Health and Social Care Committee

Croeso, bawb. Welcome back to the Health and Social Care Committee. We continue our evidence session with regards to the prevention of ill health—obesity. We have a panel of four for the second panel this morning, and I'd be grateful if the witnesses could just introduce themselves for the record. If I start from my left.

Bore da. Good morning. My name's Jessica Williams. I'm the head of partner and service development at Sport Wales.

Morning, all. Graham Williams. I'm a director at Sport Wales.

Good morning. Bore da. I'm Fiona Reid. I'm the chief executive officer for Disability Sport Wales.

Bore da. Tom Rogers, governance and partnership director, Disability Sport Wales.

Lovely. Diolch yn fawr iawn. Thank you very much, all, for being with us today. Tell us about the link between physical activity in relation to weight loss, and other management services as well.

I'm happy to start with that. Firstly, if I may, Chair, just to say that we're delighted to be able to come and give evidence to this committee. Of course, we have submitted written evidence as well, because, from our perspective—I think I speak quite broadly, from a sport perspective and physical activity—we certainly feel that our product really contributes to the preventative health agenda of the people of Wales. We can see huge benefits and huge opportunities in terms of placing physical activity at the heart of some of these conversations. So, I welcome the opportunity to talk further, but thank you for this morning.

I think, put simply, sport, physical activity can have an enormous impact on the obesity agenda, but more broadly, health outcomes for the people of Wales. We know that people who are physically active have better health outcomes, and we also know that they're more likely to engage in other healthy lifestyle behaviours, such as limiting smoking, looking after diet, thinking about eating fruit and vegetables. So, it's a really positive tool in that sense. It's a tool that we think could be strengthened. There are opportunities to think about not only how we embed physical activity into people's day-to-day lives, so how they move around a space, how they get from work, play, et cetera, but how we encourage more opportunities to be proactive in the behaviour of, in our instance, sport, which then leads to a really positive health outcome. So, there is an intricate link. I think that there's a relationship around other healthy lifestyle behaviours. But in itself, it plays a really pivotal role as well.

And to what extent do you think the public understand what you've just said?

I think that there's a reasonable understanding around the positive benefits that being active could have on one’s life. I think one of the challenges, though, is that we need to try and think about making the healthy choice the easy choice. And actually, to that degree, thinking about how we build it into our systems so that it doesn't always have to be the conscious choice of the behaviour, but actually it's really easy to think about how you get somewhere and you're physically active en route, or how physical activity is built into some of our school systems so that children have the opportunity on a day-to-day basis to be active in and around some other things. So, I think there's a reasonable understanding, but I think we could do more, and there are certainly opportunities, which I'm sure we'll talk about over the next hour or so.

Lovely, thank you. And the panel earlier talked about there being lots of strategies in this area in terms of tackling obesity and living healthier lives, and we had a conversation about 'Healthy Weight: Healthy Wales'. To what extent do these policies and programmes and initiatives from Government—to what extent do they, in your view, incorporate the importance placed on what you said, Jessica, in terms of sport and the way sport and activity is important in these programmes? To what extent do these programmes incorporate sports and physical activity?

Chair, if I may—I think they do incorporate it. I think there's more of an opportunity to think about what we are saying through those strategies and raising the profile of what sport and physical activity can do from a public health perspective. And if I just use some words that the World Health Organization said back in 2022:

'There are few areas in public health—such as physical activity—where evidence on required action is so convincing, cost effective and practical.'

And I think that sets the tone of perhaps where we need to be thinking about physical activity. I think we need to set a new ambition around physical activity. And to your earlier point, we need a new language, because talking to members of the public about 30 minutes of moderate-intensity physical activity every day perhaps doesn't engage.

It doesn't engage.

It doesn't engage, but 'Sit less, move more, enjoy your walk with your friends'—we've got to think of a different narrative that describes what not just the physical benefits of being active can bring, but the much more wider mental, social and potentially environmental benefits as well. So, I think we need to reframe it.

But going back to your original question, I think there is a good start in those strategies. Inevitably, physical activity probably doesn't get afforded the priority that perhaps it needs to be, and I think that's why I use that quote from the World Health Organization about it seems to be a real opportunity to make a step change. And I think a country of our size, actually, and our ambition—we can do that.

Okay, and Fiona, have you got any comments from your perspective in terms of my two questions?

Yes. I think I agree and completely support Jess and Graham's perspective, but I think, from a disabled person's perspective, it's ensuring that it's much more explicit about population-level action so that where we do connect up the policies and the starting points that we're all coming from, we can see it very clearly how everybody can engage. A lot of the work that we do really highlights the value of physical activity as part of the pathway into sport, but may not have sport as its only or ultimate destination. So, for us, it's just making sure that there's that differentiation by community and population, because we know that where physical activity and sport are both concerned, there's a significant gap still in participation, opportunity, accessibility. So, yes, we'd like to see that gaining slightly greater priority through policy.

Joyce, and then I'll come to you, Tom, if you want to come in as well. Joyce.

Just on some of that opportunity for disabled people—the first opportunity most children have to engage in activity is either through school or the local play area. And the local play area is, very often, not built with disability in mind. So, the question I’m going to ask you is this: when we’re looking at—. Or is there any evidence that, when local authorities or whoever are going to build a new play area, they actually have to, within their plans and their agreed formulas for funding them, pay attention to making it fully accessible for all?

I think there’s definitely a greater move towards that. Whether that’s mandated—I’m not familiar enough with local planning policy to be able to answer your question fully. But, certainly, our observations would be that where green spaces, blue spaces are—primarily in your question—accessed by children, but also by adults who might acquire an impairment later on in life, we can do better to ensure that there is good accessibility, and that we communicate that accessibility as well to disabled people within our communities, so that they do get the opportunity to play and engage with the environment that we’re so lucky to have in Wales.

Tom, did you want to come in?

Can I just add a bit on that, especially around—? Sometimes, we forget to communicate what is available to disabled people. So, in some cases, there might be excellent facilities out there, and there might be some that are not as good, but because disabled people are probably used to some of these facilities—whether that’s a leisure centre, or whether that’s a play area—not being for them, they might not go and explore and say, ‘I’ll go out and try it today.’ So, it’s around how we can explicitly go out and give them as much information about what’s available in an area, and they can make that informed choice, as that disabled person, of what is available to them as well. So, sometimes, there are easy wins and sometimes there are bigger wins around influencing any new builds. That’s 100 per cent the way we need to go.

Thank you. Jenny Rathbone.

Thank you. It was good to hear Jessica speak enthusiastically about 'Healthy Weight: Healthy Wales'. I just wonder if you could tell us how it has changed the relationship that you have with other weight management services, because it’s quite a holistic field.

I think 'Healthy Weight: Healthy Wales' has certainly given us a platform to work in a really collaborative, cross-sector, cross-policy area way. And I think, as a strategy, it’s a really good vehicle to start to talk about some of the things that we think would be important in terms of how we embed physical activity into people’s lives. And what I mean by that is that there are conversations with colleagues at a Welsh Government level who work in the health policy division. Similarly, within education and planning. So, I think it’s a really good platform for that. We might come on at some point in the next hour or so into the opportunities we can build on from that platform. In terms of weight—

I'd like to come on to them now, actually. What impact is it having on the ground?

In terms of weight management, I think, from a sport perspective, everything that we do is geared up towards preventative health. So, we, as organisations, are kind of enablers of people who deliver on the ground. And inevitably, what we deliver in terms of sport, physical activity, will contribute to positive weight management for individuals. We don’t work directly with services, such as weight management services, but we certainly collaborate in a health policy area.

In terms of the opportunities going forward, I think strengthening the elements around physical activity within those strategies, as Graham mentioned earlier, would be a real positive for Wales. And I think we’re a small enough country that, actually, we can work collaboratively when those areas are strengthened. I think it's about prioritising young people—the question just before around the environments that young people are in—so that we do set young people up for success, and we set them up to think about healthy lifestyle behaviours for the rest of their lives. That includes physical activity. That includes thinking about healthy lifestyle choices around food, drink et cetera. And then we also think about how much allocation is given around preventative health measures in terms of budget opportunities and budget lines. And I’m sure that’s a wider conversation around the positives around a preventative budget line, but also thinking really long term in terms of how we budget in that sort of space.

I’m sure that those who are making a success of sport are given lots of important advice about food and drink, but what conversations do you have with all of the grass-roots sports organisations that are represented through you? How do we counter when a person does all of this sport and then they revert back to the so-called energy drinks, the crisps and all of the other things that are actually killing them?

Like I said, as an enabler, we work with a range of organisations that will do our delivery. There are a number of specific examples. One in particular is a children and families project, and that sits within the health division and is shared as a pilot project with sport. As part of that, there’s an active arm. So, we work with three pilot organisations in terms of physical activity for a family network—so children and their families—but there’s also a nutritional arm, and that’s co-ordinated by Public Health Wales. So, there’s real collaboration there in the opportunity that somebody who is part of that pilot is getting. That pilot is called Children and Families. We’ve called our arm Pipyn Active and there’s also a Pipyn nutrition arm. It’s very much in the pilot phase at the moment, but the conversation about how this can be rolled out nationally and how can we think long-term about this as a programme—certainly, those are positive conversations.

I think in terms of, perhaps, more on a grass-roots or sport delivery perspective, I’m sure that there would be conversations happening within local sports teams, clubs et cetera. I’m perhaps not close enough to some of those clubs to be able to articulate those, but referencing my earlier point, we know that there’s a relationship between people who are physically active and then people who engage in other healthy lifestyle behaviour choices. And we see that in the national survey for Wales, we see data that proves that people who are active more than three times a week are more likely to think about other healthy lifestyle behaviours. So, there’s certainly a relationship there.

Jenny, are you happy if I bring Joyce and Mabon in here?

Yes, go ahead.

Joyce.

Five minutes ago, I had an e-mail—we’ve all had it, but I picked it up—from grass-roots sports needing additional backing because of the financial situation that they’re finding themselves in, particularly when it comes to community hubs. This has come from Sported. And that research that they’ve just launched found that 67 per cent of clubs and groups believe that they aren’t getting the investment into that grass-roots sport to back its important community-level engagement. But more worryingly, that survey finds that 50 per cent confirm that young people in their group disengaged from or reduced participation in sport and physical activity over the past six months because they can’t any longer afford it. And 53 per cent of those said that travel was cited as the major factor, and the affordability of those facilities, maintenance and limited space, particularly those who own their own facilities. So, what I’d be interested to hear, because that is of concern—this is a Wales survey, by the way—is how do you help to engage those in your role, particularly in light of that report?

As this is Jenny’s section, can I take Mabon’s question as well? I’ll ask the panel and then come back to Jenny. Mabon.

Just briefly, Jess, you mentioned there budgets and the importance of preventative measures. We heard recently that some local authorities are now looking to cut leisure centres because of the settlement from the Government, and we’ve seen leisure centres being closed over the last few years because of financial difficulties. If local authorities were to cut leisure centres, how do you think that would impact on people’s health? And will that impact the obesity levels in Wales and the preventative agenda that we are trying to develop?

Do you want me to—?

Yes, please go.

Chair, if I can, maybe, just respond to the first point in terms of Sported. So, a couple of observations, if I may. One is that we do, as a national agency, fund Sported so that they can do that type of research and evidence base that you were referring to. So, we do directly fund Sported. It is challenging. So, the findings of that are pretty stark, aren’t they? We are facing that cost-of-living challenge. We’ve had our own budgets reduced. Most of our budget goes out to partner organisations to deliver because we don’t deliver ourselves. And those challenges will remain. We do have schemes available that support local community clubs, and we do put a greater emphasis on those that are, perhaps, from our poorer parts of society. So, we put a great relevance in terms of grant funding towards those. But we can't deny that that is a challenge as we move forward. Our budget was £2.5 million less last year—a 10.5 per cent reduction. We managed to ensure that lots of that wasn't passed on to the sector, but it inevitably does impact on that sector and I think that's one of our biggest challenges.

And I think—going to the second question, which is about leisure centres and cost-of-living pressures—that if we frame leisure centres as an activity and a wellness hub, then I think that's how we need to be promoting them to show their full value to the communities in which they're based. If they are viewed potentially as a swimming pool that costs a lot of money to heat and treat and staff, and it's difficult to access, then I'm not surprised that, maybe, they are areas of services that are not core to what local government deliver and that, under budget pressures, undoubtedly will face challenges. But I think, in the way that we're trying to frame how sport and activity can help the health and well-being of Wales, we need to start looking through the lenses of facilities and local service delivery also through that same lens, which is about how they contribute to the health and well-being of Wales. I don't think it answers your question directly about what is its impact. Inevitably, it will have a community impact and we would hope that there are lots of equality impact assessments, local community assessments, that would take place before we reached a point of closure, but unless we see them as a contributor to the wider health and well-being of Wales, it becomes really challenging.

Okay. Jenny.

I'll come back to facilities in a moment. I just wanted to follow up very briefly with Jessica. You said you were having some useful conversations around the child and children and families work stream. At the moment, it's still a conversation going on with Public Health Wales—it's not something that's had any impact on communities I represent—

At the moment, we're in the second phase of a pilot of three years with that programme, so the conversation is about how we continue that beyond the pilot phase, because we are seeing some really positive impacts.

Okay, so we'll look forward to hearing about the impact there.

I just want to turn now to people with disabilities and how we enable them to have sport. And starting with people with physical disabilities, it should be, in most cases, rather obvious to everybody, including the local GP and health visitor, that this individual is going to need extra support and attention to the importance of physical activity. Obviously, we've got the Paralympic movement, which tells you that anybody can do sport, but, just at the grass-roots level, what conversations go on with the people working in the community in health about how they encourage people with disabilities to do sport? And, obviously, that needs to include feeling welcome in whatever facilities are available.

Can I hand over to Tom?

Hopefully, we have a programme or a partnership that can answer some of this. So, there's a health disability activity pathway, which is funded by the Welsh Government, into health boards. So, within each of the seven health boards, there is a practitioner whose role it is to train health professionals in those areas to get the secondary—a physiotherapist, or an occupational therapist or a GP et cetera—to signpost people who they see day to day, as their patient or whoever they're working with, into community settings. So, essentially, not at the Paralympic level, but into those grass-roots examples. That relies on partners across Wales. So, they don't come into Disability Sport Wales or Sport Wales; they go to a local authority or the equivalent, so, like a Newport Live or Met Sport in Cardiff. So, they get signposted to there to find the best opportunities for them. So, that might be a specific session—. Sorry, you started with physical impediment, but this is across every impairment group.

Then the secondary part relies on partners within national governing bodies, or those local authorities or the equivalent again, through insport club, which is a mechanism to support clubs to offer that welcome environment—so, a toolkit to help them to provide that in the best way. So, there are 340 of those nationally. They're in every area of Wales. And the secondary benefits are, when we talk about transport and facilities, that the highest number of those clubs, which I think we're seeing across Wales, would be in some rural areas. So, in Powys or Pembrokeshire, it's particularly high, and then that does transfer across a lot of those rural areas where we maybe rely on those clubs to provide those well-being places, where it's easier for them to offer that equitable approach. And about the leisure centre point, that would have that secondary impact on the transport element, because our transport network is aligned to those as well.

So, the individual in the health board is the champion for ensuring that facilities are accessible—in the broadest sense, not just physically accessible—but also for laying on sessions for people who are never going to be at the Paralympics but just want to have some fun and some exercise?

One hundred per cent, and the easiest way to align—. So, there will be someone in Aneurin Bevan health board that's aligned, in Gwent, to support the training of those health professionals and then they will liaise with the five local authority areas in that health board region. So, for example, in Newport, that would be someone called Tom Hole, who is in Newport Live's team. He will receive the signposts, and then allocate, so he'd be the champion for what's available in that area. The health board representative is the champion to support those health professionals to align the two sectors up, if you like.

Okay. So, how engaged are GP services in ensuring that they're using social prescribing to do some sport, even if it's just going for a walk? It very much depends on the individual's ability, but it's the GP or the pharmacy that is going to see somebody who is not feeling well mentally maybe. How do we ensure that everybody's thinking that physical activity is part of the solution?

Can I—

I was just going to say—sorry, the last point from me, and then I'll pass to Fi—as you said, it depends on the individual, as in the individual coming in. I think a lot of it depends on the individual that they meet, how much time they have and where they sit in the setting. You asked specifically about GPs, but we see the vast majority, a really high percentage, of the signposted people come through physiotherapy or occupational therapy. They are much higher than the others. GPs depend on engagement. In some areas, in Betsi Cadwaladr, for example, it's been established for three years—the pilot that happened in Betsi. They're much more engaged there, but, for GPs, sometimes, it's much harder to get into the training slots with those professions than it is, maybe, for some of the others. Fiona.

Yes, I was just going to reinforce that the purpose of the programme is really to kind of connect with health practitioners to raise their awareness, because, originally, it came from a pilot project funded by Sport Wales in Betsi Cadwaladr University Health Board, and the review that we started with was around awareness of opportunity for physical activity for disabled people across the spectrum of impairment profiles, and it was relatively low in terms of awareness. So, if that every contact counts with a health practitioner, but they're not one that is familiar enough with the physical activity environment, then it's unlikely that they'll be signposted; the expectation will be, 'Well, there is no physical activity opportunity for this individual.'

So, that's the whole purpose, and I think, across Wales, the connectivity into different areas of health with different health practitioners, as Tom said, just depends on availability and priority and the frequency with which they're seeing disabled people so that the training can be focused.

So, what about people with learning difficulties, because I don't know whether they get to see occupational health or physios?

There is a good example of that, actually, on Ynys Môn, wasn't there, in terms of the relationship between the health practitioner and social services, and there was quite a high volume of people with intellectual impairment, learning disability, who were then signposted into their local leisure centre to be able to access physical activity opportunities that they knew were inclusive. So, yes, it's present there as well, so it's connected, but that's not to say it couldn't be better.

Okay. And lastly, the committee's heard loud and clear the connection between mental health and obesity. So, what connection do you have with mental health services to ensure that they're using the referral pathway to physical activity to help people cope with that issue?

Again, that would predominantly come through the health disability activity partnership with the health boards and the practitioners within those health boards. I think, for disabled people, that the impact on mental health over the past few years and the benefit that physical activity can have on life satisfaction are significant, so it becomes really important that we do connect up the opportunities for physical activity as part of the solution to enhancing our life satisfaction and starting to address some of the elements of poor mental health.

Okay.

Thank you. James Evans.

Diolch, Cadeirydd. I'd best declare an interest, because Sport Wales fund an organisation that I'm a committee member of, so I thought I'd put that on the record. I just wanted to say, before I start, congratulations, as well, on signing the armed forces covenant from Sport Wales. I think it's a really positive step and something I pushed the Minister on quite heavily, so I'm quite pleased he's done that.

I want to ask about the activity levels of adults engaged in sport, because, in October last year, the Wales activity tracker survey that Sport Wales run reported a drop of 14 per cent of adults who are actually engaged in sport and physical activity. I'm just interested in what you think the reason for that is and what specific measures Sport Wales are putting in place with the Welsh Government to try and drive more people back into sport and physical activity. Whoever wants to go first—. Jessica.

So, the Wales activity tracker is something that we introduced during the pandemic, and the purpose of that was to look at, almost, if you like, seasonal trends in terms of periodic times in the year when activity levels may change because of certain things. One of those things might be adverse weather, for example, and another thing might be the cost-of-living crisis. So, it's a really nice touchpoint for us in terms of monitoring activity levels and thinking about what are the ebbs and flows. I think there's a range of factors, and I don't have all of the statistics to hand, but, certainly, there have been a number of barriers mentioned, around costs, around accessibility, around the offer that's to hand, seasonal changes—if you're going into a winter month—and there are gender differences around being comfortable exercising outside, et cetera.

We have a number of ways in which we encourage people back into sport, or, I suppose, to participate in sport. We've mentioned some of our partners that do deliver, but we also operate a community investment stream. So, we've got a stream called the Be Active Wales fund, and we fund organisations, clubs, et cetera, to really look at how they can do things differently, but deliver at a real grass-roots level. There's a number of really creative examples that have come through that—basketball clubs that have used neon-lighted vests, because people don't like to be seen exercising out in the open, so they do it in a darker room. We've had all kinds of examples of equipment that can be placed in different facilities that suit individuals. So, I guess, one of the ways in which we work is to think about what is the sporting offer that can be the most inclusive, accessible, fun, enjoyable thing possible. How do we think creatively about some of the opportunities that we have to support that, because we know that that helps people come back to sport and make that part of their lifelong habits? Sorry, you were going to—

Yes, maybe just three examples of some of the things that we've practically done to try and improve activity levels: firstly, we've changed our approach to investment, so our investment now targets those that are less likely to participate, so, in all our networks, we're widening and broadening our network of partners so we can ensure people feel more supported in their local communities, and we're starting to see some impact of that. We've also established what we've called sport partnerships across five regional areas of Wales, where they bring together a wide range of stakeholders that really look at their communities and how they can better support. It's difficult sometimes being the national agency when we're not close enough to the communities that really need the support, and, therefore, we've put a mechanism in place.

And then, really quickly, finally, we are doing some proactive work with some other national organisations, with Public Health Wales being one. We believe that part of the issue around physical activity levels more broadly is about the need to focus on young people and normalising physical activity as a behaviour—it's a normal part of what children and young people do—and we are working closely with Public Health Wales and others like Natural Resources Wales and the health team in local government to look at a whole-school approach, so how you get to school, what you do when you're there, what you do in breaks, how you can make active lessons, what you do after school, what you can do with family and community. And we've got some really interesting proposals that we're hoping to take forward, but unfortunately, at the moment, we're not able to take them forward for some of the budget pressures that are there, but nonetheless, there are real examples of where we're trying to work in partnership at a system level to try and really tackle what we know have been very persistent and stubborn inactivity levels over a very, very long period of time.

Because that same survey highlighted that 70 per cent of people classed sport and physical activity as a key part of their lives—keeping moving and keeping physically active, stopping the obesity trend and stopping people becoming inactive. How do you use that to leverage Government in terms of budgetary decisions, then, and people like Public Health Wales, for example? Because tackling inactivity is a whole-Government approach, isn't it? It cuts across education, public health, health boards and local government as well. So, I was interested in how you leverage Government for funding. I know that your funding has been cut, but considering that a big proportion of the responders said that sport and physical activity is a key part of their lives and tackling obesity through the 'Healthy Weight: Healthy Wales' strategy is a key driver for Government—. I'm just interested in how you use that data to try and lobby Government for more funding. Obviously, it hasn't worked to date, but I'm interested in how you use it to do that.

There's a range of mechanisms in place that allows us to do that, from discussions with our Minister, through inquiries in other committees. There's a recent one through the culture committee that's just reported on funding levels for sport and physical activity and wider culture and arts and how, perhaps, that's relatively low in comparison to other European counterparts, and there are some recommendations there. There was a recommendation, or some commentary from Government—not a recommendation, sorry—some commentary from Government about how sport could be the greatest preventative health tool. We've done a number of engagement sessions across Senedd Members and Government to try and make that case.

I think part of our role is that we know sport for sport is really, really important, but we're trying to communicate sport's role in its wider sense in terms of what this committee is interested in from an obesity perspective, but, more broadly, the health and well-being of the people of Wales. And we feel that it is one of the tools that probably hasn't been deployed to its maximum at a time when there are lots of budget pressures and increasing demand on ill health within health services. And therefore, it's probably one of the few interventions—the Chief Medical Officer for Wales said that if it was a drug, it would be a miracle drug. How do we translate that into practical action? I think the reality is that that is work in progress; we haven't achieved where we want to get to, but we are working in partnership. We advocate that through our contributions to the 'Healthy Weight: Healthy Wales' strategy and those wider engagements that I just referred to.

Do you think Government silos don't help? Because your funding primarily—well, most of it—comes from the culture department within Welsh Government, even from the disabled side, it all comes from the culture department, but a lot of what goes on in the disability element of it is in the social justice department, which sits under Jane Hutt. And then you've got Jeremy Miles's department on health. Those funding pots don't seem to help. With it going into the culture department, no-one looks at that holistic approach across Government of budget setting. I'm just interested, do you think that the siloed effect that we have in Government, the departmental silos, stops that funding coming through to you? And basically, the culture budget is one of the smallest in the Welsh Government, when actually, as you said the chief medical officer said, sport and physical activity, if it was a drug, it would be a wonder drug? Do you think the Government's set-up is a problem in delivering some of the aims the Government want?

It can be a challenge. I'd probably just reframe it slightly. I think if physical activity was everyone's business across all departments of Government, that gives a mandate to start thinking about it, because I suspect that, in most cases, it is an area of relative interest, but it's probably not the most important area of interest, and other priorities take precedent. I do think that the notion of a cross-governmental approach to physical activity is one that's supported. I think, inevitably, the structures can work if there’s a mandate that sits behind it, and I think it’s that work to get the mandate around, ‘Make this everybody’s business.’

It links back to my final point about 45 per cent of people as well stated cost around barriers to sport. If you look at the cross-departmental working, that probably is a barrier as well, isn’t it? I know another colleague will probably pick up on the children’s side of it, whether that’s in education or the disability side of it and the social justice element. The funding doesn’t seem to come through to address the barriers; it’s all being pulled out of one little pot, isn’t it? Is that something that worries you as well, that actually those people who can’t afford it aren’t being supported by other Government departments to enable people to take up these activities that we want them to?

Does somebody else want to come in on that?

I would say that there’s more opportunity to connect, exactly as Graham said. I don’t feel I’m best placed to identify whether it’s because of silos or not. I think it’s because we need to ensure that, as Graham said, physical activity is everybody’s business, and making sure that every community can see physical activity as part of their lives is really important. I think the opportunity to connect—. And what we’re not asking for is to take some budget from somewhere else to bring it into sport and physical activity, what we’re asking for is to take the lessons that we’re all generating around physical activity, and sport in some cases, and apply them across all of our areas of work and priority.

Can—

Sorry, Chair—

Really quickly, then.

Yes, it’s really quick, and it’s on the disability element of it. Do you think enough is done by the broader organisations? I’m going to pick a few, say the Welsh Rugby Union, the Football Association of Wales, some of the organisations funded to deliver some of the projects around disability—do you think they do enough in that space to try and improve access to sport at a grass-roots level? In a way, do you think enough is coming through the system to actually enable people to try different sports? For example, as I said earlier, a golf club that I was heavily involved with—

Just a short answer on that.

—was heavily involved in doing it, and the funding got cut.

Fiona.

I think there is a growing appetite to do more. The programme that Tom referenced earlier, insport, is how we see our role in creating inclusive cultural change within those national governing bodies. There are some really, really good examples of real thought around how they provide for disabled communities and how they differentiate the offer at grass roots through to touching on and up into performance. But there are a number who probably could give a little more focus to it. That’s how we see our role, alongside Sport Wales, to support that change.

If it's really short, Joyce, like 10 seconds.

It is short, very short. Neurodiversity training in sport—what people regard as a hidden disability, but nonetheless it's prevalent.

We provide free access to training, and we work in conjunction with Neurodivergence Wales to provide that course.

Yes, there is training for it. We offer a learning series that goes to the sector. On James’s question around the NGBs, there are 28 that work on our insport programme, so they would then access that training, and there are 10 partners, which would include the Urdd and stuff that is quite engaged within physical activity delivery. Then secondary, around the insport programme, where we support and work directly with local authorities, Pembrokeshire, which I know is your local area, have achieved gold standard in that, which included neurodiverse training across the whole local authority. We helped influence and support the development of that for all staff, not just for physical activity, sport delivery or leisure, but the whole local authority.

John Griffiths.

Diolch, Cadeirydd. Turning to children and young people specifically, you've already said—it's obvious, I guess, isn't it—that if you can get good habits established early on in life in terms of taking part in sport, being physically active, then that's going to be very good for those young people throughout their life courses and will inevitably help tackle issues around obesity. So, I just wonder, what are the latest trends? Can you tell us whether we're moving in the right direction or not in terms of participation by children and young people, and, of course, children and young people with disabilities?

Perhaps if I start, Chair, in terms of the wider picture. I think this is a stubborn long-standing issue. Overall activity levels in young people haven't really changed for many, many years. I think we know, and the committee may have heard, that one in four children are entering school either overweight or obese. One in eight teenage girls do enough activity to gain a health benefit. They're pretty stark statistics, aren't they?

I go back to my earlier point about the need to normalise activity, so that it's just seen as a natural part of what you do as part of your growing up. And the school environment—without, importantly, putting additional pressures on schoolteachers and school staff, and I think that's a really important point to make—provides us with an opportunity to provide equality of access for all, and as I said earlier, we're working with other national agencies around this whole-school approach. It's one of the identified areas, through the World Health Organization's global action plan on physical activity. A whole-school approach is one of the best buys and interventions, and we feel there's a real opportunity. We've learnt from international best practice: Finland's got Schools on the Move; there are initiatives taking place in New Zealand—Healthy Active Learning. We feel that there's a real opportunity to try and make a step change in terms of activity levels, but it needs the infrastructure and funding to make sure that that happens. Fi, I'll maybe pass to you in terms of some of the participation challenges for young disabled people.

We know that there's a gap in terms of—. There's a difference in activity levels between disabled and non-disabled children. We know that children aged two to 15 are 35 per cent more likely to be obese if they have a limiting long-term impairment. So, there's much greater risk. From our perspective, we're giving a commentary about the value of physical activity, and if school is where it starts and where you gain your aspiration to be physically active, unless that environment physically welcomes you as a disabled child to physical activity, you are then much less likely to go into activity outside.

We know that the challenges and barriers that non-disabled children face within a physical activity environment are accentuated for disabled children. So, just taking as an example transport at the end of the school day: often, children are very dependent on taxis or transport services that are quite rigid in terms of their provision, so that makes after-school activity much harder to access. And to go back to your earlier point, Joyce, just around the accessibility of green spaces and play spaces, we need to make sure we attend to that as well within the school environment. So, there are lots of things at that early stage where we know there's a gap between disabled and non-disabled children's activity, and it's not just the school environment, it's outside the school environment as well. That's where that connectivity across portfolios becomes really, really important.

Okay. Thanks for that. Could you point us as a committee to policies and programmes that are effective in teaching children and young people the importance of being active and taking part in sport, which would actually do a lot to encourage them to take part? Is there any particular improvement that you'd like to flag up to the committee that needs to happen?

I'd probably just go back to what I said earlier, really. I think the recognised best buy at World Health Organization level is a whole-school approach to physical activity to support all young people. It's important that that's done in a way in Wales that doesn't place a burden on school staff, and we are working with our health colleagues in Government, Public Health Wales and Natural Resources Wales to try and initiate it. I think the challenge, John, has been the budget pressures and other areas taking an immediate priority. We're still very, very supportive of that approach and believe it will have, in line with the Well-being of Future Generations (Wales) Act 2015, a very long-term approach focusing on prevention and better health and better activity. It would have a huge impact on people of Wales if we were able to drive that work forward.

So, there is good evidence, both within Wales and there is good evidence internationally, of what we need to do. I think we're really clear about what we need to do. It's finding the wherewithal with which to do that that has become, I suppose, the challenge.

And if I may just add to that, internationally there are some really good examples of where, in particular, the school environment, the school setting, has been used as the vehicle to encourage children to be active at a whole-school level—so, not just what happens within school, but travel, et cetera, extracurricular activities. One example—I'm more than happy to send the committee some supplementary evidence—is in New Zealand. There's a programme called healthy active learning where there's been a collaborative effort between the health sector, the education sector and the sports sector, and a shared budget portfolio there, so there are no additional pressures on any one portfolio. But the idea is that that setting is really harnessed for this idea of a whole-school approach that translates into young people's experiences, but also a wider wraparound into family experiences. Some of the challenges that we see about non-communicable disease, such as obesity in Wales, are no different to some of these other countries. And I think there's some really good best practice learning there, and we're certainly modelling some of what we would like to do here on that.

Thanks for that. Please do send it to us. I think New Zealand is such an example of excellence in many sports, including rugby, of course. And it's not just about the elite level, but having a more active population feeds into that, doesn't it? There you are; if we can adopt some of their approaches, we might find the Welsh rugby team performing better, who knows?

I think John's angling for a committee visit to New Zealand. [Laughter.]

Could I just ask? In terms of the importance of school, Welsh Government wants to make many more schools more community focused, and that's been a long-running aim that's been frustratingly difficult to achieve in practice, I think. But it's got a renewed commitment, I think, now to making more schools community focused. We've got the new curriculum. So, where do you think we are at the moment with schools in terms of how active our children are during the school day—children generally and children with disabilities? What's the current picture, would you say?

I guess, with many things, possibly quite mixed. I think one of the things that is currently live in terms of our work is how we can support teachers through the new curriculum, and particularly the health and well-being area of learning and experience, so that they have the right confidence to think about physical activity as a really important factor across the school day—sitting less, moving more, opportunities for active lessons. I think there's an awful lot that goes on around the break times and, in many schools, pre and post. I think, to your point, John, it's probably a patchwork in terms of community use, and I think we need to think about how those facilities are community assets in one sense and can be opened up when it's appropriate to do so. But the work that we are trying to move forward is—. It's the key actors, isn't it, in those spaces—teachers and learning assistants—they will enable those young people, they have the opportunity to build it into that environment. But it's important that they feel they've got the skills and confidence, particularly in a primary setting, actually, to be able to do that, and we hope to be able to support the curriculum.

And it's important, isn't it, in terms of talking about physical activity here, that it's seen as a contributor to education outcomes. It's not just physical activity in its own right. Physically active pupils, they're more engaged, they're more likely to attend, they're more resilient, and therefore we need to be good at explaining the education outcomes that can come forward as a result of young people being more active in the school environment.

Thank you. Did you want to come in quickly, James?

Just on this point, do you actually think, though, that the regulatory regime that we have in Wales goes against some of the things that, actually, I'd like to see more—sport and physical activity in school? I've seen the schemes in New Zealand, and the Falkland islands, actually, are doing exactly the same thing, mirroring New Zealand. But the regulatory regime we tend to have in Wales is focused on English, maths, sciences. It doesn't really focus heavily on the sport, and it's more about academic performance rather than what sort of pupil is coming out of the school at the end. I went to school with somebody who wasn't very academically sound, but went on to play for Wales and is very successful. So, do you think sometimes, as I said—back to the original question—that the regulatory regime we have puts more pressure on schools to push more the academic model of pupils, rather than giving that, perhaps, holistic approach to introducing them to more sport, which, as you said, has been found to make, actually, pupils, like it did in New Zealand, more active and actually interested in sport? It actually helps neurodiverse children as well, as Joyce mentioned earlier, to focus the mind a little bit more and give them something to focus on. Just your thoughts on that.

I'll just take Jenny's question as well. We are a bit tight for time, but I'll just ask for short responses to the two. Jenny.

Okay. I just wanted to focus on something that was raised in a previous session by Professor Haboubi, who's based in Blaenau Gwent, the capital of obesity, and he pointed out that the best five counties for body mass index were in London, and that was because it's impossible to commute to work in a car in London; it's punitively expensive, so people don't do it. So, I just wondered what we do to turn around this terrible label that Blaenau Gwent's got for being the capital of obesity, and what role you play in changing the culture around active travel, both walking to primary school and then getting the bike out for secondary school, because it's further away.

So, they're both quite big questions but, if you could be as brief as possible, because I've got Joyce who's leading another section and then Mabon to come in on some other questions as well. Who would like to respond to either of James's or Jenny's questions?

I would love to see physical education being a statutory component of the school day. I think that that would be a real step forward and probably would help engage activity in a different way. But I think the real benefit of the new Welsh curriculum is that it doesn't just focus on sport, so it's not just about playing football or playing rugby or playing netball or playing hockey; it's about how you move and how you can then apply that into a lifelong engagement and enjoyment of sport. And I think what, additionally, I would like to see is that that is also more inclusive of disabled children and young people within the school environment, so that they also get the same exposure to the likes of boccia and wheelchair basketball, goalball, so that we raise people's expectations around what's possible. Sorry, Graham.

I'm not sure I can answer it in the time we've got available, but I think there are certain areas that we could focus on. I talked earlier about a different narrative about how we engage communities and individuals in activity. We need to talk about sitting less, moving more, the environment in which you're able to do that. Do you feel safe? Is it lit? Is the footpath appropriate? So, we need people to be thinking about the environment, and that's why I think it needs to be everybody's business. So, from a planning perspective, I think from a health and social care perspective, from every contact with GPs, about encouragement, it lends itself—and I know it's a term that's used quite often—to this 'whole of system approach', to be thinking about how do we normalise and make it possible that activity is the easy choice, not the hard choice. It probably needs unpacking a lot more than the time we've got today, but I think they're some of the areas that I would focus on.

Thank you. Joyce Watson. Oh, sorry, Tom.

So, James mentioned the Falkland Islands earlier, and I'm involved with Ynys Môn island games, and Åland islands, which is Finnish, speaks Swedish, between the two, prioritise being able to make that the easy choice of travel. So, if they're building something new or developing something, there is a way to cycle there or to push a wheelchair or to walk. That's always a priority in any planning. That's the cross-department stuff, not taking the budget off them. And I think it was either Jess or Graham that said initially around being ambitious, and, Wales being small, that you can be that ambitious. So, an island can obviously do that, because they're even smaller, and London can do that because it's condensed, but Wales could probably do that to a certain extent as well, about being ambitious, being creative and using being a bit smaller as a benefit.

I'm sorry to rush this section. We can perhaps take some other written evidence, if you're willing to, in terms of some of the points that Jenny's raised. Joyce, if I can ask you to ask your questions in about five minutes. I want to allow 10 minutes for Mabon at the end of the session. Joyce.

I'm going to. I'm going to give another example, and I'm just leaving it on the table. I was in Norway last summer, and, from the very first time that young people are able to go outside, they go outside, regardless of the weather. It's all to do with the short days, of course, because it's getting them ready for that—for the cold, for the wet, for the lack of light. So, I'm just leaving that on the table. What I really want to know is how you convince people to become active who have negative thoughts about that, for whatever reason, who have an attitude that challenges them to think about it being a positive. We've heard—. Of course, this morning, this is in relation to obesity, so part of that will be body image and how they look.

Shall I just reinforce that, and then I'll give it to you, Jess? So, attitudinal barriers, whether that's individual parents, coaches, providers, are huge within disability and inclusive sport. There's a massive barrier around presuming something's not for you or, 'I won't be able to do that.' That first step is really hard. What we'll find, in most impairment groups, but, especially within learning disability particularly, is that, once they've built that, you've put that extra work in at the start, they're incredibly loyal to that activity, that provider, because they now know, 'That's for me and that's provided', and they will stay in that activity for life. So, you get that lifelong enjoyment, that lifelong participation, if you just put in that equitable patch from the start. So, it's really important, and it does create a bigger barrier for disabled people in that. I'll pass to Jess, because I don't think I answered your question—I just agreed with the question.

I agree with you, Tom. So, I think there are four things that come to mind in terms of how do you do that convincing piece. So, firstly, we think it's about the quality of experience. So, if somebody has an experience that is fun, it's developmental, it's safe, they're more likely to come back to that, because they've had a good time, which is exactly what Tom has described. Making it easy for people: so, making the healthy choice the easy choice and normalising it, so it doesn't feel like it's an additional burden to somebody's life. Providing opportunities that are accessible. Tom articulated that really well, but that is going to take a real person-centred approach—so, thinking about the needs of a group, of a community, or the needs of a certain individual, and thinking about how things can be adapted. And there's also some really good evidence. So, the Wales Centre for Public Policy put out a really good evidence report in 2022, I think it was, which looked at healthy lifestyle behaviours. And there was a suggestion there that, actually, talking about fun, enjoyment, experience, rather than, 'Do exercise, play sport, physical activity et cetera, because of your weight', actually that flip side of thinking about, 'Do more of it, it's really good for you, and you'll have a good time', is exactly how we need to start to talk about that from a language perspective. So, I think four things really come to mind around how we can shift that mindset into thinking about, 'This is a real opportunity' for the population.

Can I give just a practical example of that, through the Get Out Get Active programme? That was a programme that was intended to engage the least active of the inactive—disabled and non-disabled people—active together, and intersectionally. So, there was a great example in north Wales, with LGBTQ+ disabled communities, where their activity was by stealth. So, it was stuff that they were doing anyway; they didn't necessarily recognise that, when they went shopping, they walked or moved 5 km. So, it's about just alerting them to what they are doing, and encouraging them to keep doing that and just do a little more of that, whilst looking for other opportunities as well.

Since this is particularly about trying to get people active, linked into obesity, what particular or specific actions are any of you taking or do you know of that are encouraging that group of people?

It will have to be just one person responding to this, just briefly, if that's okay.

Shall I take it? I think, from our perspective, the drive for physical activity is not anti-obesity or to prevent obesity. The drive for us to do what we do is to encourage more people to be active, which as a consequence has a link to, has a relationship with, obesity, and greater levels of activity, potentially, would impact on lower levels of weight gain. So, the driver is slightly different for us, but, obviously, with disabled people, there may be a higher incidence of obesity. Certainly, for those people who are living with obesity, they may acquire impairment or a disability later in life, or as a consequence of gaining weight. So, I think, for us, it's much more about identifying programmes that focus on activity and finding something that you can access, and supporting organisations to provide opportunities that are accessible. The Get Out Get Active programme I'll keep coming back to, because it is a great example across Wales, across the UK, which gives us insight that we are lacking around intersectional communities of disabled and non-disabled people, and the impact that physical activity can have on their lives and their well-being. And—

Thank you. I'm so sorry. I feel bad, but I want to allow time for Mabon as well. Mabon ap Gwynfor.

Thank you, Chair. I'll be asking questions in Welsh. To build on the point made by Jenny earlier—she talked about the evidence that we had showing people in London are fitter and healthier than people in other areas—it struck me that there is evidence showing that obesity increases more quickly in rural areas. I represent a very rural area, as many of us do. There are hardly any 3G pitches in my constituency. For children to go to the nearest gym, it's about 15 miles. There are no buses on Sunday—there are almost no buses at all. It appears that things militate against rural areas, as beautiful as they are with the mountains and so forth, in terms of keeping fit. Do you think that there is a problem in those rural areas? Do you think we need more investment, or are there other elements where we can encourage people to keep fit in rural areas without having infrastructure resources?

I'll go first, and I'm happy to answer in Welsh. A lot of the barriers for disabled people and rural areas are very similar. As Fi was talking about intersectionality earlier, if you have one characteristic or one thing that prevents you, it causes more and more hurdles, and we know about that. You spoke earlier about leisure centres, and if you think about travel costs and how often public places are available, we do need to ensure that they are inclusive. We need to make sure there are opportunities in those areas, in the communities. Graham spoke earlier about schools; they're usually in towns, and we can build up those events on top of those, instead of having to try to find each area separately.

An example was given earlier of partnership with clubs, and clubs in Powys specifically. There are so many clubs, and those inclusive clubs are very important for disabled people to be able to have access to inclusive sports, because they're in the communities where those people reside. So, we are reliant on different things, but it is a hurdle. I have a very practical example of Plas Menai in north Wales, under Sport Wales: somebody in Menai Bridge wanted to go to Plas Menai for a sailing event on a Sunday and had to wait for two hours to travel there. They did an hour of activity and then two hours to travel home just because it was a Sunday. But because that was a perfect inclusive activity for them, they were willing to do that. So, we need to take that out of the system and try to work out how we get more than one department to work together, to try to take on some of those.

I'm here today with Disability Sport Wales, but I'm on the sport partnership board in mid Wales, and Graham mentioned that earlier on. So there are systems, through that partnership, to work out what's needed in those communities and to change the programmes to fit with that. But I'll let Graham or Jess talk a bit more about that.

Thank you, Tom. A couple of observations. I think rural areas will face different challenges. I think it's inevitable, and you described some of that in your opening remarks. There are some things that we're trying to do to help support that. In terms of sport partnerships, we have a mid Wales sport partnership, amongst others, across other areas of Wales and we're really keen to ensure that they understand the needs of their communities, they engage those communities in what they perceive to be the barriers and what they perceive to be the opportunities. So it's not a supply-driven approach, it's a very demand-led approach. I think that we need to do things that utilise our natural environment to get people active. I think that's really important. And I think we need to understand, from a service provision perspective, what is available hyperlocal to those communities, what's on the doorstep, what facilities and provision may be available area-wide, what are regional, and make sure there's a relative mix that matches the needs and wants of those local communities. That's a lot of planning and system thinking. It doesn't overcome every issue. But I think unless you engage with those communities to find out what the real barriers are—. Because sometimes they are possible to overcome. Some of them are systemic and will take a long time, but we need to understand and not just move into a supply mode of, 'Well, we think the solution is x', when, actually, we haven't really understood what the barriers are.

Thank you. On that, we've touched on rural issues, but there are several factors that do lead to personal circumstances where people becoming obese or find themselves in that situation. We touched on mental health. Environment is a factor. Poverty or economic issues—there are several things that can affect a person's situation. Of all those things, what do you think is the one most important thing that the Government should focus on to change in order to have systematic change and cultural change in our society?

We may have different views on this. If I may—we've talked about it today—I think a real focus on young people and ensuring that the early experiences of being active are ones that encourage people to have a lifelong enjoyment of being active, whatever that activity is.

I think from my perspective, you would have heard as part of committee over the last few months in this inquiry from experts on obesity, and I'm sure the evidence would have come through that it isn't just about personal choice. Of course, there are confounding factors there in terms of somebody's characteristics or demographic. But really, it's a societal, environmental, systemic set of failures or challenges. So, for me, a real focus on system thinking, where physical activity is planned for across different policy areas, and there's a real connectedness around taking responsibility, making it every policy area's business.

I agree fully with those two points. I think, in addition, taking some very positive thinking about how you engage those individuals and how we understand the physical activity patterns, obesity patterns for those communities that we don't necessarily see represented in data or thinking fully. So, I agree 100 per cent, but I think it's also making sure that we go a step further to look at community level, beyond just one number. Let's be better at differentiating.

Thank you. And finally from me, Chair, you've talked about good practice in Finland and Aotearoa as well. So, are there any good international examples that we could look at where they've introduced policy that has changed the culture and has had an impact on people and seeing obesity levels fall in society?

There are, and we can certainly provide some additional information to the committee post this meeting. Jess, I know you've highlighted a couple of examples already. I don't know if there's any more you just want to briefly touch upon.

We have talked about New Zealand, Finland and Australia. Then there are some examples of a movement towards a preventative health strategy, and that's reflected then in budgets. I'm more than happy to send some supplementary evidence around that. And then I think when we do—Joyce talked about Norway—look at some of our Scandinavian countries, and the way that physical activity is embedded into infrastructure, and embedded into people’s lives, there are certainly some really good examples there of the way in which it just is a normalised behaviour. I’m happy to send through some more info on those.

Great. Thank you very much. Thank you, Chair.

Diolch, Mabon. That brings our session to a close today. Can I apologise that we had to curtail some of the conversation in order to get through all the questions? But we’ll send you a copy of the transcript, and if there’s anything you feel that you want to add, we would very much welcome any further input following today’s session as well. Diolch yn fawr iawn, and thank you for your advance papers as well.

We move to item 4. There are several papers to note. There’s correspondence from the Petitions Committee regarding health-related petitions. There’s correspondence from the Welsh Government regarding various regulations, and correspondence from the Local Government and Housing Committee regarding their inquiry into the role of local authorities in supporting hospital discharges. Are Members content to note those papers? They are.

We move to item 5. I am unable to make next week’s committee meeting, so we need to elect a temporary Chair. In accordance with Standing Order 17.22, I call for nominations for a temporary Chair for the meeting on 6 February. Are there any nominations?

John Griffiths.

Thank you, Joyce. Are there any other nominations? There are no further nominations, so I propose that John Griffiths is appointed the temporary Chair for the committee meeting on 6 February. Are Members content? They are. In that case, that's agreed.

I move to item 6. Under Standing Order 17.42, I propose that the committee resolves to exclude the public from the remainder of today’s meeting. Are we content? We are. In that case, we draw today’s public meeting to an end.