Ms Emma Ball:

Yes. I want to pick up on some of the points discussed, the first of which was the comment about the 61% of referrals for the Up4It programme. That should have included self-referrals plus community and voluntary group referrals. That was quite significant. The approach taken with the CAWT programme was that it would be a community development led programme and not the statutory organisation delivering a programme. Part of that was looking at the experience of other programmes in terms of retention rates. We can have a fantastic programme but people drop out of it. Also, it is important to consider the hard to access clients who do not attend, DNA, for their appointments but who may have health risks.

The project went through a procurement process. In our area in Donegal a community and voluntary group, the Letterkenny Youth & Family Services, co-ordinated and delivered the programme in partnership with the health professionals. As a result, we saw there was a significant number of self-referrals because they were based in an area of Letterkenny. They already had after school services for families. They were already involved in parenting programmes. They had the knowledge in terms of bringing in and capturing those clients and as a result we had very good retention rates, both for the completion of the 12 week programme plus the follow on.

It is very important for any community programme that the community and the voluntary sector are included therein in partnership with the HSE and the primary care providers. At a local level, we have a children's services committee, which has prioritised tackling obesity for the next three years in County Donegal. We have brought in all the various community groups such as, for example, the Lifestart Foundation, the local sports partnerships and so on. Again, this pertains to creative funding and what these organisations can give to the programme. It may be they can provide a room in which to run the programmes and therefore one need not pay to rent out a room. Similarly, they may have kitchen facilities because, again, it is a skills-based programme in which we seek to have a cookery element. While there is a certain amount of goodwill funding we can gain from working with different groups, we need the statutory organisations, that is, the Health Service Executive, HSE, and the Department of Health to provide some element of funding. I agree that €10 million would be a fantastic start.

Another point to mention pertains to getting out the message to parents and again, this is looking at it being a positive programme. It is not being marketed as something like Slimming World or a weight loss programme but rather, the point is it is a healthy lifestyle programme. It is a skills-based programme that should be both fun and social and one would know this from the testimonials of those children who attended the programme, which were that they made friends and came back, that it was active and the children were doing something every week and it was not just about listening to someone talking at them. It is very important to have this fun, positive element to the programme, as well as it being skills-based, in order that the participants learn how to cook and the child learns with his or her parent how to make meals and how shopping can be done.

Another point I wish to mention relates to the weighing of children and the involvement of general practitioners, GPs. Nationally, a weight management treatment algorithm for children was developed by the HSE and the Irish College of General Practitioners, ICGP. It is available and there probably should be a little more training in respect of that. However, on the measurement of children, I must mention the public health nursing service and the school public health nurse service. Again, there are issues around the country in this regard. Because of the moratorium and the HSE embargo, this service is not available throughout the country. However, where school nurses are available, part of their remit is to measure the children at least twice - I think it may be in junior infants and in fifth class. In my local area, a questionnaire goes out to parents, prior to them coming into the school, asking whether they have issues. One question is whether there are issues with regard to food and nutrition. In addition, after the measurement and the health check take place, a report goes out to the parents that includes the child's weight and height and which ticks the box as to whether there should be any concern in this regard. In my area, the parent will be contacted and there is an option for the children to be referred through to the individual dietetic service. Unfortunately, either the school public health nurse is not available nationally or the dietetic service is very limited. Ideally, while an individual dietetic consultation can have a role, we would love then to be able to refer those involved onto something like the 12-week programme, perhaps after the first assessment. While some structures potentially are in place, it is not countrywide and has not been rolled out. I reiterate that much of the groundwork has been done and there does not need to be a lot of work done on developing programmes or systems. It simply needs to be implemented at this point.