious, perhaps, there was a discussion of the England-Wales World Cup game to which I was not asked to contribute. However, had I been asked to contribute, what I was sitting there bursting to say was, “Where is the huge programme around this high-profile event to get people out, during and after the event, kicking a ball around, throwing a ball around, running around, as people are watching so many high-profile celebrities doing on television now?” That was one question, but another question, which other noble Lords have already raised, is: where will people, particularly children, kick that ball? Where will they be able to run around?
I submitted a Written Question to the Cabinet Office on 24 November:
“To ask His Majesty’s Government what assessment they have made of the public health impacts, including on loneliness, lack of opportunities for physical activity and provision of services locally … of the sale of public buildings and spaces each year in England.”
I got the Answer a couple of days later, quite surprisingly; it perhaps suggests not a great deal of involvement. I was told:
“Any decision … will consider social cost and public value, in line with HM Treasury Green Book guidance.”
I think the noble Lord, Lord Addington, is really making a point in this Bill about the need for a change of mind in the Government: they need to regard physical activity and sport as a crucial issue, which I do not think the Answer I received suggests that they currently do.
This is not a new situation. I draw noble Lords’ attention to an interesting campaign just launched by the Carnegie UK Trust and Fields in Trust charities, with the hashtag #FieldFinders. It is looking to find lost playing fields. Between 1927 and 1935, the Carnegie UK Trust gave nearly £200,000—£10 million in today’s money—for nearly 900 playing fields across the UK. It is interesting because, as is often typical with history, it did not keep a record of where they all are, so now it is asking the public to help find them and, very interestingly, to find out how many of them are still playing fields. Because that money was given so that those fields would continue to be in use in perpetuity. I think I can guess the result: it will find that many of them will not now be playing fields.
That is focusing on playing fields, but of course the space that is very near every child, every person, is a road. Again, we have seen not government leadership in this area but civil society leadership in the form of the Play Streets campaign, which started in Bristol in 2011 and has since grown around the country. This is a scheme by which streets are temporarily but regularly closed off to become sites of play, organised and managed by people in the neighbourhood. Of course, these are not just sites of play; they are sites of interaction. What this campaign is saying is that we need a long-term culture change: it needs to be safe for children to play out on the streets all the time.
I say many radical things in your Lordships’ House; I suspect that many might regard that as the most radical, but let us think about recapturing the streets for people. That is the space we all need to be able to use freely, without danger, and, circling back to my noble friend’s Bill, in a clean air environment. That would be a huge step towards a radical society and one which, as the Bill of the noble Lord, Lord Addington, makes clear, is absolutely a government responsibility.
Lord Holmes of Richmond (Con)
My Lords, it is a pleasure to take part in this Second Reading and, as other noble Lords have done, I congratulate the noble Lord, Lord Addington, who is a champion for sport both in Parliament and, still, on the pitch. I also congratulate all members of your Lordships’ Select Committee on the National Plan for Sport and Recreation, which produced such an excellent report, as pertinent today as on the day of publication.
The Bill has two significant underpinnings. The first is to place this in the Department of Health and Social Care, a significant spending government department. The second is that we need a cross-government, cross-Whitehall effort. This is often the case for a number of policy areas and, to my mind, in recent history has really happened only twice. The first was the tremendous effort that everybody across government made with the Covid pandemic. The second, 10 years ago now, was the cross-Whitehall effort for the London 2012 Olympic and Paralympic Games. Why was there a cross-government effort for that? People wanted to be involved and wanted to make it a success.
What we were trying to do in 2012 was not just to have a sensational summer of Olympic and Paralympic sport but to try to do what no previous Games had done and drive a legacy of participation. We achieved something but by no means did we achieve everything, hence why we are where we are today: an obesity epidemic; a type 2 diabetes crisis; stroke and heart attack. I will not go on, but we as a nation cannot go on like this, which is why the Bill is so significant. First, I ask my noble friend about the name of the office. Would it not make sense to follow the excellent recommendation of the noble Lord, Lord Addington, that it should be the “office for health promotion”, as it was initially going to be? Certainly, the government response is uncompelling as to why that name does not encapsulate everything we are trying to achieve with this body.
Similarly, on the prescription of exercise, can my noble friend the Minister tell the House how successful that is currently, how widespread it is and what the department is doing to put it on absolute turbocharge to ensure that it is available to everybody up and down the country? The Bill rightly highlights the importance of detection. What is being done to have a culture across society of scanning and screening to stop disease and early death in their terrible tracks? There is much we can do, as the Bill indicates, with data and new, innovative technologies, so what is the department doing to foster an ecosystem, a culture of exploration and of concept proofing across the public and private sectors to bring forward all the possible ideas in this area? Wearables is an obvious example. What is being done to ensure that all those involved have the right level of data and digital education? I know it is not my noble friend’s department, but what is being done to ensure effective data and digital education right from primary school onwards?
The clue, in many ways, is in the name: “sport” is a contraction of “support”. What the Bill offers is support for every citizen across the country—enabling and empowering through exercise, physical well-being and the mental well-being that flows from that. We cannot go on like this. We do not have to go on like this. We have a choice. In this straightforward, significant Bill, we have an important part of that choice. Let us take it.
The Earl of Devon (CB)
My Lords, I add my thanks and congratulations to the noble Lord, Lord Addington, on bringing forward this Health Promotion Bill, encapsulating as it does many of the major recommendations of the National Plan for Sport and Recreation Committee. I was privileged to be a member of that committee from January 2021 until the publication of the report almost exactly a year ago.
Having revisited the report in preparation for today, I note how increasingly urgent its recommendations have become. As the ravages of long Covid scourge the nation, putting ever greater numbers on long-term sick leave, as the cost of living crisis and food inflation put a healthy diet out of reach for more and more families, as the cold chill of winter takes grip, with fuel prices skyrocketing, and as access to the NHS becomes ever more inaccessible, the health and well-being of our nation has never been more important. As living standards crumble before our eyes in the face of national and global headwinds, we need to build our resilience. This Bill does just that. I therefore strongly support it and condemn the Government’s apathy, as highlighted by the noble Lord, Lord Kamall.
I note my interests as listed in the appendix to the report and offer my huge thanks to the witnesses who contributed evidence during those dark and Zoomful days of the pandemic, among them schoolchildren, sports coaches, academics and even the odd world political leader. We were excellently chaired and extensively chivvied by the noble Lord, Lord Willis, wisely advised by Dr Mackintosh and energetically enabled by the dedicated team of Michael, Katie and Hannah. I thank them all.
The office for health promotion must sit within the Department of Health and Social Care and have responsibility for the national plan for sport. DCMS has for too long championed sport in this country as commercial high-end entertainment. As the football Premier League has shown, the UK has achieved unparalleled success in the highly leveraged global super-leagues of sport, but it has made us no healthier as a nation. It has made footballers and overseas club owners wealthier, but the nation is no fitter.
Just look at rugby union, a sport I once played at the dawn of the professional era. Its leading clubs are once more going bankrupt, it has brutalised its workforce through excess physicality and it has detached from its grass roots in pursuit of an audience and TV revenues. Even the legacy-laden London Olympics saw only a per cent or two increase in sports participation, while the numbers of those volunteering, coaching or officiating in sports actually declined.
This trickle-down approach to health promotion through sport has simply not worked. It is at local, community level that focus and funding must be directed. Physical literacy must be on a par with reading and maths, teachers and schools must be equipped to facilitate such learning and school fields and sports halls must be funded and treated as key community infrastructure, not locked and left to idle. Local travel must be active; close to two-thirds of Dutch children cycle to school, compared to only 3% of English children. Their weather is no better than ours, but their cycle paths are. We must also remember that sport and physical activity need not be competitive. We must not fetishise winning at all costs over participation and the inclusion of all in physical activity, as the noble Baroness, Lady Randerson, noted.
I was proud to bring a Devonian voice to the committee and was keen to highlight rural access, one of the favourite provisions of the noble Lord, Lord Addington. Farmers and land managers must be funded and encouraged to provide wider access to our countryside and all the physical and mental well-being that can be obtained therefrom. Wordsworth knew its worth. However, this access must not cost our biodiversity or the provision of healthy, nutritious food. That means it needs to be consensual, planned and permitted access, delivered in concert with local communities.
Rural land management is undergoing a generational upheaval. We must harness the well-being opportunity through social prescribing, environmental land management, proper planning and transportation reforms, all of which need to be coherently co-ordinated. This excellent Bill might just achieve this, so I recommend it to your Lordships’ House. In light of the completion yesterday of the Government’s ELMS review, can the Minister provide any detail on the funding and support for public access and social prescribing under the newly regilded environmental land management scheme?
Lord Hayward (Con)
My Lords, it is a pleasure to support the Bill introduced by the noble Lord, Lord Addington. It encapsulates the work of the committee of which a number of members have spoken today. I will introduce an element of dissent with the noble Earl, Lord Devon; he said he introduced a Devonian voice—I got there first. With that minor correction, I agreed with everything else he said.
The message has come loud and clear from a host of speakers that we need to tackle the issue of sport and exercise, not at the top level but at the lower level. This is encapsulated in Clause 1(3)(a), to
“identify and address health disparities”.
These health disparities were covered well in the report and touched on very clearly by the noble Baroness, Lady Randerson. She identified that there is, in effect, a marked difference between male and female participation and a difference in terms of class—higher class levels clearly participate to a level that lower class levels do not. There is a massive deficit among the ethnic communities. It is probably the failing of our report that we do not address that well enough or recommend any solutions, because we really need to turn our minds to that group of people—the ones who do not participate in physical activity of any form.
While we have been debating this Bill, I think I am right in saying that seven groups of schoolchildren have come to listen. I wonder how many of them participate in any physical activity at all and how many will continue to do so after they leave school. For me, that is the key issue in terms of overall societal health.
The noble Baroness, Lady Bennett, commented on media coverage. She is absolutely right that the coverage of our sport, whatever event it is, before and after the actual event involves discussions of people at a high level—what they did and what they are doing at that high level. There is no attempt to look at how they got there or how they started at some community level. They do not go back and say, “This is the pitch I played on and these are the people I now want to encourage.”
The contrast in this country is stark. I am an avid fan of viewing US college football. In the four or five hours every Saturday before the matches, a substantial segment is allocated to looking at people who have come from severely deprived communities and what they are putting back into them. I ask the media to look very seriously at how they cover sport, because it should be so much more inclusive. It would be better for all of us and better for society in general.
Lord Storey (LD)
My Lords, I start by thanking the Whips for allowing me to speak despite my late arrival. I perhaps needed healthcare when I arrived: I left Liverpool on the 7 am train, which was supposed to take two hours but took two hours and 45 minutes, and my dash from Euston station got my heart going. I also thank my noble friend Lord Addington for this important Private Member’s Bill. Given the comments from noble Lords, it seems to have support right across the House and I hope the Government will take note of that.
Having heard all noble Lords speak, it seems that we have the strategy in front of us. I have listened to all the comments made and, along with the Select Committee, your Lordships seem to have come up with a strategy. We heard from the noble Earl, Lord Devon, about the importance of funding at a local community level; the noble Baroness, Lady Bennett, about recapturing the streets; the noble Lord, Lord Moynihan, about schools and opening schools—I shall come to education in a moment; and my noble friend Lady Randerson. A couple of days ago, she said to me, “I’m going to talk about a very niche area”, because I wanted her to wind up for my party. I say to my noble friend that it is not a niche area; that is what we should all be doing, not just in Wales, where it has been done, but right across the UK. I thought the noble Lord, Lord Kamall, was very brave and honest in his comments about apathy from government. It is not just the current Government; I think we have seen apathy from all Governments in this regard.
A report was published today by the Sutton Trust—which regularly does surveys of opinion and polling on education matters—about the impact of the rising cost of living on pupils. One of its interesting comments was that, in state schools, 74% of teachers have seen an increase in pupils who are unable to concentrate or are tired in class, and 67% saw more students with behavioural issues. There are lots more comments in that report. If we dug down a bit deeper, we would find that the majority of those students come from poor backgrounds or disadvantaged homes. One of my concerns is that, if I look at my home city of Liverpool—a number of noble Lords spoke about this issue—the facilities are mainly geared to a handful of sports. For example, football, in the main, predominates; I do not see hockey pitches or netball courts there. It is also very unfair to women, as the facilities are mainly for men. If you go to other facilities in the local cricket clubs or tennis clubs, you see—I never know what the correct term to use is—very few young people from ethnic backgrounds and very few from disadvantaged backgrounds. We have to open sport up to those people. We have to make sure that people from disadvantaged backgrounds go to those clubs and are welcome at them, and we have to have the facilities.
I have often thought that if we want to change the way we do things in sport, we cannot just sit there, waiting and hoping that somebody coming from Norris Green council estate will come to the club. We have to create a link for them and schools are best placed to do that. The noble Lord, Lord Moynihan, suggested the importance of schools operating Saturday clubs, but I think we also need outreach work for those young people. Imagine if those young people were visited, encouraged and taken to those facilities, because transport and getting to them is a huge issue—those figures that I just read out would be different. The best way to deal with mental health is to be physically engaged in activities. The best way to deal with the problems of disadvantage is to get people into sport, and we are not doing that. That is a great shame.
During Covid, we saw a dramatic decline in the number of children from disadvantaged backgrounds attending schools; many have not gone back to school. They have said to their parents, or parent, “I don’t want to go to school. I’ve got problems, and I want to stay at home”, and the parent has then used the excuse of home education, or home tuition, to keep them at home. Thousands of children from disadvantaged backgrounds are “home educated”, but they are not—they are just languishing at home. Again, imagine if we could involve those children in sport, using our schools and encouraging them. We would see a huge change.
I wish my noble friend Lord Addington well with the Bill. He has huge support across the House, and I am sure he will score many goals.
Baroness Merron (Lab)
My Lords, it is a pleasure to follow the noble Lord, Lord Storey, particularly his closing remark. I also congratulate the noble Lord, Lord Addington, on bringing the Bill before the House today. I believe it seeks what many in the Chamber have said repeatedly—not just today but on many occasions—from a whole range of experiences, and always with the same focus: having a co-ordinated approach to improving our health as individuals, as communities and across the nation.
The noble Lord, Lord Lansley, talked about the need for a cross-cutting priority across government. We have heard about that many times, and it is right to remind us again today that it is what is needed. I know that is what the noble Lord, Lord Addington, is seeking to achieve. Similarly, the noble Lord, Lord Crisp, talked about the need to create good health and environments, and I am sure we are all aligned on that.
I was interested to read in the Library briefing, for which I was most grateful, that when the body we are discussing and referring to in the Bill was initially announced by the Government in March 2021, it was due to be called the office for health promotion. I know that the noble Lord, Lord Addington, is suggesting that we should return to that. I realise that this is before the Minister’s time, but it might be of assistance to your Lordships’ House if he could give us any information today as to why it migrated to a different title.
The noble Earl, Lord Devon, the noble Lord, Lord Hayward, and other noble Lords spoke about the report of the House of Lords National Plan for Sport and Recreation Committee, which was a very welcome contribution. However, it is one thing to make that contribution and another to see action; I think that has been emphasised today. That committee called for the development of a long-term, cross-government national plan for sport, health and well-being, and this debate has been calling for exactly that. The committee also heard evidence that cross-departmental co-ordination is not working, delivery is fragmented and access to funding is complicated and overbureaucratic. Could the Minister indicate what will be taken from the report that has already been done and how progress will be made in all those areas?
There seems to have been a backward move over the past number of years, not least as we see plans being scrapped or pulled back. I refer in particular to targets on obesity, which are not being met; the promotion of less healthy foods, which is now to be allowed to continue for longer than originally anticipated; the Government being seven years behind their target of a smoke-free 2030; and, as we have heard many times, the fact that we still await—I assume it is no longer going to appear—the health disparities White Paper. In all these areas, we need to see more action, but we are seeing a backward trend. Perhaps the Minister could give us some heart in this respect.
We also know that there have been considerable cuts in the public health budget, smoking cessation services having been particularly hit. There are at least two figures circulating about the size of the smoking cessation cut, but none of them is less than one-third. Why have there been cuts in the public health budget and why have they particularly hit smoking cessation services? Can he also confirm his understanding of the amount being cut and what we can look forward to in the future?
A number of noble Lords referred to the World Cup inspiring us at present and bringing us together as a nation. That is true, and we also very much saw that with the Lionesses. While the Minister should take seriously the urgings from noble Lords who have spoken today to give sport the attention it deserves, it is crucial, as many have said, that we broaden this to thinking and talking about recreation and, in particular, physical activity. The noble Baroness, Lady Randerson, made particular reference to women and girls, who may be less inclined to be involved in organised sport but nevertheless need to be supported, encouraged and enabled to take part in physical activity.
I pay tribute to the noble Lord, Lord Addington, for his tireless campaigning and look forward to the Minister’s response.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
Like the noble Lord, Lord Addington, I would like to declare an interest in that I still play rugby. If noble Lords take nothing else from this debate, I hope they will find that they have another willing, if perhaps not that able, rugby player to join the team. I hope that my contribution on the pitch will elicit a bit more than apathy, some sympathy and maybe a bit of empathy from my noble friend Lord Kamall. As a keen sportsman, I thank the noble Lord, Lord Addington, for providing the opportunity to debate this important issue. I hope I can do rather better than his impersonation of what I might say in this debate.
On the rationale for OHID’s creation, I must admit to not knowing the genesis or etymology of the change of name, but I will find out. As we know, it was established in 2021 as part of the Department of Health and Social Care, following the closure of Public Health England. Its core aim is to reduce preventable ill health and health disparities. It works towards this under the professional leadership of the CMO, which we felt was key, and the director-general of OHID within the department.
Many noble Lords, including my noble friend Lord Lansley, asked why it was felt that it would be more effective as part of the department. When reforming the public health system, this was carefully considered. This was before my time, but my understanding is that many stakeholders were engaged in this and the feeling was that having it as an in-house, in-the-tent department was the best way to go. The option of creating an arm’s-length body to sit alongside the UK Health Security Agency was considered, but it was felt that establishing those functions within government outweighed the strengths of an independent ALB. The fear was that the proposal outlined in the Health Promotion Bill would create an office for health promotion with limited advisory functions. This would simply replace or duplicate many activities which are already under way in OHID.
In forming OHID, we were clear about the distinct advantages of convening functions—something I have become very aware of in the short time I have been a Minister—and the ability to access expert advice, analysis and evidence, alongside policy development and implementation. The decision to make OHID a core part of DHSC was taken because influence and proximity to decision-making matters. In addition, advice is offered widely from across the system and there needs to be a mechanism for summarising it for Ministers.
OHID is empowered to work across national government, using evidence to influence policy and ensure greater consideration in cross-government decision-making of the links to and importance of preventing ill health and tackling disparities. We only have to think of policy considering the health impacts of housing, the potential of indoor and outdoor air quality to promote or negatively impact health, and the consequences of ill health, including for high levels of economic inactivity, for current and important examples. OHID is taking action on the major preventable conditions which drive ill health and early death, including cardiovascular disease and some cancers, and the risk factors that cause those conditions, including tobacco, obesity, alcohol and drugs. OHID does this work alongside local government, the NHS, academia and industry.
I would like to highlight some of the achievements that have resulted so far. To answer my noble friend Lord Kamall’s point on the health promotion task force, the real north star for the cross-government action we see now was publication of the levelling-up White Paper and the commitment in it to improve healthy life expectancy by five years by 2035 and narrow the gap by 2030. This provides a clear, ongoing framework and commitment—covering DfE, DCMS, DWP, BEIS, DLUHC and the Department for Transport to name just a few—to work across government and really address the major drivers of ill health.
Last December, we published a cross-government drug strategy, backed by new investment totalling almost £900 million over three years, with more than £500 million for local authorities. They are required to provide 54,500 new drug and alcohol treatment places over the next three years. Going back to last week’s debate on tobacco, my belief is that we are on target for our smoke-free objectives, but again, I will check on this and confirm. Another great example is our effort to tackle health inequalities early on. The investment of over £300 million in family hubs and Start for Life will deliver new and expanded family health networks in 75 local authorities.
We are improving joint local working on population health and reducing health inequalities through integrated care systems. This includes an expectation that local directors of public health will play a vital part in informing the strategy developed by the integrated care partnership and the forward plan of the integrated care boards.
In all of this, as was so wonderfully put, exercise is the “wonder drug”. We really recognise its importance. That came through very strongly in the contributions of many noble Lords. The drivers of physical inactivity are deep-rooted and influenced by the places we live, work and play in. Change will not happen overnight.
During preparation of the national plan for sport and recreation report, which lays the foundations for the Health Promotion Bill, noble Lords provided the Government with plenty to consider. The evidence is clear that physical activity is good for health. Being active offers wide social benefits, brings people together, maintains friendships and through active travel, as was mentioned, can help connect people and places. We remain committed to the former Prime Minister’s commitment on active travel.
As we are all aware, activity levels have declined due to the pandemic—I am probably more aware than most of how hard it is to get 15 out on a rugby field on a Saturday. This is not good for children’s healthy development and is putting adults at greater risk of disease. Furthermore, there is a disparity in physical activity levels, as was identified by many speakers. This affects groups including women, older people, people living with long-term conditions, people from lower-income areas and people from black and Asian ethnic-minority groups. The Government recognise the challenge and the renewed efforts needed to ensure people have the access, opportunities and motivation to be active in their everyday lives. Our commitment to the sport and physical activity agenda will continue.
In quarter 1 of 2023—not quite 2022, I accept—the Government will publish a new sport strategy and a new school sport and activity action plan. We believe there is an opportunity for this refreshed strategy to focus on two areas: strengthening action to address inactivity levels, and making the sector more sustainable for the future. We will continue to proactively engage across government and with the wider sector to effectively inform and shape the strategy. This will allow us to ensure that action is focused on the key issues and the right direction for the future.
As mentioned by the noble Baroness, Lady Bennett, everyone should have access to local, safe and inclusive opportunities to play sport, get active and stay fit to benefit their health.
At the heart of the government policy on physical activity are the UK Chief Medical Officer guidelines, which set out how much and which forms of physical activity are essential across a healthy life course. Through our work on the Everybody Active, Every Day physical activity framework there is consensus that long-term, system-wide action is required; physical activity is everyone’s business.
The Government provide primary schools with £320 million per year for PE premium and school active sport, to support schools to provide high-quality PE and at least 30 minutes of physical activity within the school day. This is at the heart of the school sport activity programme, which enables schools to use a whole-school approach to embedding PE and school sports. I will write to my noble friend Lord Moynihan on the specific points he made on access to those activities.
Our action includes continuing to provide ways for people to access local parks and green spaces through the Department for Transport’s walking and cycling initiatives, and the setting up of Active Travel England to support local councils to help people walk and cycle to work, the shops and to school.
Our world-leading digital and social media campaign Better Health provides digital resources and signposts to opportunities to support people to start to become and stay active. As I have part of the digital agenda, I will look to the use of wearables as another way in which we can increase participation and information. Digital health behaviour change approaches such as Couch to 5K have now had 5 million downloads, and Active 10 provides opportunities for people to build up activity levels.
We recognise that progress has not always been as fast as we would like. Our plans should help to change that. Sport and physical activity are golden threads that run through and align actions of government departments, local government, the NHS, sporting bodies and communities. Understanding the data and evidence on what works and what does not is vital to delivering our ambition to shift the status quo and address inactivity. By doing so, we can create access to more opportunities for everybody, especially people living in underserviced communities, to enjoy leading more active and healthier lives.
I am aware that many questions have been raised in this debate. As a new boy I understand that my response to a Private Member’s Bill is slightly different, but nevertheless I commit as in other debates to follow up in detail and writing on all the points, because I want to make sure that the points raised today have an appropriate response.
It is a privilege to be speaking after such accomplished speakers: some of the sports athletes here today, former Ministers and Secretaries of State for Health, chairs of sporting organisations such as ukactive and others, and top health professionals. They make my Saturday afternoon rugby efforts look rather weak in comparison.
We are all united in wanting to find the best way to promote healthy living through sport, education and active lifestyle. I know we want the same thing, which was probably put best by the noble Lord, Lord Crisp, as health creation, prevention and services. Some strong and passionate views were expressed on that and some excellent points were made.
I think noble Lords are also aware that I have a very broad background, with many leadership roles in businesses, charities and arm’s-length bodies, and I have been involved in four government departments and now government itself. Honestly, I have seen many different organisational models, both centralised and decentralised, setting up ALBs and having departments inside government. I can say from personal experience that in every one of those, in each instance it took a while for a new organisation to bed down and become effective. It took probably at least a year before you could really see its effects, and I believe that is the same in this instance. Therefore, while I understand and support the reasons expressed today, it is important that we need to give OHID time to take root, to see the publication of the sports strategy by DCMS with our involvement in quarter 1, and judge it on the results. However, I undertake, having listened to this debate today, to come back to the House and speak again on this subject when I believe it has had a proper amount of time to see whether it is working or whether we need to think about some other ways of setting it up.
For these reasons, I maintain my belief that the best way to achieve the objectives set out—which, as I said, were described so well as health creation, prevention and health services—is by OHID as a key and central part of government.
Lord Addington (LD)
My Lords, I thank all noble Lords who have spoken in this debate. I look forward to the Minister, as a new boy, playing alongside me in the parliamentary team; the Scottish Parliament team is coming down on the Calcutta Cup weekend, so he should be ready.
It is quite clear that there is a groundswell of opinion that says that something coherent should be done about the lack of structure behind recreational activity and the fact that it should be linked to public health. The Government tell us that they have a new approach, but unless it is prepared to upset things or has the capacity to interfere with other plans and make sure that it comes to the fore, my experience is that it does not happen unless you are prepared to say, “No; you’ve got to work with this and integrate.” The Government like their Chinese walls. They do not like to be interfered with in any way. I therefore suspect that the Government’s approach might dent things a bit but not actually move them.
I could say more about all the friends in sport, to use the expression of the noble Lord, Lord Moynihan—we have acquired a couple today. We have taken a step forward. I also thank my noble friend Lady Randerson for the justified smack on the wrist. Making sure that we tackle discrimination is part of the Bill, but without that being recognised you will miss groups. You will miss the fact that in the big team games both genders are now represented, but not well enough, not integrated enough, and with not enough emphasis. There are more than those dominant sports, and we should go out from them.
I remind the House that when all three major political parties looked to their sport strategy about 15 years ago, we all came up with documents and you could literally swap paragraphs in them, putting them in and taking them out. One of them was that sport at school should not only be linked to your local clubs but you should try a range of sports, culturally attuned to your area. Unless we do that and have the capacity to carry it on—and many of the other things in the Bill are required for you to do that—you will always miss out. If you have somewhere where you can take exercise and a support structure with good role models to help you through, it will help mental and physical health—it is proven. At the moment the Government have a suggestion that says, “Yes, it’s quite good”, but they do not have enough capacity for intervention within their structure to do it. I hope I am wrong but experience tells me that I am not.