Skip to main content

Health: Sports Medicine

Volume 692: debated on Monday 4 June 2007

asked Her Majesty’s Government what steps are being taken to make sports medicine more readily available through the National Health Service so as to support healthy living programmes, particularly those aimed at combating obesity through greater physical activity.

The noble Lord said: My Lords, I thank all noble Lords who have decided to put off having dinner or have scrambled it hurriedly to speak in the debate.

I have always considered that the subject of sports medicine is not taken seriously by the department, not because of a lack of will but simply because it did not appear on the radar targets until comparatively recently. It smacks of sport and thus has nothing to do with the Department of Health. The silos between the departments are starting to break down but each department regards sport as not being in its bailiwick. The noble Lord, Lord Hunt, basically agreed with me that bringing in sports medicine is almost a no-brainer, if you like—I doubt whether that was the parliamentary expression used—because it is part of the preventive healthcare scheme; it is a part of national health. Hence the fact that we are encouraging and helping people to take part in physical activity.

I stress that this is sports and exercise medicine. The basic discipline is to make sure that people know how to exercise and, more important, that they receive “repair work” help, to put it at its most basic, when something goes wrong. Why is this important? One of the big health scares at the moment is obesity and the fact that we are all getting larger. People, particularly those in the lower economic groups, are not taking exercise. This is probably because the sporting activities available tend to be middle class. It costs money to join gyms, it costs money for membership fees and you often have to travel to take part in the activities. You also need to have money to stay in the sport because you need support when things go wrong. I have said before in the Chamber that I have met people who have stopped playing certain sports because of their fear of an injury that could lead to their losing their livelihood. This group may be declining statistically, but we should still pay attention to it.

How do we get the help that this group needs? We should concentrate on sports and exercise medicine and its delivery. When you start to consider sports medicine, there is a grave danger that you can get sidetracked into a great many websites—I know that I did for quite a while—but let us consider the Olympics. The elite professional end of the sports medicine structure is reasonably well taken care of. Groups are investing in athletics or the athletes themselves, who are valuable people in a professional world. In association football, players are incredibly valuable pieces of cattle, effectively. If a person breaks down, it matters and he gets the right help. A person who attracts a great deal of national prestige—an international athletics competitor, for example—would have access to help. Such people, statistically, have had the best access for a long time. Most people in the higher economic groups have access because they can pay for it themselves. I refer to the amateur athlete who wants to make sure that strains, pulls, bumps and bangs are dealt with. The problem comes with those people who may not have as much money or knowledge and are dependent on the NHS.

I have mentioned before, and I believe that the noble Lord, Lord Hunt, agreed with me, the idea that if you get a bump on a Saturday or Sunday, you go to casualty, but if it does not require immediate attention—for instance, a break that requires surgery—they will say, “Don’t worry about it, go home, and we’ll put you into a clinic at some point to receive physiotherapy for your soft tissue injury”. Then what happens? You wait a week or two. The injury is not improving, if it is at all serious. If you have remained inactive, you have weakened your muscles. Ligaments and tendons are tending to shorten. Effectively, not only do you have the injury but you have physical deterioration around it. Fitness will also go down, so you will not heal quite so fast. We must find some way of getting enough expertise quickly to people.

My question for the Minister is: what is the thinking about trying to get these groups that cannot pay to people such as physiotherapists more quickly? Is there some way in which the first port of call would be not a GP but a physiotherapist, or at least could the GP make sure that the person got to a physiotherapist very quickly? What is important is not just the help that a physiotherapist or a doctor in sports medicine can give, but the exercise plan and the amount of treatment that can be self-administered—for instance, the right type of exercise and stretching. When do we get the expertise and back-up? It is worth remembering that, even if you happen to be an enthusiastic rambler, you are still quite capable of slipping and twisting something—your ankle, knee or whatever. It is not just sportsmen who are affected; all forms of exercise have the same pressures.

My noble friend has more exact figures than I have been given, but the advice that I have had from experts in the field is that there is no seedcorn money. There is not enough central training to get a significant number of junior specialist doctors trained in exercise medicine—the figure that I was given was a target of under 50 in about a year’s time. If we are going to try to keep people active and provide them with advice about taking up and getting involved with exercise, that is a ridiculously small number of doctors nationally.

There is also the problem that we have something of a postcode lottery. Nottingham and Sheffield are two of the areas that have some input from the National Health Service and, according to the briefing that I am holding in my hand and ignoring half the time, centres of excellence are building up. But unless you plan to do all your exercise and then get injured in one of those places—the Royal College in London is another such centre—what use are they to you if you cannot get access to them, and quickly?

I am trying to get the Government to give me some idea of their thinking on this subject. How are they going to address the fact that we are not helping people to help themselves? As I have mentioned, rehabilitation is probably the first thing, but the second is that we are encouraging people who are overweight or who have been inactive back into exercise. I had a letter from Slimming World this morning—whether that was personal or not, I am not sure; I think that it was about something parliamentary. Regardless of what people do in trying to lose or control weight through exercise, it is vitally important. I indulged myself tremendously at one point in an eight-minute rant against the body mass index, a medical term that was used for a long time, which ignores the basic fact that muscle is smaller and heavier than fat. My favourite example was that Pinsent and Redgrave were not obese but simply very heavily overweight when they were in their last boat together. They are over six feet four inches, I believe. A height/weight chart just does not work.

How will we provide information to the medical profession generally that will enable it to refer on to the existing resources? That is something else that must be addressed. Enhancing the status of sports medicine may enable the NHS to take some pride, and a trickle-down effect may result from having more status at the centre. In making such information more readily available throughout the system, we would be dealing with many of those problems as well.

I will curtail my remarks, except to say that this is primarily me saying to the Government: back up your 2002 White Paper, Choosing Health, your 2004 Chief Medical Officer’s report, At Least Five a Week, the healthy living programme and the Wanless report, Securing Health for the Whole Population, by giving support to those doctors and groups who are trying to make people healthier by making it easier for them to help themselves.

My Lords, I congratulate the noble Lord, Lord Addington, on having initiated this debate and commiserate with him that the response has not been as large as it should be. If he will forgive me, I should like to interpret the debate on a fairly wide basis. I shall talk about sports medicine and also about combating obesity through physical activity.

As the noble Lord said, the issue of measuring obesity is not straightforward. It is quite a debated issue. On the other hand, it is difficult not to accept the fact that the rising incidence of obesity and people being overweight is a fundamental health problem for our society and for many others. If you look across the world, it is plainly not just an issue for this country. There are not many respects in which the UK can be said to be ahead of other EU countries, but one trait of which that is true is that we have more people in prison than other EU countries do, and another is that we have more people who are obese.

This is a global trend. We are still lagging a bit behind the world champions, the United States. Recent material on Japan shows that it had the highest levels of longevity and overall good health in the world, mainly sustained, so far as we know, by the diet that people followed there. Now there is a massive increase in obesity, especially among people under 21. That is the most rising curve you could have seen, associated largely with the introduction of fast food into Japan but also quite directly correlated with physical activity.

The health consequences of all this are very strong. There have been discussions about the issue in the United States. It has been said by some specialists in the medical services in New York that obesity and other eating disorders could swamp the health system some 15 to 20 years down the line just because of the incidence of diabetes type 2 alone, leaving aside heart disease, cancers and other illnesses that are the result of this tremendous secular change in the physical health of the population.

I argue that this is part of a wider agenda of politics that we should give our attention to, which I describe essentially as the politics of lifestyle and contrast with the traditional welfare state. It has a lot of implications for the question of sports medicine itself, but also more broadly for how we attack these issues of exercise in relation to public health. In the past the welfare state and the NHS were primarily designed as insurance systems. They were concerned with picking up the pieces after things had gone wrong. If you get ill, the welfare state will help treat you. If you become unemployed, the welfare state will pay you unemployment benefits. If you have the misfortune to get old, the welfare state will pay you a pension. The welfare state and the NHS have been traditionally defined mostly as a kind of safety net, picking up the pieces. However, I do not think that that approach—and this does have a bearing on sports medicine—is possible to sustain any longer, not as a single approach to how we understand welfare and try to relate to the lifestyle practices that people follow. We must have a much more investment-based welfare system; we must invest more in children, as the Government are trying to do, and invest much more in positive health rather than in just treating people once they have become sick or ill.

The statistics on inequality in health bear this out very clearly. Health inequalities in this country between more affluent and poorer people have actually been increasing rather than decreasing. The reason for this is not traditional poverty but changes and differences in lifestyle behaviour. We have had a big transformation, going from an industrial manufacturing base to a knowledge and skill-based or service-based society. When 40 per cent of the population worked in manufacturing and another 5 per cent, 6 per cent or 7 per cent in agriculture, poorer people, especially men, undertook a great deal of physical activity in their everyday lives. Most of that has disappeared—someone working on a supermarket check-out does not get much natural exercise in the course of the day. The rise of obesity and other health problems is related to that, but it is also plainly related to class differences, type of diet, and in the propensity to take exercise and to smoke. Some of the most difficult issues in trying to produce a more egalitarian society are located there.

In a general way, the Government have responded quite strongly to these issues. There has been plenty of action around obesity and participation in sport. For example, the Government, working in conjunction with Sport England, are proposing to increase participation in sport by some 2 million people by the year the Olympics will take place, although it is not clear whether we are on track to achieve that.

We know that people’s behaviour can change. This has been achieved in Finland, which had some of the highest rates of heart disease and other diseases in Europe, as a result of eating a high-fat diet, especially people in rural areas. But as a result of a series of programmes, based mainly on incentives rather than constraints, this was radically changed. Finland has become one of the healthiest countries in Europe, with one of the lowest levels of heart disease. So we know that it is possible to make changes, and it is plain that sport has to be a core part of that, which I take to be the centre of the noble Lord’s Question. He set out the issue of sports medicine very clearly and I do not want to repeat it. If we are to have a healthier population, which we must have, it is surely important to bring sports medicine into the core of available forms of treatment, especially in the NHS. More affluent people can get such treatment easily outside the state-based medical system. We are talking about reproducing the very inequalities I have been describing.

I am afraid that sport is inseparable from injury and strains. It is true that people give it up if they do not get the right kind of medical attention. We should pay special attention to women, alongside men. I would not mind my noble friend commenting on this. We have to achieve a much higher proportion of women taking part in sport. The UK is lagging miles behind several other countries where girls are overtaking boys in sport as they have in education. More women than men are taking part in sport and physical activity in some countries. In this country, women are a long way behind in participation. Sports medicine has to apply to women as well as to boys and men and there is still a sexist residue in terms of treatment. There should certainly be gender-neutral opportunities within the health system.

One point I have about sports medicine links in to what I was saying about the welfare system. I do not know what the noble Lord, Lord Addington, had in mind when he used the term “sports medicine” but I do not think that treatment should simply be after the event. To sustain a fit population and get people involved in sport, there needs to be investment in a lot of other more generative forms of treatment, including things that can help people be and stay fit. After all, affluent people use massage and physiotherapy to stay fit and to avoid sports injury, and we should be considering those things under the auspices of the NHS.

These issues should be dealt with by third-sector groups, as well as just the NHS. The principle applies across the board with welfare. I have come to the end of my time but I would like to end with a joke. I was asking people beforehand to laugh at it; this is the smallest audience I have ever told a joke to.

A guy researching old age in the US came across this wizened fellow, all bent over, rocking in his chair on the porch. He asked, “How long have you lived here?” and the man said, “I have lived here my whole life”. The guy asked, “What kind of life have you led?” and the man said, “I’ve smoked every day of my life: I’ve eaten junk food every day and I never take any exercise. I just sit here and rock in the sunshine all day”. The guy said, “That’s amazing. How old are you?” and the man said “35”.

My Lords, I congratulate my noble friend Lord Addington on securing this debate and on the persistent and dogged attention he has given this subject. He has a bit of the Geoff Boycott determination to see this through.

It is important to be clear at the beginning that we are talking not about the small subject of treatment for elite athletes. Approximately 700,000 people suffer a sports injury every year. In addition, RoSPA notes that about 87,000 people suffer accidents as a result of gardening and DIY. Their injuries can be very similar, requiring surgery, physiotherapy and rehabilitation. In addition, there are some occupations where physical injuries are an occupational hazard. Police, firefighters and builders, for example, are prone to these sorts of injuries.

The timely treatment of injuries does not only mean that people who have been taking exercise continue to do so. Research in this area of medicine shows a knock-on effect in that it can lead to a better understanding of issues such as muscle strength and balance in older people, and the prevention of falls. That is perhaps a related cost that we do not think about when we talk about sports medicine.

My noble friend is right that most people who sustain an injury go to their GP or A&E as their first port of call. If they are lucky, they may happen upon a practitioner with a special interest, but most people do not. Because the level of rehabilitation and aftercare is low, there is a consequent economic loss, with people going on to suffer conditions such as chronic lower back pain or low-level disability and sometimes they do not return to work. The Minister’s colleagues in the Department for Work and Pensions will know the extent to which that failure to treat people has a consequence for unemployment and underemployment. That is a huge economic drain on the country, especially in terms of incapacity benefit payments. When the Government come to do their accounts and their cost-efficiency reckonings, perhaps a bit of cross-departmental calculation might yield some interesting figures.

The new sports and exercise medicine qualification is a welcome development, It will be particularly valuable if it is available to NHS consultants, specialists in private practices and GPs—perhaps GPs with special interests working with A&E teams to develop their skills and those of the acute sector.

Private practice requires a little attention. Many high-quality facilities exist, often associated with major sports clubs, but there is a question about their overall quality. From time to time, one reads about footballers who come to this country from France, Germany or Italy and bemoan our standards of physical training, physiotherapy and rehabilitation, even in the Premiership. It is worth noting also that when England internationals—I can say this because I am a Scot—sustain an injury, they always seem to be flown off to the United States of America while the rest of us are left reading the Sun and resorting to prayer. Given that we have in the NHS the largest possible range of specialists working together in disciplines such as nutrition, physiotherapy and musculoskeletal medicine, it seems strange that we are not further ahead in sports medicine. We are only just starting to address it at the elite end.

For individuals who have sustained an injury, getting access to the right treatment at an early stage is a critical factor which determines how well they will recover. However, finding the right people, and knowing that the treatment that one receives is correct, is often a matter of luck based on personal conversations and recommendations. I know that chiropractors and osteopaths are increasingly regulated, but there is a degree to which such informal recommendations must be unsafe. When I sustained an injury some years ago, I made the conscious choice to go to my GP to make sure that it would be all right to see an osteopath and a chiropractor, because I did not want to put myself in danger of sustaining an even greater injury.

It is estimated that there are approximately 30 full-time sports medicine physicians in the UK. In answer to a Question put to him by my noble friend on 22 February, the Minister, the noble Lord, Lord Hunt, said that he anticipated that there would be a further 40 specialist doctors in the near future, with a further 12 starting training each year. Those are not enormous numbers, but, now that we are in a new financial year, will the Minister say whether the predictions of the noble Lord, Lord Hunt, were right and have been realised? Where will those new training places be and how will people get access to them?

I turn briefly to accreditation. I understand that the Intercollegiate Academic Board of Sport and Exercise Medicine has been created by the Academy of Royal Colleges to formalise future training of specialists in sports and exercise medicine. Some consultant posts exist, but they have usually grown out of an existing speciality; for example, orthopaedics or rheumatology, because formal training and formal recognition are not sufficiently widely available. A number of universities offer diploma or MSc courses, but they vary in one crucial aspect: the amount of students’ clinical exposure. Is the Minister’s department planning a move towards a standard of accreditation for sports medicine which covers a range of disciplines and not just musculoskeletal medicine?

Like, I suspect, other contributors to this debate, I took a very interesting trip around the internet during my preparation. I dipped into the e-library of the American Orthopaedic Society for Sports Medicine. I use the word “dipped”, because it is huge. It covers a wide range of topics, including preventing cycling injuries, health and activity, starting a strength training programme, anterior cruciate ligament injury prevention, how to rehabilitate a sprained ankle, exercise for bone health and shoulder dislocation treatment. I could go through the list of misery that befalls people who are engaged in physical activity. However, I cannot help but think that if the NHS, with the access to all the specialisms that it has, had such a resource and made it available to patients, a great deal of the demand on the NHS would decrease because people would be able to take the right steps in their own self-medication and self-treatment, particularly to avoid that period after an injury, about which my noble friend Lord Addington spoke, when they simply wait around not knowing what to do.

I hope that the Minister will in her response tackle the question of how we can apply the rich base of multidisciplinary research which exists in the NHS and become world-beaters in sports and exercise medicine. Will she speak particularly about accreditation and provision of preventive services? I again congratulate my noble friend on securing this debate.

My Lords, the subject of obesity is never far from our thoughts whenever we debate public health issues, and that is entirely appropriate and right for a condition which, perhaps more than any other, has so many adverse long-term implications for the well-being of the nation. However, this evening, the noble Lord, Lord Addington, has brought us into the obesity debate from an angle that is rather different from the usual one. For once, we have the opportunity to look at the “calories out” aspect of the obesity equation as opposed to the more familiar and well worn arguments that surround “calories in”. I for one find this very refreshing.

When it comes to sport and exercise, the Government have said and done a lot that is worthy of approval. Some useful targets have been set. The best known is perhaps the target contained in the public service agreement of 2004 to,

“halt the year-on-year increase in obesity among children under 11 by 2010, in the context of a broader strategy to tackle obesity in the population as a whole”.

As part of that target, the Government aimed to have three-quarters of all schoolchildren doing at least two hours of school sport a week by 2006—a target which, happily, has been exceeded—and four hours of sport a week by 2010. The emphasis on children’s sport is certainly not misplaced. We know that, when it comes to diet and exercise habits, it is much easier to influence the behaviour of the young than it is of adults, and it is among the young that the most alarming rise in obesity has taken place during the past 10 years. It is therefore welcome that, at local level, there are school sports partnerships, which have the aim in particular of increasing the participation of overweight and obese children in physical activity. I have to say that those partnerships have yet to prove their worth. The National Audit Office, the Healthcare Commission and the Audit Commission published a joint report last year, and one of the criticisms in it was that the programmes being rolled out to combat obesity are essentially unproven. There is a serious shortage of evidence about what works for obesity and a serious shortage of baseline data against which to evaluate results. A process of rigorous evaluation is therefore absolutely critical if we are to determine whether resources have been used efficiently and effectively in this area. We know that a social marketing campaign has been commissioned by the Government to try to get closer to what drives people’s behaviour as regards eating and exercise. While that is not by any means a silly thing to be doing, one has to say that, for such an important undertaking, it has been started rather late in the day.

The Government’s general message, encouraging us to be more physically active, is of course only partly to do with sport, but it is clear that for young people, assuming all goes to plan, sport is going to be a major ingredient in the mix. That is why the noble Lord, Lord Addington, has focused on sports medicine. If more and more people are being encouraged to take up sport, then it follows that they should be backed up by trained doctors and nurses with appropriate specialist knowledge. That indeed was the context in which the new specialty of sports medicine was established by John Reid two years ago. The other day we heard from the noble Lord, Lord Hunt, that quite soon we will have 40 specialist doctors with another 12 starting training each year. Presumably that rate of admission to the specialty is based on some sort of forecast of likely demand, and it would be interesting to know what set of assumptions underpin the figures in that sense.

When people talk about sports medicine specialists—and I am thinking now of some of the pronouncements made by the government agency, UK Sport—it is often in the context of elite athletes who are training to Olympic standard. The noble Lord’s concern, quite rightly, is not about Olympic athletes so much as about the millions of ordinary men, women and children playing sport. In that context, 40 specialists are a start but they do not sound all that many. In the wake of the recent debacle over MTAS, it would be helpful to know from the Minister how many of those doctors seeking to enter the specialty have been accepted into specialist training posts and how many such posts remain unfilled. But on a wider scale, what we have not seen, as the noble Lord said, is any real encouragement in the regions through the postgraduate deaneries for junior doctors to train in the specialty. I should be interested to know whether the cost of setting up run-through programmes in sports medicine was thought about when the global budget for delivering medical education was originally set.

The noble Lord, Lord Addington, also spoke about the patchy provision of sports and exercise medicine around the country, to which one could also add the patchy nature of commissioning. Of course the Government are right that PCTs and strategic health authorities are the people best placed to assess local needs and to develop plans to deliver the services that are required to meet them, but how do they really know what services are required? To an extent, we are working in the dark when looking at the demand side of the sports medicine equation, because as far as I have been able to discover, there are no statistics on the number of injuries that are attributable to sport and exercise and treated under the NHS.

What we do know is that there are not enough employed physiotherapists. The Chartered Society of Physiotherapy has reported that in 2004-05 over 1 million patients admitted to hospital had conditions that required physiotherapy treatment but in many cases had to wait for a long time before that treatment became available. It is highly likely that exactly the same situation obtained during the year just gone. The irony is that there are plenty of physiotherapists out there, but they are unemployed. Seven out of 10 physiotherapists who graduated in 2006 had not found a job by Christmas. The reason, of course, was that trusts did not have the money to take them on. Another 2,500 physiotherapy students are due to graduate this year, and one has to be fearful that the same fate may await them. As a nation we surely cannot afford this waste of resource, but from the patient’s perspective the waste of resources is a secondary issue.

The recent funding difficulties in the NHS have been very damaging. The money that PCTs have been given to promote wellness programmes has been swallowed up by the demands of service provision. The same has happened to the money at SHA level for education and training. On the wider issue of medical education against that backdrop, the universities whose job it is to deliver medical education and training perceive the scene before them as unstable and unpredictable. They have seen that the over-riding priority of SHAs has been to achieve financial balance at the expense of anything and everything else, including education budgets and workforce plans. This is still happening. Some SHAs are continuing to raid their education budgets. Nor do the universities see themselves as being an equal partner in the planning of the future workforce, as by rights they should be. They see themselves being told what to do by the NHS—and, sad to say, they see in SHAs a dearth of the skills needed to deliver what is at the best of times a very complex agenda.

The engagement of the academic and research community—the mobilisation of universities—is a key part of what it takes to modernise the health service but, at almost every level, this kind of engagement is being hampered. At departmental level, there is not enough formal dialogue between the DfES and the Department of Health. At SHA level, there is no longer a requirement for there to be an academic representative on the board as of right. At provider level there are no direct incentives for trusts to engage in education, training and research. The result is an increasing disconnect between higher education and the health service. If that persists, it would I think be dangerous to assume that the universities will want to put up with it indefinitely: some may well decide that they would be better off devoting their resources to other things. That situation, if it were allowed to happen, would not bode well for the future of medical education generally, or for sports medicine in particular.

A great many initiatives and a great many organisations are involved in the delivery of the Government’s anti-obesity agenda. Expertise in sports medicine, shared among a sufficient number of practitioners, is a small but important part of that agenda. I hope that the Government will make it their business to ensure, by proper performance management, that it is delivered.

My Lords, this has been a very good debate, and I too congratulate the noble Lord, Lord Addington, on his dogged determination. I am grateful for this opportunity to demonstrate our commitment to healthier living, particularly by using all the available opportunities to encourage people to eat more healthily, take more exercise and participate in more sport. Too often we forget that not only is public health everyone’s business but it is everyone’s responsibility. As individuals and as a society we gain from healthier living. The noble Lord, Lord Addington, is absolutely right: sports and exercise medicine is a preventive medicine and the case for it is a no-brainer.

Promoting healthy lifestyles is a vital government responsibility, helping people to help themselves. That was the purpose of the White Paper Choosing Health: Making Healthy Choices Easier, published in 2004, which demonstrated our commitment to making healthier choices easier by offering people practical help to adopt healthier lifestyles. We recognise that diet, physical activity and public health are essential elements of addressing health inequalities and other inequalities in our society. Since Choosing Health, the Department of Health has been involved in many initiatives to help people quit smoking, eat more healthily and exercise more. The implementation of our smoke-free legislation from 1 July is a prime example.

The noble Earl, Lord Howe, mentioned our challenging target for tackling obesity. As my noble friend Lord Giddens pointed out, obesity is a fundamental problem which is common to many countries. It is a complex public health problem responsible for many early deaths. In 2005, approximately one-fifth of adults were classified as obese. We know that unless we act now, within the next three years those figures are set to increase dramatically. The situation for our nation’s children is particularly worrying. In 2005, almost 17 per cent of boys and girls aged between two and 10 years were classified as obese. That is a huge increase since 1995 and is something about which we should all be concerned. Obesity is associated with a number of diseases. It causes depression and low self-esteem in many people. About 58 per cent of type 2 diabetes, 21 per cent of heart disease and between 8 and 42 per cent of certain cancers are attributable to excess body fat.

The costs to our health are huge, but there are also economic costs, and physical inactivity is estimated to cost the economy £10 billion a year. Choosing Health set out a detailed plan of action on physical activity, diet, personalised support and information and curbs on marketing that helped to provide a good foundation for tackling obesity. Since then we have made good progress on food labelling and restrictions on food promotion to children, healthy schools, work on infant feeding and work with Sure Start centres. Our schools are now healthier places. More than 12,000 schools have achieved the healthy school standard, which means that they meet criteria for obesity, physical activity and diet. We understand the importance of supporting parents and helping their children to eat healthily and take more exercise. We are working on a number of campaigns to encourage healthier eating and increase physical activity, such as the recent Top Tips for Top Mums campaign to encourage children to eat more fruit and vegetables. My noble friend Lord Giddens is absolutely right that we have to encourage more women to participate in sport, not only for their own interests but because of their influence as mothers.

We see the development of sports and exercise medicine as a further strand of our strategy to reduce obesity and promote healthier lifestyles; indeed, it could have a real role in improving health and well-being. Sports and exercise medicine is not just the medical discipline that addresses injuries occurring as a result of sport, but also has an important role in the treatment and prevention of illness. It is yet another way of supporting Choosing Health priorities. Sports and exercise medicine doctors will be key players in encouraging people to safely increase exercise levels and participation in physical activity. They will be well equipped to work in partnership to help develop programmes aimed at tackling obesity and eating healthily. They could also have an important role in reducing cigarette smoking and improving mental health.

The sports and health medicine curriculum has been specifically developed to include a section on aspects of population health. As part of their training, sports and exercise medicine trainees will undertake public health attachments to develop specific health-promotion skills. This will enable them to promote physical activity both in the workforce and in the general community, to develop and participate in programmes for those most resistant to physical activity and exercise, and to develop and give educational talks to community groups promoting the health benefits of exercise. Naturally, we will expect sports and exercise medicine specialists to work in close partnerships with their public health and primary care colleagues.

The 2012 Olympics provided a useful catalyst for both the Royal College of Surgeons and the Department of Health, but we recognise that there is a lot more work to be done to develop this field of sports medicine. I, too, think it rather strange that it has taken so long for this specialty to take off. At present only a handful of hospitals have a trained sports and exercise medicine doctor, and many sports and exercise conditions are seen in general practice. However, we are making real progress in developing this specialty. The noble Earl asked whether our figures were based on demand. The Faculty of Sport and Exercise Medicine has estimated that, to fulfil our Olympic promise, there need to be 31 specialists in sports and exercise medicine on the specialist register. However, I emphasise that that is just the start. Noble Lords are absolutely right to say that there need to be a lot more of these people. The Faculty of Sport and Exercise Medicine aspires to have one specialist in each primary care trust. I am sure noble Lords consider that that is not enough, but it is an important part of our aspirations. The faculty has developed a curriculum to ensure a robust training programme, and by September 2006 there were three doctors on the specialist register. I say to the noble Baroness, Lady Barker, that the faculty sets the standards.

By February 2007 there were eight doctors undertaking specialty training in sports and exercise medicine, and from August 2007 it is expected that there will be at least 16 doctors training in sports and exercise medicine in London alone. There are also training posts in other parts of the country—one in the north-east, possibly two in the east Midlands and two in the Armed Forces. In addition, following a statement by the Secretary of State last week that an additional 200 specialist medical training posts are to be created and funded centrally, it has been decided that the specialty of sports and exercise medicine will be allocated three of these additional new training posts. They are accessed like any other specialist training posts. I am assured that offers for the 16 posts went out this week. We see no difficulty in the posts being filled. If that is not the case, I shall certainly come back to noble Lords.

The noble Baroness, Lady Barker, referred to 30 to 40 specialist exercise physicians. These physicians are not on the faculty register but would be eligible for top-up training via Article 14. The Faculty of Sport and Exercise Medicine is also keen to support doctors with relevant sports and exercise medicine experience to apply for specialist accreditation via the Article 14 process. These doctors would not be required to participate in the full training programme, but would be eligible for inclusion in the specialist register if they received a short period of top-up training. In that way we shall see a lot more people who have a specialty in sports and exercise medicine. In recognition of this the Department of Health recently allocated some top-up money for training in 2006-07. This money is being used for pump-priming a sports and exercise medicine post in Nottingham and providing two six-month top-up training posts in London.

The noble Lord, Lord Addington, is absolutely right to say that people need access to sports medicine specialists in the community. That is our aspiration and is exactly what we want. As many noble Lords said, to date only the wealthier members of our society have had access to these people. We want people wherever they are to have access to those who have specialist training.

We have demonstrated our commitment to strengthening the availability of sports and exercise medicine services throughout the NHS. But this is not just about complying with our Olympic bid. Of course that spurred us into action, but this is also about supporting people as they make their healthy lifestyle choices. It is also a means of improving governance in sports and exercise medicine services and of democratising access so that more and more people have access to those services.

I am delighted that this evening’s short debate has demonstrated that there is strong support for our commitment to strengthening the availability of sports and exercise medicines throughout the NHS as a means of achieving that commitment. There is a lot more to be done but we are committed to doing it so that the whole of our society can partake healthily and safely in physical activity, we decrease the number of obese people, and we have a healthier society.

My Lords, I beg to move that the House do adjourn during pleasure until 8.35 pm.

Moved accordingly, and, on Question, Motion agreed to.

[The Sitting was suspended from 8.28 to 8.35 pm.]