(10 years, 5 months ago)
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Lord Krebs
That the Grand Committee takes note of the Report of the Science and Technology Committee on Sport and exercise science and medicine: building on the Olympic legacy to improve the nation’s health (1st Report, Session 2012-13, HL Paper 33).
Lord Krebs (CB)
My Lords, I start by thanking the members of the Science and Technology Select Committee for their excellent contributions to this report, and our specialist adviser, Professor Ian Macdonald, Professor of Metabolic Physiology at the University of Nottingham. I also thank the Minister for the Government’s response to our report. I am particularly delighted to see that the Minister who will respond to the debate is from the Department of Health as many of the recommendations in our report refer to health as well as to sport and exercise.
We conducted the inquiry, which resulted in the report Sport and Exercise Science and Medicine: Building on the Olympic Legacy to Improve the Nation’s Health, during the run-up to the 2012 Olympics. The inquiry had two purposes. First, we wanted to find out how robust the research and evidence base for improving the performance of our elite athletes is. Secondly, we asked how this knowledge for helping elite athletes might be translated into treatments and preventive interventions that could help improve the nation’s health. Our focus was on biomedical research rather than the engineering science that refined and improved the equipment used by elite athletes and amateur sports men and women alike.
Our inquiry included sport and exercise science, which is about understanding the physiology, nutrition, genetics and biomechanics of the human body in order to improve performance as well as sport and exercise medicine, which is about the treatment and prevention of ill health that might arise from exercise: for instance, muscle strain or joint injury. We did not investigate the important issue of behaviour change—how to encourage people to become more active—because we had already completed an inquiry into this topic in 2010. Although we focused on sport, we recognised that exercise includes a much broader range of activities, such as recreational walking, gardening and housework.
Both of our questions were highly relevant to the Government’s two objectives for the Olympics. These were, first, to ensure top performance of our athletes in winning medals and, secondly, as part of the legacy of the Games, to encourage the nation to be,
“healthier, happier and more active”.
On the first of these two objectives, Team GB surpassed expectation, winning more medals than in any Olympics since 1908. The haul of 65 medals, against a target of between 48 and 70, included 29 gold, placing Britain third in the gold medals table and fourth in the total medals table. This was a stunning success, but might the performance of Team GB have been even better with more systematic appliance of better science? One of Team GB’s greatest Olympic successes was in cycling, winning seven out of 10 track cycling gold medals. While the majority of this remarkable success is down to the athletes themselves, it is thought that some of it is attributable to the meticulous attention to detail of Matt Parker, “head of marginal gains”. He analysed down to the last detail the factors that might make that marginal difference between a medal and no medal: techniques such as spraying tyres with alcohol to remove dirt and increase the friction at the start of a race; heated shorts for the cyclists to keep their muscles warm; and measures to reduce the chance of athletes succumbing to performance-diminishing infections may all have contributed to the fraction of a second difference that is needed to win gold instead of silver.
However, as our inquiry showed, even in the outstanding cycling team, not all the techniques believed to enhance performance of elite athletes are based on sound evidence. For instance, we were told by an expert witness that feeding elite athletes large quantities of antioxidants to help muscle recovery not only does not have a beneficial effect but may even be detrimental. So when we look ahead to the next Olympics, there may be room for even better performance by our athletes by deploying the best scientific knowledge.
Our second question was about using scientific knowledge to help the Government’s objective of getting the population as a whole to become healthier through exercise. The health benefits of exercise are undisputed and affect a wide variety of health outcomes. The Department of Health told us that there was research to show that exercise could help to prevent or manage more than 20 chronic conditions, including coronary heart disease, stroke, cancer, type 2 diabetes and a number of mental health problems. Yesterday’s news story about an article in the British Journal of Sports Medicine lamenting the lack of exercise by children even used the emotive language of “child neglect” to refer to the health problems that will arise because children are not encouraged to do enough exercise.
Scientists do not yet understand the biological mechanisms that give rise to such far-reaching benefits of exercise. One theory is that exercise promotes a process called autophagy, in which worn-out surplus or malformed proteins and other components of our cells are recycled. Perhaps an understanding, through research, of exactly how exercise benefits our bodies would help to improve and enhance the advice to the population at large on exercise, and thereby increase the benefits.
How robust is the research into sport and exercise science and medicine? One fundamental problem of research on elite athletes is that, by definition, there are very few individuals to work on. Furthermore, elite athletes are understandably reluctant to be exposed to invasive measurements that might interfere with their training or become part of a control group in an experiment to test the efficacy of a particular intervention. For this reason, most of the research on elite athletes is observational and anecdotal. That is not to say that all sport science and medicine is weak, but several of our witnesses, including the Physiological Society and the Ministry of Defence, were critical of weak methodologies.
One way to improve the quality of research is to carry out the work on non-elite athletes and the wider public and explore the two-way flow of understanding between those groups and elite athletes. We heard about examples of well known techniques that are supported by good evidence—altitude training to improve stamina, and carbohydrate loading for long-distance runners—as well as those for which there is no evidence of benefit, including taking ice baths after vigorous sport and, as I have already mentioned, taking antioxidant supplements.
UK Sport is the arm’s-length body of DCMS charged with funding research to enhance the performance of elite athletes, with a budget, we were told, of about £20 million over the period between 2009 and 2013. We were surprised that DCMS did not appear to have in place any mechanism to ensure that UK Sport was commissioning science of the highest quality, comparable to that in fields of basic biomedical research. The Government’s response did not specifically address that point, and I would welcome clarification from the Minister about how DCMS carried out that quality assurance.
I now turn again to the relevance of sport and exercise science and medicine to the wider public. Most but not all of our witnesses agreed that the findings from research on elite and non-elite athletes had relevance to the wider population. Examples include the use of exercise and muscle conditioning to improve back and knee pain in osteoarthritis, conditions that affect many people in this country.
Advice to the public on exercise is contained in the Chief Medical Officer’s guidelines on physical activity. These guidelines exist, but how many people are aware of them? I have no doubt that all noble Lords in this Room are acutely aware that the CMO recommends that 19 to 64 year-olds do 150 minutes of moderate exercise or 75 minutes of vigorous activity a week, and that there are specific guidelines for people such as myself who are over 65, but we found in our inquiry no strategy for ensuring that those guidelines were more widely disseminated to the public. Indeed, we were told of one survey of 48 GP practices in 28 London boroughs, which found that none of the GPs was aware of the latest CMO guidelines.
The Government welcomed our recommendation that training at all levels for health professionals should include the need to support the prescription of exercise for both prevention and treatment of ill health. We also suggested that physical activity should be added to the quality outcomes framework for GP practices. I would welcome comment from the Minister on what progress has been made in this area and whether any measurable change in disseminating activity guidelines and encouraging physical activity by health professionals has been achieved.
At the same time, the National Institute for Health and Clinical Excellence—NICE—has a role in ensuring that any prescription of exercise for chronic disease is based on sound evidence. Could the Minister please update us on NICE’s assessments and how they are being translated into recommendations? Many of us who exercise do things that we believe—and are told—are good to do, like stretching before or after exercising, or engaging in muscle-strengthening as well as aerobic exercise. I would be interested to know how robust the evidence is to support these particular pieces of advice and information that are in the general public’s mind.
Finally, I turn to the National Centre for Sport and Exercise Medicine, which the Government established as part of their commitment to a lasting public legacy from the Olympic Games, as well as to improve support for elite and non-elite athletes. The Department of Health’s vision for the centre was for it to be,
“a hub of clinical and research expertise”,
used for the following objectives:
“increase exercise in the community; develop strategies to prevent diseases related to inactivity; and prevent, diagnose and manage injuries for both professional and amateur athletes”.
The centre was established with a £30 million grant to three consortia. However, we were told in our inquiry that no ongoing funding for posts or research was provided and therefore there is a question about the sustainability of the centre. We also suggested that the centre should take the lead in developing a national strategy for sport and exercise science and medicine. Could the Minister please update us on the progress of the national centre and how its sustainability is being established, and also on the production of a national strategy?
No one can doubt the importance of sport and exercise. The health of the population at large would be hugely enhanced if people exercised more. The prestige and entertainment provided by our elite athletes was vividly demonstrated by our national success at the 2012 Olympics and by Andy Murray’s Wimbledon triumph. Science and medicine can make an important contribution to the realisation of these benefits of sport and exercise. The United Kingdom has an absolutely outstanding science base in the biomedical sciences but the evidence that we heard suggested that there is insufficient cross-fertilisation between this excellent science base, carried out in our world-class universities and institutes, and the application of that science to improving the performance of our elite athletes and the health of the nation. I look forward to hearing other noble Lords’ contributions to this debate and the Minister’s reply. I beg to move.
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.
Lord Addington (LD)
My Lords, this is one of those papers that when you pick it up and read it makes you think, “Oh!”. I have raised sport and exercise medicine on numerous occasions, and the noble Lord, Lord Hunt, and the noble Earl, Lord Howe, have been dragged in. My approach has always been about enhancing general medicine and making sure that people are encouraged to take up sport, because they are put back together again quickly to carry on with the rest of their lives and to carry on with sport.
This report is a fairly academic paper, and I feel that it misses some of the point. You do not play a sport or push yourself to keep fit; that is a by-product. If we could all stay fit by jogging 2.3 miles every third day or whatever it is, everybody would be happy. We would have the medical benefits. We could get on with it without trouble, but we do not. We know we do not. We need an incentive and a reason to take the exercise to get the benefit. This report slightly missed the point that you do sport because it gives you a buzz. Enjoyment is not quite the right word. Sport at various levels gives you a buzz, a feeling of achievement, the competition and the thrill. Exercise sometimes provides you with another good feeling: the chance to get outside. These feelings are going on. Although the report mentions the psychology, I do not think it got under the skin of why you are doing it.
Having said that, the report is right about the fact that we do not co-ordinate, in trying to make sure that we get the benefit of the health agenda—and, presumably, the preventive health agenda—and the saving that the nation gets. The two bits do not speak to each other.
I have come to the conclusion that sports are slightly worse than political parties for wanting to sit in darkened rooms talking to each other about themselves—only slightly, but probably worse. They do not like people intervening on what they do, and change is usually forced on them—usually by a failure to perform at a certain level, to achieve an increase in numbers or, classically, to compete at the level to which they aspire or that they are used to. So when the report says that the science of elite-level sport is unclear, that does not surprise me very much. I suspect that the art of coaching and getting the best out of people is at odds with scientific method. The psychology involved, and the signs that you are responding to what goes on around you, are probably not approached best by this. There is also resistance to intervention. Sharing—and we are much better at sharing now than we were before, probably because we have to take on funding from outside government, and it is taken seriously—still has not gone into the culture.
One obvious thing that I had not even thought about until this report came out is that, if you are an elite-level sportsman, you do not want to be experimented on. It is a bit of a no-brainer. Who does want to be experimented on, to be perfectly honest? They want to be treated, helped, supported—yes. But they will take on a revolutionary new course of action only if they absolutely have to. That is a very logical point of view to take. It is always going to be anecdotal when slight changes in practice occur.
I am increasingly aware that I am not qualified in my own sporting life. Although I flirted with the top of my sport, I am totally aware that we were amateurs; although we did not think that we were amateurs, we absolutely were. I remember the shock when a first-class rugby club got its first diet sheet. Those days are long gone. But having worked a little bit with the elite level, I can say that trying to change the culture of behaviour, when people’s whole lives have been dominated by trying to achieve performance, is something that acquires scientific language, if nothing else. Trying to identify exactly what you are getting out of it is a very important factor here. To get benefit for wider society in terms not just of health but of community support and interaction is another very important point that is not covered here.
Sports medicine has important lessons to teach ordinary medicine. It is a simple fact that a sportsman knows that, if you get a bump, you get it treated quickly; you do not go to your GP and wait three weeks for a physio appointment, because then you would find that a muscle was weakened or that there was a slight imbalance in how you walked that has led into an imbalance in your entire body, which means that you might have to take time off work. The noble Lord, Lord Hunt, said that it was a very sensible idea to get more physios involved in accident and emergency, when I raised this issue a few years ago. We are still not quite there yet, because we do not take soft tissue injuries seriously enough. Sport has already taught us, and given us examples, that you should intervene early on those things to stop them becoming chronic. We have simply not adopted that yet.
I have always been something of a fan of having sport more closely linked to the Department of Health so that we can get those benefits together, especially preventive stuff. Certainly, exercise is a factor in controlling weight and gives you an incentive not to carry extra weight—by which I mean surplus weight. My rants against the body mass index are well recorded here, and I think that we will leave the subject there. But a sensible approach to how to control weight and stay healthy is something that probably should be led by the Department of Health.
The report is interesting because it starts to open a door to what is going on. When you open a door you do not know what you will find, but here was a corridor leading to interesting places which was perhaps felt to be irrelevant to sport, at least at the moment. It is an interesting start but to think that the Olympics would change the culture overnight was a total misconception. It will not be the only misconception about the Olympics. My noble friend and I have been sitting on a committee which looked at this issue and we got the impression that many people felt that, once the Olympics arrived, the days would be longer, the summers warmer and we would be guaranteed to win gold medals not only for the next 20 years but for the next 30 years.
This has been an interesting start to a debate that needs to go further, and for that I thank all noble Lords who sat on the committee.
Lord Moynihan (Con)
My Lords, I congratulate the noble Lord, Lord Krebs, and his Select Committee on their report on sport and exercise science. It considers in detail whether there is any evidence that the Games have left a lasting legacy to encourage the nation to be,
“healthier, happier and more active”.
It questions whether the science-based support for high-performance athletes, as measured by medals at the Games, was sufficiently comprehensive and adequately disseminated to assist future generations. In commending the work of the committee on reviewing sport and exercise science as applied to elite athletes and how that work can be disseminated to a wider public, it is of no surprise to me that very little elite research is published in the United Kingdom.
It is certainly true that some sports fare better than others in this respect but in our flagship sport—football—those who earn a living dance to the tune of the paymaster. When Alex Ferguson employed a team of sports scientists, he did not want its work made publicly available to Chelsea. As a result, the Premier League has no research-based ethic, in part because of the powerful marketing machine of professional sport in the United Kingdom, and in part because there is little equipment research as the great confounder is the constant change of kit for commercial gain. The public want to buy the style of football boots used by Messi or Bale. The money is in the kit that people want to own. Tennis players will employ one model of shoes for a year and the likes of Adidas and Nike, with their research teams, will fiercely guard their commercial-in-confidence research. Every season brings a new range of kit—new ski shapes and sizes; new tennis shoes. That commercial reality is a major inhibitor to long-term research.
Secondly, it is very difficult to extrapolate the science of elite sport down to the recreational player. The science required to provide a marginal gain to Chris Hoy is of little relevance to the recreational cyclist in the country lanes this weekend. The outstanding work that Sir Clive Woodward, his team, the coaches and the intricately woven sports scientists undertook for Team GB in 2012 only marginally impacts on wider participation. For this is specialist science; it is world-leading scientific knowledge. It was borne out by 29 gold medals, as opposed to one in Atlanta only 16 years before when such specialist knowledge was absent.
This valuable work is now being taken forward by UK Sport and its subsidiary the English Institute of Sport, focusing as they are on performance solutions based around a holistic range of science, medicine, technology and research designed to increase the probability of success by optimising training programmes, maximising performances in competition and reducing the number of training days lost to injury. Clive Woodward was a pioneer in aligning and integrating this approach for the British Olympic Association—I declare an interest in having had the privilege of being chairman from 2005 to 2012, through Beijing and London—and while there are wider benefits we should not overstate the case for its application to recreational sport.
That said, there is room for wider dissemination of research where it does not impact competitive advantage for young athletes. Other countries do better in this respect. The NHL and NFL in the United States are examples. The NFL collates data centrally and provides public awareness programmes without disclosing the internal secrets of the sports scientists at the Miami Dolphins or Seattle Seahawks. Australia and South Africa deliver excellent sports science research.
The main reason for the difference is the sources of funding. In countries where research is funded by those without vested interests, the prospect for dissemination is enhanced. For countries such as ours, where tight funding control is exercised via our Premier League football clubs and governing bodies of sport, operating as they do in a highly competitive global market, the opportunity for long-term funded research is restricted.
On the wider issue of an Olympic legacy to improve the nation’s health, it is universally accepted that we need to address the challenge caused by obesity among young people, the expensive consequences we face as a country from having low levels of physical activity, inadequate facilities, and an absence of policies to address improving the nation’s health. I regret that we still have a department of sickness, whose default position to sport is the treatment of sports injuries, rather than a proactive Department of Health geared to improving the nation’s health. It is not as if the challenge came to light only during the Games. I would argue that government had a better approach to the subject 150 years ago, when the modern Olympic Games were constructed on the premises of preparing a physically active and fit generation—in that case, principally of men to fight for king and country.
Indeed, between the two world wars the British Government made comparisons with Germany and Italy and quickly recognised that as a nation we were physically ill prepared. The then Minister for Health, Sir Hilton Young, later Lord Kennet, asked at a dinner of the BMA in 1935 whether something could not be done,
“to bring home the benefits of physical culture, which was a culture of mind as well as of muscle”.
The challenge was accepted and was followed by the establishment of the BMA’s Physical Education Committee, the Central Council for Recreative Physical Training, which became the CCPR and now thrives as the Sport and Recreation Alliance under the chairmanship of Andy Reed. It was established then, in 1935, as the first significant body to receive government funding to meet the grave concern about the physical health of the community. It is indicative of the approach at the time that of the 34 original members of the council, no fewer than 14 were members of the medical profession. I declare a somewhat distant interest in that one of them was my grandfather, who was the president of the Royal College of Surgeons at the time.
Alongside those 14 sat seven physical educationalists and three prominent politicians, including Herbert Morrison. The wider aims they pursued resonate to this day. They sought,
“to establish the closest link between the Council and those responsible for physical activities in voluntary organisations and to investigate the best methods of placing the specialised knowledge of the physical training associations at the service of the population”.
They wrote their own mandate,
“to help to improve the physical and mental health of the community through physical recreation, by developing existing facilities for recreative physical activities of all kinds and also by making provision for the thousands not yet associated with any organisation”.
The last 80 years have seen successive Governments struggle to translate these aspirations into political reality, despite subsequently hosting the Olympic Games in London on two occasions.
However, as the Select Committee report and its recently published sister report on Olympic legacy highlighted, hosting the Olympic Games in London offered a unique opportunity to this country to raise the bar. Those of us involved with sport saw this as being a once-in-a-lifetime opportunity to take wide-ranging steps to create opportunities for a more active society on a national and integrated scale. Hosting a great Games was always, in my view, more than 17 brilliant days of Olympic sport and the breathtaking excellence of the Paralympic Games. As important was the objective to leave a lasting sports legacy for young and old, able-bodied and disabled, the length and breadth of the country. The sponsoring department for the Games—the DCMS at the time we won the bid to host the Games in 2005—set a target shared with the departments for education and health in the DCMS public service agreement 2005-2008 to:
“Halt the year on year increase in obesity among children under 11 by 2010”.
In reality we have witnessed a growing prevalence of obesity among all age groups during this time.
So why were the Olympic Games so important in this context? I would argue that the remarkable success of the Games—the brilliance of Sir John Armitt and Sir David Higgins in overseeing the design and build of the facilities for the Games on time and on budget, and the platform they created for the BOA to field its largest and most successful British team in over a hundred years, coupled with the work of the organising committee in putting on the Games—led to a level of national commitment and inspiration that was unparalleled in our time.
Lord Moynihan
My Lords, for politicians the Olympic Games were manna from heaven. The inspiration was there, and public enthusiasm backed by all-party support was in abundance. What was needed was the political will to translate inspiration into participation through improved facilities and a transformational change in priorities capable of matching the brilliance of the Games.
The opportunity for health and education to lead this agenda remains as strong as it did 80 years ago. Physical activity, not just sport, is the key to keeping people healthy and reducing the burden on the healthcare system. In Raising The Bar, the report I wrote with Kate Hoey when the bid was won in 2005, we called on the Government to: begin work on pioneering a nationwide programme of sport and exercise medicine, echoed in parts of this new report; substantially increase the number of training schemes for GPs as well as for sport and exercise positions; prescribe physical activity to patients, both for remittal and for preventive healthcare goals; and plough half the money saved by the proposals into the provision and maintenance of suitable sport and recreational facilities.
Of course, at the heart of such a programme is the need for co-ordination in government. In my view, the Department of Health should lead a major cross-government strategy to promote the health benefits of physical activity, so as to reinforce its importance. It was hoped that the Cabinet committee would launch this nationwide sports legacy to encourage the nation to be, to quote from the report,
“healthier, happier and more active”.
Indeed, we have had a raft of welcome initiatives labelled legacy projects, but no more initiatives in total than have been launched on an annual basis since the inception of the National Lottery. To us who are passionate about sport they are very welcome—to many other people they may pepper the daily bulletins with government press releases—but they have not transformed the landscape of the health of the nation. Now we have this report which concludes with disappointment at,
“the apparent lack of joined-up thinking in Government about the Olympic health legacy”.
The scientific case for a unified, high-priority national campaign could not be stronger. The twin causes of so much of the burden on the National Health Service are either genetic or environmental. On the environmental side, so many diseases are preventable if you maintain a healthy lifestyle. We need lifestyle departments, with teachers qualified in relevant disciplines in every school, both primary and secondary. We need to design opportunities which young people enjoy. If you want to try to improve the health of the nation it has to be through a sport that people can do by themselves. A sport requiring 22 people to take part is never going to be easy to facilitate and roll out nationwide. If you want to get girls involved, which should be a priority, it has to be in activities they want to do. They do not all want to take part in outside team sports, which is why dance is such an important option.
In closing, the report also calls for further work to be undertaken on international best practice. There is no better place to begin than Finland. No more than 30 years ago—I speak with affection and respect for that great country—it was characterised as a heavy-smoking, heavy-drinking, unfit country. It has completely changed. The past two decades have been marked by a major shift in emphasis from competitive and elite sports to health-enhancing physical activity for all, as seen most clearly in two successive sports Acts and a government resolution. Now, increasingly, multi-sectorial initiatives have led to substantial changes in the public funding of sports organisations, services and the construction of sport and recreational facilities. It is a system built on the enthusiasm of volunteers. In stark contrast, it is also a country where local authorities are central to the delivery of facilities. In the UK, sport and recreational provision is a low-priority, discretionary-line item in local authority budgets, too often to be cut first.
Finland’s sports policy places health enhancement before competitive or high-performance sports. It prioritises well-being and health and supporting children’s and young people’s growth through sports. It recognises the health benefits of the cradle-to-grave approach that is so important. We need a health and fitness programme that is both low-cost and designed from cradle to grave. Cycling, swimming and, in Finland, cross-country skiing figure prominently—all activities that you can do from five to 105. A similar nationwide approach in this country would be politically popular. I can think of no better leader of that initiative than the Minister.
We have a nation inspired by the Games. Surely it is time to translate that inspiration into participation and, in so doing, embed recreational activity as a fundamental building block for a true Department of Health in the 21st century.
Baroness Grey-Thompson (CB)
My Lords, I thank noble Lords for allowing me to speak briefly in the gap.
I am a huge fan of the benefits of sport and exercise science if it is used in the right way. In my career I have undergone numerous tests, aerodynamics, skinfold measurements, maximum lung capacity testing, something called a VO2 test—there is nothing like pushing on a treadmill until you feel you are about to collapse, and then having needles stuck into you—and I can confirm that ice baths are indeed vile. On one memorable birthday, my husband bought me three metres of aluminium so that I could build a racing wheelchair that was one kilogram lighter than that which was commercially available.
I agree with the noble Lord, Lord Moynihan, about history. There is an assumption that not much has gone on before and that sports science testing has been used for a long time. I also agree with the noble Lords, Lord Krebs and Lord Addington, that athletes do not want to be used as guinea pigs—I certainly did not—unless it is your own idea, and then it is marvellous. However, it is quite difficult sometimes to get sports scientists to think about doing things in a different way.
Within limited careers, it is important that we disseminate the information so that it goes through to quality coaching, the teaching of good physical literacy, and enables us to educate our young athletes right through to senior squad level, so that they remain injury free for as long as possible.
One of the problems I see going forward—and I have seen way too much of it—is that of literally reinventing the wheel: we do not learn from the past, somebody comes along with a new idea and sometimes wastes money doing things that have previously been done. Overall, lottery funding has significantly helped our athletes by ensuring they get the right support at the right age. As an athlete who benefited from it, I think that is tremendous. We need to keep urging national governing bodies to invest and use sports science. Some sports are using less of it now than they were 15 years ago.
Overall, there has been a positive influence on the general population. The design of sports equipment at Paralympic Games level has led to better design of day chairs. They are lighter, stronger and more aesthetically pleasing. Certainly in amputee running, the work that has gone into the development of prosthetics for sprinters has had a massive positive influence on non-runners in terms of their walking gait and equipment, and it is more generally accepted that they deserve really good prosthetic equipment. There have been some very positive things that we need to keep pushing forward.
Finally, I commend the work of the committee. I am very pleased and I am grateful for being allowed to speak.
Lord Hunt of Kings Heath (Lab)
My Lords, I, too, welcome this debate and the report of the committee chaired by the noble Lord, Lord Krebs. I think it is a truth universally acknowledged that the Olympic Games in London were outstanding and never to be forgotten and that the legacy is as important. The argument for investing in sports science in elite performance and in non-elite sports and exercise has been very persuasively put by all noble Lords who have spoken in the debate this afternoon.
The question first posed by the noble Lord, Lord Krebs, was: the performance of Team GB in the Olympics was outstanding, but could it have been even better if even more use had been made of science? The noble Lord, Lord Moynihan, answered in the affirmative and pointed the way forward in terms of there being a very strong case for future investment in science in relation to elite sport.
The noble Lord, Lord Krebs, referred to heated shorts. As a commuting cyclist, I am very attracted to the idea, particularly as Christmas is coming up and the winter will, no doubt, get colder. More seriously, it would be good to hear from the noble Earl, Lord Howe, about future investment in sports science in elite and non-elite sports. The noble Lord, Lord Moynihan, made a very important point when he said that there is a problem with the sharing of knowledge with the vested interests of investors in sports science as opposed to the non-vested interests. That does not necessarily have to be government, but government can, no doubt, play an important role.
The other question that arises from this is about the extent to which we are investing in science to increase our knowledge of the impact of exercise on good health. This is the second argument that has been put in your Lordships’ debate this afternoon. The noble Lord, Lord Krebs, and other noble Lords referred to the health benefits of exercise, and it is striking that although this is increasingly known about, it does not seem to have much impact on the general public’s desire to exercise. The post-legacy figures for the public taking up sport or more generally taking part in exercise have been very disappointing. The figure of 150 minutes of moderate exercise per week seems as far off for many of the population as it ever was. Noble Lords probably know that I live in Birmingham, and my understanding of the latest statistics there is that 22% of young people in Birmingham are classified as obese. That is a shocking figure. We know the impact that that will have in future years in terms of health inequalities and demands being made on the health service. As we know, we have an epidemic of diabetes in many parts of society and of the country. As regards the figure of 22% obesity among young people in Birmingham, you do not need much knowledge of science to know that that will lead to huge pressures being put on the health system in that city in the coming years.
I wish to ask the noble Earl, Lord Howe, about the role of general practitioners. A number of points have been made in that regard. It was argued persuasively that if GPs were to prescribe exercise that might have a positive impact in terms of people’s response. We know that as regards health issues, particularly smoking, nothing is more effective than a GP telling a patient that he or she needs to think about giving up smoking. It would be helpful to ensure that GPs are all facing in the right direction on this issue.
Does the noble Earl think that health and well-being boards ought to prioritise investment in sport and exercise vis-à-vis local authorities and the health service? After all, health and well-being boards recognise that local authorities have a big role to play in this area. Local authorities are also responsible for running extensive leisure services—or at least they were—and have a wider role in this area in liaising with schools. Surely sport and exercise ought to be a major priority in joint strategic needs assessments, which attempt to bring together wider health policies. Will the noble Earl assure the Committee that the Government will push health and well-being boards in that direction? I would argue that they could be the local equivalent of the committee set up by the BMA in the 1930s, and its successor organisations, to which the noble Lord, Lord Moynihan, referred.
Another very important point raised by the committee of the noble Lord, Lord Krebs, was the attitude of the Department for Culture, Media and Sport towards the health benefits of sport. The Government reject the committee’s assertion. My own experience in government suggests that there is a gap between the Department of Health’s policy of encouraging exercise and the DCMS’s focus on sport. Indeed, I have taken part in theological debates between the two departments on where one element ends and the other begins. This is a fruitless exercise as it is patently obvious to anyone with any common sense that sport and exercise go together. If those departments find it difficult to resolve that issue, something else needs to happen. That could involve assistance in the form of a Cabinet committee, to which the Government refer in their response to the report of the noble Lord, Lord Krebs, or, as the noble Lord, Lord Moynihan, suggested, we should simply make it clear that a good health outcome is the number one priority. I believe that something more needs to happen in this area.
Noble Lords have not really mentioned the role of the Department for Education despite the fact that it has a crucial role to play in this area. We have seen very regrettable reductions in government support for school sport and I hope that the noble Earl’s department has actively pointed out to Mr Gove the error of his ways. Following the reaction to the original cuts in government support for school sport, the Department for Education partly retracted its proposals and established the School Games project—as we are told in the Government’s response—which attempts to provide more opportunity for pupils of all abilities to take part in competitive sport in schools. But I would like to see more—and I would like to see the Department of Health become the champion in Whitehall of the need to promote school sports, competitive sports and other exercises.
I would also like to hear more about how we can encourage sports clubs to work in schools. The noble Baroness, Lady Heyhoe Flint, has done so much to encourage girls to take part in competitive sports; she will know of the Chance to Shine project, which is about encouraging state schools to come back to playing cricket. Part of that approach is to encourage local cricket clubs to send their coaches into schools. I would like to hear more about how the Government might encourage that in future.
We then come to the issue of investment. The noble Lord, Lord Krebs, referred to the role of the National Centre for Sport and Exercise Medicine. Clearly, there is a concern here about its future viability. Can the Minister give the Committee some comfort that the Government recognise that continued funding support needs to be provided? Does he think that the Department of Health’s own research and development fund could come up with some support? It seems a persuasive argument that, given that the department is concerned with improving the health of people in this country, and given that sports and exercise clearly have a vital role to play in doing so, I would have thought that the argument for some support and funding from his own department’s R&D fund, which is not extensive but is very significant, ought to be considered.
The noble Lord, Lord Addington, suggested that the noble Earl, Lord Howe, and I were interlopers in this debate. However, I have no doubt that the encouragement of sports and exercise can play a critical role in improving the nation’s health and well-being. I am also in no doubt, having listened to the debate and read the report, that investment in science and science research could help us and use that knowledge to encourage more of the population to play a part. When one looks at some of the great health problems that we face—of frailty, dementia and obesity—one can see emerging research that suggests that exercise and sports can very much help us to meet some of those challenges. Given the department’s role, does the Minister not accept that it could play a much bigger role in this whole area in future? I hope that the department will accept that opportunity.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, first, I congratulate the noble Lord, Lord Krebs, on securing this debate and on the excellent work of the Select Committee on Science and Technology, which he chairs, in highlighting the important issues associated with sport and exercise science and medicine. The Government have welcomed the Committee’s report and its focus on the quality and application of research in this area.
We agree that the biomedical basis for improving performance of elite athletes needs to be of the highest quality possible and meet international peer review standards. For this reason, UK Sport and the English Institute of Sport have robust processes in place to quality-assure the projects that they support. For example, all projects are reviewed by an independent research advisory group, which includes a number of leading experts in the field of sport science.
Our elite sport programme is the envy of the world. UK athletes continue to perform strongly at the highest levels, thanks to the funding and technical support they receive from UK Sport and the home country sports institutes. Based on Team GB’s performance, there is no reason to doubt the quality or appropriateness of the research.
In the light of this success, it makes sense for this knowledge to be shared so that it might benefit non-elite sports men and women. Indeed, there are a number of ways in which UK Sport disseminates research findings. However, it is important to remember that the end goal of research is to support and maximise athletic performance on the world stage. Although UK Sport and the English Institute of Sport concede that more could be done to disseminate their findings, they need to do so without compromising the UK’s competitive edge.
The committee’s report rightly highlights the societal and economic costs of inactivity—a point well made by the noble Lord, Lord Hunt—and the benefits of exercise in promoting health and treating chronic disease. Indeed, the UK CMOs’ report, Start Active, Stay Active, contains recommendations across the life course on the levels of physical activity needed to achieve these benefits. The noble Lord, Lord Hunt, mentioned the research funded by my department. I can tell him that the department’s National Institute for Health Research funds a wide range of research on the benefits of physical activity.
I completely agree with my noble friend Lord Selborne that it is of crucial importance that breakthroughs in sport and exercise science and medicine are translated into health benefits for patients and the public whenever relevant and applicable. For example, characterising the mechanisms by which heart function improves with exercise in elite athletes and the military can help explain how heart function is impaired in people with diabetes or with high blood pressure. There are numerous examples of where the work of UK Sport and the English Institute of Sport is linked to benefits in the health and wellness domains. These typically involve partnerships with universities and necessitate the sharing of knowledge—for example, vitamin D supplements for bone injury and soft tissue injury recovery. There are a number of other channels, including formal and informal events where knowledge is shared within and outside the elite sport community. I think we can therefore be reassured about one of my noble friend’s central points—that taxpayer funding should lead to benefits to the wider public.
Translational health research is a high priority for the Government. In August 2011 we announced a record £800 million to support this through biomedical research centres and units funded by the National Institute for Health Research. Some of this money has been used to establish a new research unit at Leicester and Loughborough. This unit is helping to expand lifestyle interventions available for the prevention and treatment of chronic diseases. The funding is also enabling the NIHR biomedical research centre at University College London Hospital to study the mechanisms through which exercise promotes health, and how to deliver effective exercise strategies.
An important link in all this, which was mentioned by the noble Lord, Lord Krebs, is the first ever National Centre for Sport and Exercise Medicine, a legacy bid commitment of the 2012 London Games. The £30 million project funded by health is on track, with the London hub now actively functioning and treating patients. Loughborough is anticipated to become operational in 2014, and Sheffield will be the final site to become operational in late 2015. As well as supporting elite athletes, the centre’s influence will extend to local NHS hospitals and primary care facilities to provide a service for anyone who plays sport. Public Health England is overseeing the continuing development of the national centre and is keen to ensure that the centre performs a clear leadership role for sport and exercise science and medicine for the next five years and beyond. Public Health England is supporting the national centre to position it as an international voice on sport and exercise medicine, with strong links with the wider physical activity agenda and a global academic platform. PHE is considering an outline business case for funding in 2014-15 to support co-ordination across the national centre and as pump priming for long-term sustainability. The centre is keen to be seen as an independent organisation which generates income through direct patient care and research funding. It has appointed R&D leads to start that work. We can see the makings of the centre as a sustainable long-term organisation going forward.
The noble Lord asked about the centre as a source of a national strategy. Public Health England is, once again, working with the national centre to develop a sport and exercise medicine network of academics to help collaboration in research funding bids across multiple academic units. However, potential for conflict of interests has emerged as a stumbling block in developing a national research strategy.
In the context of public health, the noble Lord, Lord Hunt, asked about the role of health and well-being boards and his view that they should be prioritising investment in exercise. Many noble Lords would identify with that view but we must remember that health and well-being boards have been given, quite explicitly, the freedom to prioritise their own spending in relation to local public health priorities. However, I expect Public Health England to show the way in the area for local health and well-being boards to follow.
We envisage that the national centre will continue to attract grants from the research councils and deliver work of the highest quality, with the support of their world-leading host institutions.
Given the important health benefits of physical activity, the Select Committee was right to focus attention on the training of health professionals at all levels to be able to prescribe exercise for prevention and treatment. Clearly, the content and training curricula for doctors is determined by the medical schools and royal colleges, but the Department of Health will work closely with Public Health England and other interested organisations to make the case for physical activity in healthcare. On a more practical level, I am pleased to announce that Public Health England has commissioned an e-learning module on physical activity for healthcare professionals, to be distributed by BMJ Learning.
The noble Lord, Lord Krebs, mentioned the National Institute for Health and Clinical Excellence. NICE plays an important role in turning research evidence into authoritative and practical guidance for practitioners and commissioners. Where appropriate, both its public health and clinical guidance recognise the contribution that physical activity can play in the prevention, management and treatment of particular conditions, ranging from obesity to osteoarthritis and low back pain. I assure the noble Lord that many of NICE’s clinical guidelines recognise the important role that exercise and physical activity can play in the management of individual conditions. For example, its clinical guidelines on osteoarthritis and low back pain already recommend exercise. I am confident that NICE will continue to consider the role of exercise and physical activity in the management of particular conditions, where the evidence allows.
The noble Lord, Lord Hunt, asked about the scope for disseminating exercise guidance for specific chronic conditions to GPs. We are exploring the options for a national dissemination of this learning, which would need to be underpinned by better training for doctors in the benefits of physical activity. The new e-learning package commissioned by Public Health England represents an important step in that direction.
Exercise professionals also play an important role in supporting the most vulnerable patients to exercise as part of their treatment for a range of conditions—for example, as part of cardiac rehabilitation. Ukactive has been working with the royal colleges and training organisations for the fitness industry to develop new professional and operational standards for exercise referral. That work is awaiting the update by NICE of its existing recommendations on the use of exercise referral schemes, which it plans to publish in September next year.
The noble Lord, Lord Krebs, asked about the possibility of incorporating physical activity into an indicator in the quality and outcomes framework. This year saw the introduction of two new QOF indicators for physical activity. Those measured the percentage of patients with hypertension who had been screened for inactivity and, of those not meeting the guidelines, the percentage offered brief advice on how to be active. I have to tell him that these indicators have been retired from the 2014-15 QOF as part of the exercise to free up space for GPs to provide more personalised care. That agreement saw a reduction of the QOF by more than a third. However, the NHS health check programme continues to recommend that patients should be screened for their physical activity levels and the delivery of brief advice or an exercise referral for those who are shown to be inactive. At the same time, we are actively considering the case for continued monitoring of the retired QOF indicators to help inform NHS England’s developing primary care strategy.
We are committed to the dissemination of the UK Chief Medical Officer’s guidelines for physical activity, to both the public and medical professionals, and we are working with Public Health England and other organisations to help make healthcare professionals aware of those guidelines.
My noble friend Lord Addington asked why there are not more sports injury people in A&E to treat soft tissue injuries. I agree that athletes understand the importance of prevention. Sport and exercise medicine is, as he knows, a young specialism. Part of the work of the National Centre for Sport and Exercise Medicine will be to scale up sports and exercise medicine services and it will be important to ensure that supply is linked to demand.
The noble Lord, Lord Krebs, asked about the quality assurance of research initiated by the DCMS. I have already alluded to that very briefly. There is no specific monitoring or assessment undertaken by the DCMS of the research commissioned by its arm’s-length bodies. However, UK Sport acknowledges that further steps are necessary to provide stringent assessments of standards and has already made progress on this for the next funding cycle from 2013-17. This includes the appointment of an independent, technically structured sub-committee in addition to the research advisory group that has been in existence for a number of years. That will provide a more extensive overview of all investments in science, medicine and engineering.
Sport is a key part of a wider physical activity agenda, with an important role to play in getting and keeping people active and thereby improving their health and well-being. All sport is physical activity but an important part of Sport England’s youth and community strategy is pilot funding to support how sport can best contribute to improving health and, at the same time, grow weekly sports participation. There are important links between elite sport and the health of the public.
Aligned to the ambition of getting more people participating in sport once a week, Sport England has focused its work on tackling inactivity as this is where we can make a significant contribution to reducing health inequalities and produce the greatest potential health benefits.
Returning to elite sport, the fruits of National Lottery funding are there to be seen in Team GB’s recent success in the Olympics. I was reminded today that in 1996 GB won only one gold medal. In 2000, that went up to 11; in 2004 it was 9; in 2008 it was 19; and last year it was 29 gold medals.
However, the lasting impact of sport and healthy living has always been at the centre of the legacy ambitions of the Olympic and Paralympic Games. Our 10-point plan includes: elite sport, world-class facilities, major sports events, community sport, the strategy for youth and community sport, the charity Join In, school games, physical education and disability sport. For example, there will be £150 million a year for primary school sport starting in September 2013 and £1 billion over four years to boost youth and community sport.
In his Autumn Statement, my right honourable friend the Chancellor of the Exchequer announced that the Government will provide £150 million of funding to continue the school sport premium into the academic year 2015-16, meaning that primary schools will be able to put in place longer-term plans to improve their PE and sport provision. This is not just about elite sport. It will help people start to be and stay active, whether through sport or wider physical activities.
My noble friend Lord Moynihan asked about a cross-government push. The Olympic and Paralympic Legacy Cabinet Committee is the focal point for legacy and is well placed to ensure a joined-up approach to sport and physical activity. The Department of Health is obviously the lead department for health in promoting physical activity. We are working with other departments to support active lifestyles. Departments have jointly made available £300 million to raise the game in primary school sport. The Department for Transport awarded £77 million to increase cycling in eight of our major cities, with £1.2 million from the Department of Health to support walking. More than a million more people are playing sport than in 2005. I suggest to noble Lords that that progress is positive. As regards the Government’s effort, all this adds up to a significant investment in health-enhancing physical activity, driven by what we have learnt from sport and exercise science and medicine.
Lord Krebs
I thank all those who have taken part in this debate. It has been a privilege to hear the contributions of all noble Lords, but particularly of those who have first-hand experience of participating in elite sports as Olympians or other forms of competing at a very high level.
One theme has come through repeatedly: the huge importance of the health benefits of sport and exercise in tackling the chronic diseases that plague the population of this country and will cost us huge amounts of money in future. The noble Lord, Lord Addington, raised a very important point when he talked about the enjoyment of sport and exercise. Perhaps the key to encouraging people to be more active is to show them the enjoyment that can be obtained from it. He also referred to the art of coaching elite sports men and women. There may well be an art to it but that does not mean there cannot be science as well working alongside the art. The point made by the noble Lord, Lord Moynihan, and others about learning the lessons of history and from other countries is immensely important. Although we are obviously doing many things very well, we must not forget the possibility of healthy plagiarism from other countries and the history books.
I thank the noble Earl, Lord Howe, for his responses to the questions raised during the debate. I was encouraged to hear about additional investment in sport and exercise science and medicine, the sustainability of the national centre and the e-learning module that will help professionals to disseminate the importance of exercise to patients and the public at large. I also noted and welcome that he said that there was an emphasis on disseminating and publishing the results of work on elite athletes so that it could benefit the wider community. I still very much hope that a national strategy for sport and exercise science and medicine will emerge in the not-too-distant future, but I am very pleased with the responses obtained.