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Table 1 Challenges of implementing health interventions in primary schools

From: Community led active schools programme (CLASP) exploring the implementation of health interventions in primary schools: headteachers’ perspectives

Government-led priorities and funding “We know that physical activity is hugely important but when we’re actually getting measured by the Welsh Assembly Government on our performance in literacy and numeracy, you can tend to push physical activities out to one side…”(Participant E - Headteacher)
“It’s English and maths you know, we’re being hammered, English and maths, English and maths, that’s all that counts, and the Olympics come along, well sports important, or obesity comes up, sports important, it’s not really because there’s no extra funding in it you know…” (Participant N - Headteacher)
Initiative overload “We have the Welsh Assembly Government giving us initiatives, we have regional giving us, we have then our Local Authority giving us initiatives. We have then other things like we’re doing rights respect in school, we’re doing restorative practice, we do valley’s education, we do Healthy Schools, we do sustainability, we do a European schools, we do all these things, so yes, we do feel burdened.” (Participant A – Headteacher)
“They want us to manage their agenda for them, they don’t really… they’re not terribly bothered about ours…I mean, [X] will ring up at the end of a term and say, ‘Oh, how many children have taken part in after school clubs this term? We need the figures. And you just feel… I mean, that’s it, though, isn’t it. You need the figures. It’s a data crunching exercise. It’s got very little to do with you actually coming out and seeing if there’s any quality in that activity.” (Participant J - Headteacher)
Autonomy v statutory approaches “I mean obviously there are some interventions which are statute and we’ve got to and there’s no choice I’m afraid, but I think it’s those, (coughs) excuse me, that sometimes, well it’s because of those that the more exciting, more creative activities don’t happen if you like, because of the legislative, the ones that we have to do that are statutory requirements.” (Participant H - Headteacher)
  “…we don’t have that power as a school. We’re a recipient, if you like, rather than a leader.” (Participant J - Headteacher)
  “I think sometimes there, that’s taken away from us in terms of that expertise because I know what works in my school isn’t necessarily going to be relevant in the school next door so it’s that lack of trust really that ‘just leave us alone to do it’ and yes, of course we’re accountable and I wouldn’t want to take any of that accountability away, but just let us get on with what we’re doing because it, we’re making it work for our children and you know, we’re not the experts but we do know what we’re doing.” (Participant H - Headteacher)
Health and safety litigation “But I did have a parent come in ‘cos we had some stepping stones made out of pieces of wood and they’d have little bit of fungus growing on the side and parents saying, ‘They shouldn’t be out there, that’s a health hazard that is,’ and I’d say, ‘Well no, they’re okay’, and again you’d have to tough it out sometimes and take it like the rest of it, because if the pieces of wood get wet and the children are jumping from one to the other they get slippery, they fall off and they learn then, it’s no good trying to play stepping stones when the wood is all wet, you know, we’ll do that when it’s dried out.” (Pilot 1 – Retired Headteacher)
  “Well they can’t, they couldn’t just go into the gym break time ‘cos it’s break time, you know, it has to be supervised and you know, we don’t tend to have an after school for our infants because obviously you’re staffing ratio gets higher, you know…” (Participant K - Headteacher)
  “We do things, we’ve taken the children to London and, you know, as long as you’re confident as a staff that you’ve risk assessed, you know exactly what you’re doing, the staff are all briefed, the ratios okay, you know, and we’ve just tried to carry on, because at the end of the day you want to enrich the children’s education, don’t you, you don’t want to sort of narrow it down, but health and safety is a nightmare, yeah.” (Participant D - Headteacher)
Staff and headteacher influences “Our football, Mr [X] you just met in there, he takes the football club and it’s basically in his own time and he is, you know, he’s fantastic, he’s a real sort of football enthusiast and that rubs off on the children because they’re very successful in football.” (Participant Q – Deputy Headteacher)
“…the previous headteacher was a heavy smoker (laughs). So he wouldn’t even let the Healthy Schools Coordinator in through the door. So (laughs) this was like the jazz club in here, it was just smoke filled…”(Participant D - Headteacher)
Physical environment and facilities “It’s almost as if we’ve kind of got it backwards in this country because if you go to any university campus you will generally have very good sports facilities, especially if they’re offering a sports science kind of degree, you’ll have out of this world facilities. Go backwards towards the comps and you’ll kind of get reasonably good facilities, a lot of comps have got gyms, they’ve got big, you know, indoor halls. But then as you go down to primary schools you’ve got, usually the school hall, that’s usually for cooking as well and you know, for assembly and for everything else…” (Participant I – Healhy School Co-ordinator)
  “Yeah, I think you just need to be quite… you need to have a plan, basically. And what we’ve found is discipline goes, behaviour goes at play time if there isn’t anything structured. So our children, they get to play football at the front every break time, sometimes if it does go a bit too far we do have to say, ‘Well, look, you’ve had your yellow card now and if it carries on there’ll be no football tomorrow,’ and we do have to stop it sometimes.” (Participant L - Headteacher)
  “The only thing that really, I think the barriers to that quite often are your consumable equipments so, you know, balls will go over the gardens and the skipping ropes get sort of manky and disgusting so it’s having a regular supply really of equipment because school budgets are very tight but that’s another issue for us, you know, if you’re talking about constraints.”(Participant E - Headteacher)
Parental engagement “Parents are more of a problem than the children perhaps… So it's educating parents and getting through to them because they seem to be the barrier. You know you educate the children and they seem to understand and they can sort out healthy and non-healthy foods but it doesn't, the message doesn't seem to get home so it's parents and actually getting the parents in to school. Some of them are very you know not really interested, some are some aren't, you know it's the same isn't it?” (Participant M - Headteacher)
  “If you want to effect the parents then you need to get access to the parents and you need to get access to them in an informal way, and I’m sure then they come onboard…you’ve got to go say through children to places like children’s centre, which are non-threatening, yeah, which they feel comfortable going there, it’s their choice to go there, do you see what I mean, they’re there to offer support and help and I think that is a good way of reaching them.” (Participant G - Headteacher)