Olympic Legacy (S&T Report)

Earl of Selborne Excerpts

Wednesday 11th December 2013 Grand Committee

[The Earl of Selborne (Con)]

My Lords, the Committee will be most grateful to the noble Lord, Lord Krebs, for the way he introduced this debate and for chairing the inquiry. I served on that committee and was enormously interested and impressed by it, particularly at the seminar that started our deliberations where I learnt a lot about the quality of the sport and exercise science and medicine in this country. It seemed very timely with the Olympics just about to start to have an inquiry into the extent to which the two objectives set out in paragraph 1 of our report were being delivered.

I will confine my contribution this afternoon to the second of those two objectives: how can the R&D base,

“be translated into treatments and preventative interventions to improve the nation’s health?”.

After all, if one thinks about it, the justification for spending public money on sport and exercise science must ultimately rest on its role in improving national health. That is not to say that winning more medals is not a perfectly laudable objective; it is clearly good for national morale and we should be proud about it. However, Dame Tessa Jowell, who we quote on page 8, paragraph 3, was right when she said that the goal of increasing participation in sport was,

“not just about increasing participation in sport for the sake of it … it was also to tackle one of the most serious health epidemics facing the UK, that of obesity”.

When you realise that the Department of Health had put an estimate on the direct and indirect cost of physical inactivity in England among our population at large at approximately £8.2 billion, you realise that we are talking of sums that concentrate our minds wonderfully.

We have not gone into behavioural change. It is one thing to estimate the cost but one knows how difficult it is for the most observant commentators to change even their own behaviour, let alone that of other people. Nevertheless, it is clear that this goal is well worth achieving, and if sports and exercise science and medicine can impact on the population at large and reverse what is, in the case of obesity, an epidemic that has been running for many years, it will be something well worth attempting. As well as mentioning obesity, as the noble Lord, Lord Krebs, reminded us, Tessa Jowell could have mentioned the 20 other chronic conditions identified as lending themselves to prevention or alleviation through physical activity. So we seek to increase participation levels in sport and exercise for all ages in order to capture the health benefits for the population at large.

The Government must be given credit for having put together a number of cross-departmental initiatives, listed at paragraph 45. They involve, of course, the Department of Health, the Department for Transport and the Department for Education. It was a bit of a surprise, I have to say, that the then DCMS Minister, when giving evidence to us, said that,

“the baseline for ... the whole sport plans, is driving up participation in sport; it is not a bigger drive on the nation’s health”.

That does not make a lot of sense. We all agree that we want more people to participate. Why? I think we all recognise that it is because there are going to be those benefits. I say again that it is perfectly reasonable for UK Sport—a DCMS arm’s-length body, as the noble Lord, Lord Krebs, reminded us—to spend government money and, for that matter, lottery money on promoting the agency’s primary objective of winning more medals in competitions. I am all for that. UK Sport also receives money from third parties that are not subject to the same commitment to share the benefits that derive from public funds. With commercial organisations there may well be a confidentiality clause, and I recognise that. However, it should be a condition of receiving public funds for there to be an obligation to promote the sharing of the research findings that I mentioned in order that the wider public might benefit. That is not happening; the links between some of the elite research, other athletic research and the wider public are not as strong as one would have hoped.

For healthcare professionals plenty of information is available. We have heard about the Chief Medical Officer’s guidelines on physical activity. However—I repeat what the noble Lord, Lord Krebs, told us—there does not seem to be an effective mechanism for promoting this information, the guidelines and other advice, to the medical professionals. Surveys show that their knowledge of the guidelines is, frankly, disappointing. At paragraph 36 we point out that Sport England told us that exercise prescription should “sit alongside” pharmaceutical and surgical interventions. Yet GPs have no incentive to prescribe exercise; I can quite see that many GPs say that that is all very well but it is most impractical for them to tell some of their more obese patients to go out and take exercise. What they want is a prescription. Nevertheless, as a layman, I am fairly confident that in many cases a prescription which simply said “Go out and take more exercise” would be a jolly sight more effective than a surgical or pharmaceutical intervention.

If you think about the quality and outcome framework, there are incentives to GPs to do this, that and the other. One incentive is to list those of their patients who fall into the category of obese, but the incentive is to put them on the list, not to take them off it. Once they are on the list, GPs get paid for keeping them there. That is not exactly an incentive for them to tell their patients how to get below the magical figure at which they are considered obese. Clearly the quality and outcome framework needs to be revised. Adding physical activity to the quality and outcome framework, as Sport England suggested, might be a good start. It would save a lot of money—I am quite confident of that. You would perhaps even make a very modest dent in the culture change we are looking for so that people recognise that exercise can help solve some of the problems that we are facing as an ageing and ever more obese population. We need to raise the profile of physical activity.

We have heard that there are up to 20 different chronic conditions which could benefit from physical activity, and I shall not repeat them. I am surprised, as a complete layman, how little understanding there appears to be of why physical activity can help with so many of those conditions, including, for example, mental health problems, cancer, type 2 diabetes and the like. This is clearly a field of great potential interest and benefit and one where sports and exercise medicine has a unique contribution to make alongside the medical and biological sciences. It would be enormously helpful if there could be much greater collaboration in order to ensure that these helpful insights are captured. However, as I said earlier, that will happen only if we have a culture where research findings—particularly those funded by the public—are made available to the wider research community and, through that, to the public at large.