Tuesday, February 28, 2006
Obese Nanny Falls Down On Job
As usual, my good friend Doc Crippen has a refreshingly clear line. Go to him with a weight problem and he'll provide some counsel:
"There are ways of doing this.“Look, you fat slag, if you don’t diet you are going to die” is one approach, although not one I favour.
But sometimes you just have to say, “Look, I am sorry. You are seriously overweight. You are overweight because you eat too much. If you don’t do something about it you are going to damage your health. Please, please let us help.”
If only Nanny had such a straightforward approach. Sadly, she has taken responsibility on herself to sort out our weight problems for us, and in the process has turned the whole thing into another bloated ineffective public sector industry.
Take today's NAO Report on Tackling Child Obesity. It is a high profile issue, so the government naturally wants to be involved. As usual their response is to set a target, a so-called Public Service Agreement (PSA):
"To halt, by 2010, the year-on-year increase in obesity among children under 11 in the context of a broader strategy to tackle obesity in the population as a whole."
And as with all PSAs, somebody's got to "own" it. Clear accountability, right?
Wrong. "Ownership" of the obesity PSA is split three ways: the Department of Health (DH), the Department for Education and Skills (DfES) and the Department for Culture, Media and Sport (DCMS). "A jointly-funded cross-departmental Obesity PSA Programme Manager has been appointed to support a Programme Board... Progress...is being monitored at Cabinet level by the Deputy Prime Minister."
So in some nebulous way- with responsibility already split three ways- the obesity programme is reporting to hi-fat hi-cal supersize Prezza, a man composed entirely of lard.
It gets worse.
"The natural lead rests with the DH. Many of the programmes supporting the PSA target are led, however, by the DfES, the DCMS, local authorities, schools and sports bodies, over which the DH has no direct control. Coordination has been made more difficult because the various organisational tiers of health, education and sport have not been aligned. PCTs are not always coterminous (sharing geographical boundaries) with local authorities. The education and sport sectors have no direct equivalent to the 28 SHAs that share responsibility."
Overall, there are five government departments, dozens of quangos, and hundreds of local bodies, all with a finger in the obesity pie. The whole spaghetti mess is charted in the excellent Times graphic reproduced above.
Unsurprising that after nearly two years, all we have is a working definition of obesity- and even that took 31 experts 18 months to produce (again, see the Doc for his bracing views on the DH's "interim obesity care pathway").
If you're saying "I smell costs", you'd be right: £235m on school meals initiatives, £459m on the "School Sport Strategy", £155m on the "Child Play Strategy", and £17m on the "Healthy Schools Programme"- getting on for £1bn up to now, with more in the pipeline.
Will it at least work?
Seems highly unlikely. Although of course, there's every reason to believe those 31 experts could revisit their definitions to exclude children who are BMI-disadvantaged by reason of being big-boned.
Posted by Mike D at 3:27 pm