The End of the NHS: Prioritise prevention or prepare for its collapse
The British public live longer, yet unhealthier lives than previous generations. Many people in the UK will experience decades with serious chronic illness, much of which is preventable. While the ability of our NHS to sustain life is admirable, a long history of ineffective public health policy has created a toxic recipe for extremely long-term illness that will soon finish-off a health service already on its knees.
The UK is officially on track to become the ‘most obese country in the EU’ by 20301, 2, and obesity does not exist in isolation. It is one of the most prevalent risk factors for all other non-communicable diseases; cardiovascular disease, type two Diabetes Mellitus (T2DM), cancer, and mental health. We also cannot ignore the correlations between obesity and diet.
Our national diet is comprised of more than 50% ultra-processed foods and drinks3. This statistic alone is alarming. As a nation, we are moving further away from real food. As our diet has shifted towards ultra-processed foods, our national health has worsened. We are now living in an age of diet-induced chronic disease. While there are many complex factors involved in health and disease, we must urgently confront the role played by the food we consume. Britain is eating itself to death, and it is a recipe for imminent disaster for the NHS.
Focus on disease prevention is our only option if we are to future-proof the NHS. We need a system that recognises the major contributors of modern-day disease, and understands which factors are modifiable with preventative measures.
Nutrition and lifestyle factors are central to the future of healthcare, providing a practical solution to ease current chronic health crises. One glaring omission, as things currently stand in 2023, is the absence of nutritionists in the NHS. Their integration into primary standard care (SOC) would immediately add preventative nutrition and lifestyle services into the care of the public. Currently, there is no adequate provision for nutrition-based preventative care within the NHS to support the 63.8% of the population living with overweight (25.9% of which are obese), or the 5 million + people living with diabetes or in a state of pre-diabetes4,5.
The current model is built on a marriage of emergency intervention and pharmaceutical maintenance. You can thankfully be saved from a heart attack and thereafter be given ‘a pill for every ill’ to manage your blood pressure, cholesterol, and blood glucose levels. However, if you are an individual with risk factors for cardiovascular disease, you are highly unlikely to be guided through a preventative programme – combining diet and lifestyle change - to reduce your risk of a cardiac event. There is simply no provision for this.
Since 1992, 14 government-led strategies and 680 policies related to obesity have failed6,7. Meanwhile the NHS is imploding under unsustainable strain. Non-communicable diseases cause an estimated 89% of UK deaths8, drain as much as 75% of health budgets with The Department of Health releasing data back in 2011 noting that "total long-term care expenditure was forecast to rise by 29% to £26.4 billion" by 20229. This underlines the worsening trend in diet-induced illness. Currently only 5% of NHS spend goes on prevention10. Yet, we need funding now to invest in long-term initiatives if we want to change this.
The NHS needs to prioritise prevention, and fast!
The NHS constitution claims to ‘improve our health and wellbeing, supporting us to keep mentally and physically well’. But how true is this in modern-day Britain?
Arguably the NHS remains our biggest source of national pride, but the public are worried about the future of the NHS. A recent poll showed 77% of people believe the NHS is not prepared to meet the increasing health demands of an ageing population11. The reality being we’re not just ageing but ageing badly.
NHS employees are just as concerned, record numbers, 170,000 staff have left NHS England in 2023 due to stress and unmanageable workload12. We are looking at a situation where the health of our health workers is at risk. Strike action is crippling services and new dates announced for December and January 2024 threaten to plunge the NHS into further crisis.
The biggest change to national health has been the rise of diet-induced chronic illnesses. The World Health Organisation has coined the term ‘“globesity” to describe the global obesity epidemic, and obesity correlates directly with diet13.
Prevention of illness through diet is therefore the most effective intervention.
Tim Gardner, Assistant Director for Policy at the Health Foundation, said: ‘‘People’s concern about the current state of the health service shows that the public wants a better health service, that can respond to changing health needs’11. In short, we need a health service that can respond to diet-induced chronic disease. Therefore, we need nutrition practitioners within the NHS.
A pill for every ill does not work with lifestyle-induced illness.
The NHS excels at providing medication-assisted treatments; however, these need to be backed-up by programmes that go beyond symptoms and instead seek to address the root causes of disease.
Standard of Care (SOC) is so heavily reliant on pharmaceutical interactions, that we are misguidedly trying to ‘treat’ diet-induced chronic disease with drugs – not diet!
A recent example of this is the promotion of Ozempic, a drug developed for Type 2 Diabetes, being put forward as an anti-obesity drug promoting fast weight loss. This follows in the footsteps of bariatric surgery with the NHS performing over 4,035 bariatric surgery procedures in the financial year 2021/2214. Even if all these surgical and pharmaceutical interventions are fully effective, which they are not, they come at a huge financial and staffing cost to the NHS. Most experts agree that the obesity crisis has resulted from changes in modern life, diet, and activity levels.
The long-term solution to diet-induced chronic disease is not pharmaceuticals. In 2022, The College of Medicine launched the Beyond Pills Campaign – calling for urgent Government intervention on over-prescribing in the NHS. The campaign seeks to address the ‘unsustainable prescription service… around 110 million drugs are currently prescribed unnecessarily every year’15.
Pharmaceutical companies provide compelling arguments for their products. From a patient-perspective it is often easier to pop a pill than make challenging lifestyle adjustments. David Ludwig, an obesity specialist in the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital says, “Big pharma can come up with a billion dollars to take a promising drug through Phase 3 clinical trials without difficulty because the profits can be enormous, whereas researchers trying to understand the environmental and dietary drivers of obesity must manage with a shoestring budget,”. He goes on to argue that despite this “diet- and lifestyle-based approaches should be at the forefront of obesity prevention and treatment”.
For this to happen, we need a workforce to implement diet and lifestyle programmes. We need nutrition practitioners within the NHS.
Prioritising prevention with a nutrition and lifestyle approach
Nutrition practitioners are experienced in personalised and group nutrition recommendations, and behaviour change.
Currently there are c.3,500 Registered Nutritional Therapy Practitioners not working within a primary care setting due to lack of joined-up-thinking. Only Registered Nutritional Therapy Practitioners and Registered Dietitians are trained and qualified in clinical practice to meet national standards and work in a one-to-one setting. These nutritional therapy practitioners are represented by the leading professional body, the British Association for Nutrition and Lifestyle Medicine (BANT) who also acts as self-regulator for BANT Registered Nutritionists®. There are c.9,508 dietitians registered with the British Dietetic Association (BDA).
Despite the lack of industry-wide regulation, BANT practitioners are required to be registered either with the Complementary and Natural Healthcare Council (CNHC) or be statutorily regulated. CNHC holds a register accredited by the Professional Standards Authority for Health and Social Care (PSA). A 2017 report by the Royal Society for Public Health and the Professional Standards Agency made a key recommendation that PSA Accredited Voluntary Registered (AVR) practitioners have the authority to make direct NHS referrals, in appropriate cases, to ease the administrative burden on GP surgeries. This has not been acted upon. Anecdotal feedback from GPs at industry events attended by BANT in 2023 is that they are crying out for nutrition practitioners to support their patients but require additional funding to enable this.
Prevention is paramount. Nutrition practitioners are agents for health promotion and disease prevention. We need nutrition practitioners within the NHS.
1. https://www.theguardian.com/society/2015/may/05/obesity-crisis-projections-uk-2030-men-women
2. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Accessed 09/01/23 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30054-X/fulltext
3. Mertens, E., Colizzi, C. & Peñalvo, J.L. Ultra-processed food consumption in adults across Europe. Eur J Nutr 61, 1521–1539 (2022). https://doi.org/10.1007/s00394-021-02733-7
4. National Obesity Audit (NOA) . Accessed 17/01/2023 https://app.powerbi.com/view?r=eyJrIjoiYmIyZWRmYjUtYTQ1ZS00YWEwLWIxOGUtYTkyZTM2ZDlmNDQ0IiwidCI6IjUwZjYwNzFmLWJiZmUtNDAxYS04ODAzLTY3Mzc0OGU2MjllMiIsImMiOjh9
5. https://www.diabetes.org.uk/about_us/news/number-people-living-diabetes-uk-tops-5-million-first-time
6. bulletins/ukhealthaccounts/2018
7. https://www.england.nhs.uk/publications/business-plan/our-2022-23-business-plan/our-funding/
8. https://publications.parliament.uk/pa/ld201617/ldselect/ldnhssus/151/15109.htm
9. https://fullfact.org/news/how-much-nhs-budget-spent-treating-chronic-conditions/
10. Office for National Statistics. (2020). Healthcare expenditure, UK health accounts: 2018. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem
11. https://www.health.org.uk/news-and-comment/news/nhs-remains-our-biggest-source-of-national-pride-but-public-are-worried-about-its-future
12. https://www.theguardian.com/society/2023/jul/01/revealed-record-170000-staff-leave-nhs-in-england-as-stress-and-workload-take-toll
13. https://www.who.int/activities/controlling-the-global-obesity-epidemic
14. https://commonslibrary.parliament.uk/research-briefings/sn03336/#:~:text=28%25%20of%20adults%20in%20England,bariatric%20surgery%20and%20international%20comparisons
15. https://collegeofmedicine.org.uk/beyondpills/
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