10/01/18 – Meeting with Officials from the Dept. of Health

A meeting was held at the Department of Health to discuss the findings of the 8th APPG report “Physical Activity in Early Childhood”.

The following members attended:

Helen Clark, Lead Author of the report
Helen West, Note-taker
Dr Vicky Randall, University of Winchester
Dr Deborah Albon, University of Roehampton
Steve Franks, Water Babies

and from the Department of Health:

Richard Sangster – Head of Childhood Obesity Branch
Tom Wood – Childhood Obesity Branch – Schools
Hayley Keegan – Childhood Obesity Branch – Early Years

RS opened the meeting by praising the report as being detailed and very informative, and asked the APPG members to tell him which three of the recommendations would make the biggest difference.

HC’s opening remarks explained that the report should be looked at as a whole in the context of the child obesity strategy, and while some progress has been made and the next stage is to be welcomed, it is a shame that the focus to date has been on food intake rather than activity.  It is true that there are many play activity initiatives – a document had been launched by the Dept of Health on the topic just the previous day – but physical activity in children should have a bigger role to play in the obesity strategy.

HC went on to explain that what would really make a difference would be a focus on childhood as a whole, with physical activity integrated with everything else instead of considered in isolation, because activity is not just sport. We should also be looking earlier than school starting age, even back to the ante-natal period.

The second point concerns information. Where do organisations go to find information? There’s a wealth of information available but it’s scattered and very confusing even for health professionals, let alone parents.  A focussed, integrated website containing research, best practice, policy, news and guidance, working as a one-stop-shop for information, would be a big step forward.

Finally, we’d like to see a holistic follow up and an Education and Health crossover on the child fitness and health strategy.  The term “obesity” is a huge turnoff now and more positive language should be used to avoid alienating people and giving the impression of blaming and shaming.

RS acknowledged the points and said that dealing with obesity was not straightforward and it was tricky to get people to do more physical activity. He asked the members “Do you feel there are any game-changing things we could be doing?”

SF, picking up on HC’s point about information, advocated a single hub for case studies, initiatives etc. and underlined the point about the term “obesity” being sanitised and in need of change.

SF also pointed out that children from birth to five years old are not really seen as people, which is clearly nonsense. Physical activity is not just sport and it needs to connect with diet and lifestyle. Our report challenges norms and assumptions, and he felt that the Dept of Health is in a very strong position to influence and lead on this.

VR: building on earlier comments, early intervention is going to be most crucial, as much physiological development has already largely occurred by the time children start school.  Money is going into primary schools now (partly from the DoH) in the form of the Primary and Sports Premium, but we don’t have a separation between physical activity and physical education. In many teachers, the knowledge to judge whether an intervention should be activity or education is missing. We’ve missed a trick, because the premium has made it a priority but Physical Education and Personal and Health Education (PSHE) are non-core subjects within the National Curriculum. There’s pressure on teachers to make everything higher-activity, but there needs to be a clearer steer on how to spend the money, especially as some schools have been using the money to overcome other budget deficits. The money is great, but more guidance on how to spend it is necessary.

RS asked what would help and was told that a clearer distinction between physical activity and physical education would be a good start.

TW outlined the “Active Lives Survey”, a new survey being undertaken to find out what activities are happening in schools. Teachers and pupils are being asked to provide information about the frequency, duration and level of intensity of activities. In this way the DoH can find out what is happening now.

VR said that a similar survey pre-2012 found that 90% of schools offered 3 hours per week but that this had gone down since.

DA wondered if the survey was looking at the entire school period, at all ages, and across the curriculum as a whole. She pointed out that in pre-school nursery education, children are often there from 0800-1700, 52 weeks a year, i.e. for much longer periods than school, and there don’t tend to be specific PE activities. Also, when looking at “outdoor” activities, DA often finds that the activity is simply an indoor activity transported to an open-air setting.  When this happens it is not the gross motor skills that are being developed, and Ofsted don’t really pick up on this. Indeed, under the heading of “Physical Activity” half is self-care (for example toileting and washing) and the other half also includes fine motor skills such as holding a pen. There is very little emphasis on being really active. In practice, early years practitioners give more focus to things that will be valued at school, such as sitting still and being able to write their name, not considering that being physically active is also part of being school-ready.

HC said that the media (in particular the Daily Telegraph) had picked up on that point in the report, and the “being seen and not heard” attitude to children is still prevalent but needs to change.

HC added that portraying things negatively damages the message and reformulating the campaign to focus on fitness and health instead of obesity might improve its chances. If successful, it would have a very positive economic outcome, saving the NHS lots of money.

DA pointed out the mismatch in messages to adults and children on the subject of activity. Adults are told that every small activity is important while children are told to sit still and be quiet.

VR would like to see the three departments (that provide the pupil premium) promote the idea of embedding movement across the school day, with a culture of movement throughout the school across all subjects and acceptance and understanding of the idea that movement helps learning and cognitive development.

SF asked how the three departments connect and was told that they work closely together with monthly meetings on the child obesity plan. RS acknowledged that there is a natural tension between departments as they have different aims and objectives, and it can be sometimes difficult to get things working in unison, but it’s not impossible. There are examples of joined-up thinking occurring, e.g. they are currently working with the Dept for Education on health ratings for schools. RS added that the pupil premium was a big pot and that there is scope to review it and improve it. He hopes that the Active Lives Survey and the forthcoming Ofsted report (into physical activity and healthy eating in schools) would provide valuable insights into what is happening now.

RS added that there is another tension, which is a problem for all government departments, and that is the appropriate level of prescription for guidance. Having said that, he agreed that schools have been asking for more detailed guidance on how to spend the pupil premium.

DA pointed out that the very language used sends a problematic message, by implying that movement is all about sport and organised sporting activities carried out in curriculum time. This is damaging.

HC raised a point about inclusivity and said that a whole range of people are missing out on opportunities: whether because they are economically or socially deprived, from ethnic backgrounds, are disabled or for other reasons. There is a tendency to just service the norm and not go beyond that in terms of how the messages are delivered, where the activities are available, and so on.

A few points and messages were then repeated, i.e. movement aids cognition, children are encouraged to be sedentary, and TW assured the meeting that everything that was being said was already known to them in some form, and that they were trying hard to address these issues. For example, the Active School Planner initiative, which promotes the idea that when children are physically active, their brains are active too.

RS raised the issue of Early Years and said there was new funding (£5M) for an obesity research unit with three areas of focus: inequalities; marketing and advertising; early years. He acknowledged that more needs to be done and said that they come at it from an attitude of what you put in your mouth because there was so much evidence to support that approach.

SF asked how some of that money could be leveraged for research, and RS confirmed that it was a research project and added that it would actually take some years to get this right. Anything connected with health is difficult because it can be hard to engage the NHS, so it’s always a slow process, but this is very much what they want to do.

30 free hours of childcare will give fresh opportunities, although the Dept for Education has some issues about delivering this is some areas.

DA said that there is a different practitioner base in Early Years settings, with NVQ3 being typically the highest qualification. SF added that there is a massive sector of Early Years providers making an enormous contribution, but they’re currently just drifting. It’s like a ghost sector, with a fortune being spent on unregulated activities for thousands of children.

HC noted that there is a lot of good practice around, but people don’t know about it, and that came back to the point about collating the information in one central hub.

RS acknowledged that that would be a very valuable resource but said in practice it would be very difficult to achieve.

HC mentioned champions and role models who might be happy to come in and promote the campaign messages and that this could be a way to launch the next stage in the strategy.

HK felt that it was a shame that play activities are downplayed and are not part of the Early Years curriculum and it would help if they were.

VR said she has just 9 hours to train teachers in play activities and all those other things, which is not enough. Because of this, the pupil premium is being used to outsource sports coaches instead of the teachers being able to run things themselves.

If it’s a serious issue for health, which it is, then we should be more prescriptive. It’s true we don’t want to be a “nanny state” but it’s costing us money then a more prescriptive message is justified.

SF asked what the APPG could do to help the Dept.

RS advised the group to find a hook, something that’s singular. He explained that they get inundated with messages and information and cited the example of Jamie Oliver who campaigns successfully because he picks a single issue at a time and runs with it – like a battering ram. These simple, singular, repetitive messages are easy for the media to understand as well.

HC said that, in that case, we should focus on rebranding the obesity strategy and use more positive language of “child fitness and health”.

RS agreed that obesity had a negative ring to it and admitted that he had been on the receiving end of comments to this effect when he introduces himself and the name of his team.

He went on to say that they are also interested in barriers and what prevents activity in children, e.g. screen time and sleep. (DA added building design as having an impact on movement.) RS said there were some interesting international examples and mentioned Amsterdam and having tried to tackle the problem with a three-pronged approach. He didn’t elaborate but said they were looking at it.  There is no one simple solution though, as we all know.

RS added that there will be a lot of “noise” in the near future: a forthcoming sugar report and various TV documentaries are due to be released, so he recommended that to cut through all that noise we should try to focus on one key message at a time.

VR asked if we could have a follow up meeting with all three departments?

RS agreed that this would be a good idea and said that the DfE in particular needed to hear what the APPG is saying. TW will set it up.

HC/VR said we can be of help across all areas with ideas to take back to schools and teachers. RS said, yes, please, send anything through. SF added that he was getting the impression that RS wanted us to “keep it simple, stupid” and RS agreed, but added that no one should lose sight of the fact that this is a very complex topic. He added as an aside that the previous Government did more in terms of connectivity, and that they were operating in a different world now.

HC added that she knew there was the political will and interest, for example from comments earlier from Jeremy Hunt and David Cameron and RS agreed that Jeremy Hunt is 100% behind the work they are doing.

TW came back to the idea of the central hub for information and asked the APPG who they thought would be in the best position to host that? SF responded that for credibility and consistence, it should be some sort of government agency.  All agreed with this but RS warned that we have no idea how difficult it would be to set up, but added that he wasn’t saying that it can’t be done.

SF said that it would make such a huge difference to be able to access good quality information that is of economic value to the sector.

The meeting drew to a close after an hour with agreement that it had been extremely useful and a promise from TW to set up the follow meeting and get back to PR.