An audit of the implementation of NICE public health guidance on promoting physical activity for children and young people in Oxfordshire in the academic year 2011/12
Lisa Peto
Public Health Specialty Registrar and NICE Scholar
NHS Oxfordshire
September 2012
Acknowledgements:
Angela Baker, Kate King, Toni Flanders, Margaret Stevens, Matthew Bunston, Carl Hamilton, Emma Jackson, Rachel Mills, Jenny Smith, Jamie Lewis, Herjyot Dharni, Sue Lygo & Mike Kelly
Objectives 4
Background 4
Methods 6
Results 7
Response rate 7
Levels of physical activity 8
Out of hours school sport clubs 9
Meeting NICE public health guidance 17 recommendations 10
NICE recommendations: Promoting active travel 11
NICE recommendations: Promoting activity in the curriculum 11
NICE recommendations: Consultation with and involvement of children 11
NICE recommendations: Involving families 12
NICE recommendations: Provision of physical activity space/facilities/equipment 12
Effectiveness of NICE public health guidance 17 12
Barriers to implementing NICE guidance faced by schools 13
Conclusions 14
Recommendations 15
Locally 15
National Institute of Health and Clinical Excellence 16
References 17
Appendices 18
Appendix 1 – Physical Activity Audit Questionnaire for Primary Schools 18
Appendix 2 – Physical Activity Audit Questionnaire for Secondary Schools 25
Appendix 3 – List of responding schools, type of school, district, IMD score and rural/urban index 32
Appendix 4 - % of schools meeting each NICE public health guidance 17 recommendations aimed at schools 36
Objectives
To determine:
· the extent to which the NICE public health guidance 17 on promoting physical activity for children and young people has been implemented by schools across Oxfordshire
· whether variations in implementation of the NICE guidance exist between affluent and deprived areas and rural and urban areas within Oxfordshire
· barriers that schools face in implementing the NICE guidance
· Physical activity levels of pupils in schools in Oxfordshire
Background
Evidence shows that children who are physically active have a better chance of becoming healthy adults, yet a significant proportion of children are not reaching recommended levels of activity. Regular activity not only reduces the risk of obesity in adulthood, but it also reduces the likelihood of risk factors for chronic diseases, such as heart disease and type 2 diabetes, developing early in life and has been shown to lead to higher academic attainment.1
Children and young people in Oxfordshire are considered to have significantly lower rates of physical activity than the England average. This is based on the PE and Sport Survey in 2009/10 which found that only just over a quarter (26.7%) of year 1-13 pupils spend at least 3 hours per week on high quality physical education and school sport in Oxford compared to the national average of 55%.2 However as Oxfordshire has significantly better rates of obesity in children and adults compared to the national average and significantly better rates of physical activity in adults it is possible that children and young people are being more active outside of the school curriculum in after school clubs, break times, travel to school and outside of school in the community.3
Under the new coalition government, schools have gone through some changes that are likely to impact on the physical activity levels of pupils. Most notably, the government is encouraging all schools in England to become academies and ring fenced funding for the Schools Sports Partnerships and the National Healthy Schools Programme has ceased with a move towards giving schools more freedom over their budget.
Currently Oxfordshire has 17 secondary academies (49% of Oxfordshire secondary schools) and 7 primary academies (3% of Oxfordshire primary schools). Academies are publicly funded schools which operate outside of local authority control and have more freedom over finances and curriculum than other state schools. There is a worry that this may lead to schools choosing to spend money on reaching government targets over interventions to improve the health and wellbeing of pupils.
The previous Labour Government’s Physical Education and Sport Strategy: PE, School Sport and Club Links (PESSCL) was launched in October 2002. It was supported by funding of £1.5billion from 2003 to 2008 with the aim of increasing the percentage of school children participating in two hours a week of high quality PE and sport to 75% by 2006. To deliver this the Government created a network of 450 School Sport Partnerships across England. Partnerships are families of schools which typically comprise a Specialist Sports College linked to a set of secondary schools, each of which has a further group of primary and special schools clustered around it. The Partnership Development Manager (PDM) is at the core of the Strategy and is responsible for managing the partnership; in every secondary school there is a School Sport Co-ordinator (SSCo), and in every primary or special school there is a Primary Link Teacher (PLT) or Special School Link Teacher (SSLT) who is responsible for leading the strategy at that particular school.2 The PESSCL strategy was extended in 2008 by the PE & Sport Strategy for Young People which was supported with funding of £755million to be spent from 2008 to 2011 in order to continue increasing the percentage of children participating in two hours of high quality sport and to create new opportunities for children to participate in a further three hours a week with a new “5 hour offer”.
The new government’s approach is to increase participation in competitive sport and reduce bureaucracy for schools by giving schools more freedom over their budget for PE. They launched A new approach for school sports - decentralising power, incentivising competition, trusting teachers in December 2010 which announced an end to direct government funding for School Sport Partnerships in August 2011 and the 5-hour offer and that funding was being provided to fund one day a week of secondary school PE teachers’ time to be spent out of the classroom encouraging intra-and inter-school competition in primary schools. It was emphasised that although central government funding was ending, schools could continue to fund SSPs directly. In addition, lottery and government funding of £128million was announced to fund the School Games, a national competition designed to encourage young people to take-up competitive sport. The local School Games are run by a network of School Games Organisers (SGO). Oxfordshire has funding for a SGO in each district for 3 days per week to run competition within schools (Level 1) and between schools at a local level (Level 2), but no longer has central funding for PDMs.
The National Healthy Schools Programme (NHSP) was set up in 1999 to help schools to reduce health inequalities, raise standards, promote social inclusion and support children and young people in developing healthy behaviours by focusing on Personal, Social, Health, and Economic (PSHE) provision, healthy eating, physical activity and emotional health and wellbeing. Schools had to meet a range of standards, including physical activity standards, in order to achieve National Healthy Schools Status. Funding for the Programme ceased at the end of March 2011 and schools now have to self-fund NHSP either by buying in services or providing it themselves. There is a danger with no support or drivers to encourage them, schools may not continue with the Programme or there will be a reduction in quality of the Programme.
In January 2009, NICE published public health guidance on promoting physical activity for children and young which, in line with the Department of Health’s physical activity guidelines published in July 2011, recommends that children and young people should do at least 60 minutes of moderate to vigorous intensity physical activity every day.4,5 The NICE guidance makes recommendations for those working in the NHS, education, local authorities and the wider public, private, voluntary and community sectors on:
• how to promote the benefits of physical activity and encourage participation
• the importance of consultation with children and young people and how to set about it
• planning and providing spaces, facilities and opportunities
• training people to run programmes and activities
• how to promote physically active travel such as cycling and walking
• high level strategic planning
The guidance contains many recommendations aimed at schools and these cover active travel, promoting physical activity in the curriculum, consultation and involvement of children and young people, involving families and provision physical activity space/facilities/equipment.
An audit of the implementation of the NICE guidance on promoting physical activity for children and young people across schools Oxfordshire will determine whether we are providing the recommended promotion interventions in schools to help ensure children and young people are active for at least 60 minutes over the course of the day. It will also help to determine any gaps and variations in practice and provision of promoting physical activity for children and young people in schools Oxfordshire. Nationally, by collecting information on barriers to implementation in schools in Oxfordshire, it will help NICE to develop guidance that it is more likely to be implemented by schools.
In addition, collecting data on physical activity levels in schools will help assess the impact of the recent government policy changes described above on curriculum PE and provision of out of hours clubs in schools in Oxfordshire.
Methods
Physical activity audit questionnaires were sent by email on the 27th of June 2012 to head teachers of all primary and secondary schools across Oxfordshire, excluding schools in Oxford. Head teachers were given the option of completing the questionnaire via email or survey monkey. They were given three weeks to return the questionnaires. Schools in Oxford were contacted by the Schools Sports Development Manager at Oxford City Council to arrange face-to-face interviews to complete the questionnaire.
In addition to the recommendations in NICE public health guidance 17 on promoting physical activity in children and young people, the questionnaire included questions around barriers to implementing NICE guidance, levels of physical activity, out of hours school sport clubs (OSHL) and competitive sports. See Appendix 1 for primary school questionnaire and Appendix 2 for secondary school questionnaire.
Results were analysed in Excel. Where possible results were analysed by school type (primary and secondary schools) and district (Oxford City, Cherwell, South Oxfordshire, West Oxfordshire and Vale of White Horse). Results were not analysed separately for special schools due to the small numbers responding or by academy schools as the majority of secondary schools who responded were academies. Pearson correlation coefficients were calculated where appropriate to determine whether outcomes were associated with deprivation and rural status.
Results
Response rate
In total, 281 schools (232 primary, 35 secondary and 14 special schools) were contacted to complete the questionnaire. Questionnaires were sent out by email to 239 primary and secondary schools in Cherwell, South Oxfordshire, West Oxfordshire and Vale of White Horse Districts. Forty-two primary and secondary schools were contacted by telephone to arrange face-to-face interviews in Oxford City District.
Seventy-six schools responded (64 primary and 12 secondary schools). The overall response rate was 27%. Table 1 shows the response rate by type of school and district.
Type of school/District / Response rate (%)All schools / 76/281=27
Primary schools / 64/232=28
Secondary schools / 12/35=34
Special schools / 1/14=7
Academies / 8/24=33
Cherwell / 16/58=28
South Oxfordshire / 21/68=31
West Oxfordshire / 16/57=28
The Vale / 16/56=29
Oxford City / 7/42=17
Table 1 - Response rate by type of school and district
Secondary schools had the highest response rate at 34% compared to 28% for primary schools. Schools in South Oxfordshire had the highest response rate at 31% and schools in Oxford City had the lowest response rate at 17%. Of the schools that were contacted by email, 52 returned their questionnaires via email and 17 returned their questionnaires via survey monkey.
See Appendix 3 for a list of the responding schools by type of school, district, Indicies of Multiple Deprivation (IMD) score and rural/urban indicator.
Levels of physical activity
Schools were asked the total curriculum time in minutes that all pupils in each year group spent taking part in PE in a typical week in the academic year 2011/12. They were also asked the percentage of pupils who walk to school and the percentage of pupils who cycle to school. Table 2 shows the levels of physical activity results by type of school and district for Oxfordshire schools in 2011/12.
Average weekly PE curriculum time (mins) / Average % of pupils walking to school / Average % of pupils cycling to schoolYR 1 / YR 2 / YR 3 / YR 4 / YR 5 / YR 6 / YR 7 / YR 8 / YR 9 / YR 10 / YR 11 / YR 12 / YR 13
All schools / 54 / 11
Primary / 116 / 117 / 123 / 123 / 123 / 122 / 54 / 10
Secondary / 128 / 128 / 133 / 108 / 108 / 33 / 13 / 54 / 16
Cherwell / 116 / 118 / 127 / 127 / 122 / 122 / 120 / 120 / 140 / 140 / 140 / 38 / 0 / 61 / 7
South Oxfordshire / 116 / 117 / 121 / 120 / 120 / 121 / 140 / 140 / 140 / 115 / 115 / 25 / 25 / 53 / 11
West Oxfordshire / 119 / 121 / 114 / 114 / 114 / 114 / 110 / 110 / 110 / 80 / 80 / 25 / 25 / 56 / 9
The Vale / 117 / 118 / 126 / 128 / 128 / 126 / 120 / 120 / 120 / 120 / 120 / 60 / 60 / 47 / 10
Oxford City / 98 / 98 / 105 / 105 / 120 / 113 / 140 / 140 / 140 / 93 / 93 / 30 / 0 / 60 / 30
Table 2 - Levels of physical activity by type of school and district for Oxfordshire schools in 2011/12
A wide range of average weekly PE curriculum time was seen across the year groups, ranging from 13 minutes in Year 13 to 133 minutes in Year 9. Across Years 1-13, pupils spent an average of 106 minutes taking part in PE in a typical week and across Years 1-11 an average of 121 minutes. Primary school pupils spent more time on curriculum PE than secondary schools with an average of 121 minutes compared to 93 minutes in secondary schools. Only Years 4 to 9 are reported to be doing over 2 hours of PE per week.
Comparing these results to the last national PE and Sport Survey in 2009/10 shows that pupils in Oxfordshire in the academic year 2011/12 spent less time on curriculum PE than the national average in the academic year 2009/10.2 The PE and Sport Survey in 2009/10 found that Years 1 – 13 spent an average of 117 minutes taking part in PE in a typical week compared to 106 in Oxfordshire in 2011/12 and 123 minutes across Years 1 – 11 compared to 121 minutes in Oxfordshire in 2011/12. Nationally in 2009/10 pupils in secondary schools spent 107 minutes in curriculum PE compared to 93 minutes in Oxfordshire in 20011/12 and 127 minutes in primary schools compared to 121 minutes in Oxfordshire in 2011/12.