The Blog

Too Fat For The NHS? The Obesity Crisis Facing Our National Health Service

The Vale of York Clinical Commissioning Group (CCG) recently took the decision to refuse surgery to people with non-life threatening conditions if they have a body mass index of 30 and above for up to a year.

Within that timeframe, people must shed up to 10 per cent of their body weight before they can be considered eligible for elective treatment.

To some, this policy comes across as a draconian measure. However, the decision raised an important question regarding what we should expect our NHS to deliver given the growing financial constraints it faces, and how much responsibility we should hold for our own health.

Do we want to have a National Health Service or a National Sickness Service?

In other words, do we want a health service that provides not only care, but provisions to stop preventable diseases occurring, or do we want a health service that solely treats those illnesses?

The National Health Service is rightly free at the point of use but it is not cost-free.

Ultimately, it is the public that covers the cost of the NHS. We, as users of the NHS, must take some responsibility for our health.

Given the financial limitations that entails, should we be expected to continue to pay for the treatment of costly long-term conditions that are largely preventable through lifestyle changes? If we continue taking this approach, we will inevitably run out of the money needed to treat the conditions which contribute to life-threatening diseases such as cancer.

The wider context is that the NHS is generally in a troublesome financial state. Last year, the health service had a record overspend of £2.45 billion.

In addition, analysis by the Chartered Institute of Public Finance and Accountancy projected that the NHS will exceed its budget by £10 billion in four years' time. This forecast comes against the NHS' target to make £22 billion in efficiency savings.

Under this climate, one begins to understand the motivations behind Vale of York CCG's decision.

Indeed, the principal justification for the decision by the CCG was that it represented the best way of "achieving maximum value from the limited resources available".

Vale of York CCG is not alone in adopting this mind-set. The Health Service Journal's survey of CCG's across the country found that 39 per cent were considering rationing care to save money.

Rationing of care is not new to the NHS. The National Institute for Clinical Excellence has made numerous tough decisions to stop the distribution of drugs it deemed too costly to administer.

The cost-saving provisions we see across the NHS are inevitable when you look at our population. It is growing steadily while general life expectancy continues to rise.

While this is undoubtedly beneficial to all of us, a consequence is that the NHS is dealing with an exponential increase of long-term conditions it has to treat. After all, as our population has increased, so have our waistlines.

A result of this is that the cost of maintaining the NHS and ensuring that it delivers a high level of care is only going to go up.

So what can we do about this?

There are those who say that the solution is to chuck more money at the NHS. However, they cannot be taken seriously unless they give a clear indication of where that money would come from.

Which services would you take the money from to fund the NHS? Defence? Education? Pensions?

I would love to continue injecting billions into the NHS every time it ran into trouble, but the money has to come from somewhere.

We need to recognise that our NHS could grind to a halt if we do not implement tough measures to tackle a condition that is placing an increased strain on its resources, obesity.

Obesity is a direct contributor to the most costly chronic long-term conditions such as diabetes and heart disease. Given that approximately 70 per cent of NHS spending goes on long-term conditions, not taking adequate measures to tackle it is financially dangerous for the NHS.

Last year, NHS England spent approximately £5.1 billion treating overweight and obesity-related conditions.

Today, nearly a third of children aged 2 to 15 are overweight or obese.

In addition, according to the Royal Society for Public Health, less than a third of children in England are achieving recommended daily activity levels.

The result of this is that the NHS spends more money on the treatment of obesity and diabetes than we do on the police, fire service and the judiciary combined.

These points suggest that we need to make the reduction of obesity a national priority.

If tough measures were implemented to tackle this problem today, we would alleviate a significant source of the financial strain placed on the health service and help to make it sustainable under the current funding model.

More importantly, we would be avoiding poor health outcomes for ourselves and our children. Reducing childhood obesity would be a giant leap forward in addressing health inequalities in London and nationally.

After all, when it became clear that smoking was detrimental to society's health and placing an increasing financial strain on the NHS, the Government stepped in and, among other measures, introduced tax rates high enough to discourage people from smoking.

The benefits of such measures became apparent quickly. For example, in London, the proportion of people who smoke has reduced by 10 per cent since 2010.

Regarding obesity, the Government's response to the crisis is its National Childhood Obesity Strategy.

If I was being generous, I would happily state that the strategy is a sign that the Government recognises the challenge ahead of us.

However, the strategy simply does not go far enough.

The focus of the strategy is to challenge companies within the food industry to reduce their sugar content by "at least 20% by 2020, including a 5% reduction in year one."

While this appears to be a step in the right direction, the fact that this is a challenge as opposed to an instruction worries me.

The nature of the proposal means that companies can choose to adopt or ignore it.

There does not appear to be any concrete steps in place to ensure that the companies will adhere to this challenge.

Companies will not voluntarily put themselves at a competitive disadvantage and therefore, if we want to achieve real change, any proposal needs to be legislative so that it is applied across the board.

Furthermore, the strategy dictates that every primary school child should take part in at least 60 minutes of moderate to vigorous physical activity a day.

While the intention is commendable, without a proper framework in place to ensure that this aspiration is delivered, how will we know whether schools are adopting this policy?

It is also important to note that obesity will not be defeated by exercise alone. Although physical activity is hugely beneficial for your health and weight control, obesity is largely about food intake as opposed to physical output.

As my gymnastics coach always used to tell me, "You cannot out-run a bad diet".

By taking the voluntary approach to tackling childhood obesity, I fear that we are giving the food industry free reign to continue making unhealthy products, disingenuously advertised as being healthy because they are the 'low fat' option.

Unless we adopt the robust measures needed, we should expect to hear more stories of CCG's around the country refusing specific methods of non-emergency treatment because they have to manage resources.

As a Conservative I don't like to ban things and I hate the idea of creating additional taxes. However, these tactics are the only way of addressing the extreme levels of obesity in our country.

We also need to force the food industry to use clearer and simpler labelling on their products. The idea that busy cash-strapped families are making a conscious choice to eat unhealthy products is losing traction with me, as we have no idea what is in our food because of the complicated labelling system used. On top of this we are constantly bombarded with confusing and conflicting messages on what foods are healthy for us to eat.

If we do not tackle obesity, we, as a country, will ultimately pay the price.

We need a concerted effort to ensure that our population is equipped with the knowledge necessary to make healthy dietary choices.

To my mind, the role of the NHS is to support our quality of life, not just to treat us with expensive drugs so we can limp on. After all, family and good health are the most important things in life.

If we are willing to be bold and take the tough measures necessary to tackle obesity, we can make our health service sustainable, and our society healthier.