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Get serious about obesity or bankrupt the NHS – Simon Stevens

The health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health, the Chief Executive of NHS England tells the annual conference of Public Health England in Coventry today.

Simon Stevens points to the fact that nearly one-in-five secondary school aged children are obese, as are a quarter of adults – up from just 15 per cent twenty years ago. Unchecked, the result will inevitably be a huge rise in avoidable illness and disability, including many cases of type 2 diabetes which Diabetes UK estimate already costs the NHS around £9 billion a year.

“Obesity is the new smoking, and it represents a slow-motion car crash in terms of avoidable illness and rising health care costs,” Stevens says. “If as a nation we keep piling on the pounds around the waistline, we’ll be piling on the pounds in terms of future taxes needed just to keep the NHS afloat.”

In an NHS ‘Five Year Forward View‘ to be published next month, the NHS will set out some of the actions that could make a difference over the course of the next Parliament. Proposals being debated include:

  • A shift in NHS investment towards targeted and proven prevention programmes. Stevens will point out that the NHS is now spending more on bariatric surgery for obesity than on the national rollout of the intensive lifestyle intervention programmes that were first shown to cut obesity and prevent diabetes over a decade ago.
  • New incentives to ensure the NHS as an employer sets a national example in the support it offers its own 1.3 million staff to stay healthy, and serve as “health ambassadors” in their local communities. While three quarters of NHS trusts say they offer staff help to quit smoking, only about a third offer them support in keeping to a healthy weight. Three quarters of hospitals do not offer healthy food to staff working night shifts.
  • Recommending that financial incentives should be offered to employers in England who provide effective NICE-certified workplace health programmes for employees. Stevens will argue that one of the benefits of a tax-funded NHS is that UK employers are not on the hook for health care costs, but that should not mean that the workplace is neglected as a setting for more concerted health action. Sickness absence-related costs to employers and taxpayers have been estimated at £22 billion a year, and over 300,000 people each year fall out of work and onto health-related benefits.
  • A “devo-max” approach to empowering local councils and elected mayors in England to make local decisions on fast food, alcohol, tobacco and other public health-related policy and regulatory decisions, going further and faster than national statutory frameworks where there is local democratic support for doing so. Stevens will draw attention to the public health leadership of Michael Bloomberg as Mayor of New York City, and of leading local authorities in England.

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6 comments

  1. Lynne Hayward says:

    I don’t think people including health professionals yet realise the subtle influences involved.anecdotally, from my observations and experiences as a nurse, I find as nurses we are not treated in the NHS or in the “independent ” realms of general practice, with a healthy working environment. In my present post there is nowhere to have lunch away from the desk so it’s either in the car or local Macdonalds. My last post installed a “healthy” dispersing machine of chocolate and crisps and told us we were no longer allowed to use the kitchen.
    From an observation of patients’ behaviours, I find parents cramming crisps and chocolate into the mouths of babies during baby clinic as an incentive to not cry (another emotional pressure), and nearly everyone who wants to lose weight “doesn’t eat much “. In this instant society of “I want it now”, food is caught up in no responsibility of its ok to feel hungry for a while, and so instead of trying to change behaviour we offer gastric surgery that does not address that over consumption is a brain problem. Likewise we are presently making our Nhs departments “obese” by whatever the patients want the patient gets creating expectations beyond reason in some trivial problems when we are struggling to manage at a basic level the less trivial ones.

  2. Sue Henry says:

    We have a programme that has been proven to improve NHS staff health and wellbeing, reduce costs to organisation and inspire staff to lose weight. Over 220,000 staff have benefited from the prog. Launched by Sir David Nicholson in 2010 in response to Boorman review, a London 2012 Inspired Programme, Jonathan Edwards as it’s ambassador but inspite of this in March this year our central funding ran out. We’ve set up a not for profit org to take the work forward and asking NHS orgs to pay £1.00 per member of staff per year to support us to continue to to support the system to get staff active. The programme is currently being run on a voluntary basis. The evidence base for the benefits of being more physically active is indisputable but stiil the system doesn’t seem to be able to take it’s own advice nor invest £1.00 per member of staff per yr – less than 10p per month! Why can’t we support what works and stop funding programmes that don’t? Lets use the expertise, knowledge and enthusiasm within the system to put our own house in order. We may not be an NHS organisation now but our only chance to continue the programme was to take it outside of the system-something isn’t right!!!

    • Sorry for the long reply but felt I had a lot to say!

      I agree with Sue Henry. NHS staff in the West country took part in the 2012 initiative. As a result of sustained health promotion through the 2012 initiative we saw thousands of NHS staff start to take responsibility for their own health and wellbeing by increasing their physical activity and eating more healthily. We demonstrated that staff morale improved and sickness absence reduced as a result.

      However, the action came from individuals who woke up to their personal health behaviours and started to do something about it. There was a distinct lack of interest, support or action at management or “workplace” level. For example, we introduced fully funded weight loss courses on work sites, (free to individuals) but staff were not allocated any time to attend them and, if they were able to attend, they had to make the time up. So we made them after work but staff were too tired after a day of pounding the wards or were resentful of having to do it in their own time. Then we tried to introduce weight loss vouchers to give to staff so that they could attend commercial organisations at a time and place to suit them. But PCTs( at the time) worried about the potential media outfall – eg “Cash strapped NHS staff given weight loss voucher perks” put a stop to that.
      For those staff who did attend massive amounts of weight were lost and that weight loss was sustained for over a year. But they had to do it all by themselves and all of the evidence shows that workplace health and wellbeing initiatives are much more successful when seen to be important and overtly led by Managers at the very top of each organisation. In this way, health and wellbeing permeates throughout the organisational culture.

      Maybe this is to do with the opinion (often heard) that the health and wellbeing of individual staff is their own business and nothing to do with anyone else, especially managers. I have never, ever had an enquiry from an NHS manager about how to help their staff improve their health and wellbeing.
      What we often forget is that NHS staff are people too and, because often they come from a “clinical” perspective we forget that they still need education, motivation, inspiration and support, as the general public does, with positive health behaviours.

      In terms of NHS staff health and wellbeing, there are a lot of entrenched attitudes and to face. From a denial that ill health may happen to “me” (for example look at the poor staff uptake of the flu vaccine), to a kind of “do as I say not as I do” attitude (look at the number of obese staff who are advising patients to lose weight and justify it with the “well they can see that I understand and experience what they are going through, therefore this gives me a more empathetic relationship with my patient” stance.

      Those of us who work in workplace health and wellbeing have been hearing this “NHS staff should be health role models” for years. Even in recent times we’ve heard it a lot – Look at what Lord Darzi said in 2008 in High Quality Care for All, let alone the findings of the Boorman NHS Health and Wellbeing Review! Most people would agree that it’s morally and ethically true that NHS staff should be “health ambassadors” but, in order to achieve this, there’s a lot of work to be done around entrenched attitudes and values and a lot of help support and innovation to introduce. It looks like Simon Stevens really means it this time –it will be good to see what happens.

      Also, what is “NICE certified” workplace health and wellbeing. I’ve been working in workplace health and wellbeing for over 20 years and never heard of this. There are NICE recommendations for certain aspects of workplace health and wellbeing, for example, physical activity, but there is no NICE certificate. There is a new Workplace Wellbeing Charter which has been developed by the charity Health@Work, along with Liverpool City Council, ….. But it depends on people with an interest and who volunteer to deliver it locally. Some Local Authorities (very few) offer their own healthy workplace awards as an attempt to improve health, work and wellbeing standards thereby contributing to aspirational public health outcomes of reducing sickness absence and increasing the employment of those with long term health conditions.

      All in all, there’s some stirling work being done in terms of workplace health and wellbeing throughout the country, and some great aspirations but it’s all still a bit too scatter gun instead of being from an evidenced, co-ordinated and strategic plan.

  3. Colin Howard says:

    I agree that as a nation we are becoming overweight, and encouraging businesses to help employees tackle obesity by offering tax breaks etc might help. May I suggest that Mr Stevens starts with his own concern ie the NHS as I have found employees in our local hospital, both medical staff and receptionists are in many cases grossly overweight. The NHS should be at the forefront leading by example. What must an obese patient think when attending a hospital or doctors surgery, and being confronted by staff in many cases larger than themselves, that it isn’t so wrong being fat?

  4. I agree wholeheartedly with Simon’s views and have first hand experience of the use of gamification and enabling technologies to tackle lifestyle related conditions such as obesity and diabetes. However, trying to engage with medical professionals and specialists in diabetes is virtually impossible for anyone outside the medical profession, however relevant their contributions. I very much hope Simon takes the trouble to watch the video at [Link removed – video not working]

  5. christopher chappell says:

    I am developing a strategy to reduce obesity in Faversham (pop.18,000) – and in the Premier Obesity League.
    This is based on incentivising overweight people to’ Lose pounds and gain £s’.
    At present I am trying to assess the collective size of those by reference to their BMI by seeking the co-operation of local medical practices to supply this information to try and assess the cost of funding the project (The Faversham Challenge) over a fixed period of say 6 or 12 months.
    I plan to offset the cost to the NHS by not only pointing to the benefits for limiting new Diabetes 2 patients coming on stream but also by seeking sponsorship for which I have a proven track record.
    In March 2013 I was told I was borderline Diabetes 2 and by reducing my weight from just under 16 stone to under 12 stone by March 2014 my BMI dropped to normal and I was taken off the ‘at risk list’.
    If I can do it (aged 74) anyone can do it.
    The carrot I am offering is not just £20/40/60 for respective weight loss but the opportunity to appear in a documentary I am discussing with a TV company.
    There is plenty of advice being dispensed out there on how to lose weight but I like to think my proposals could be a win /win solution for what is a national problem.
    Glad to see Simon Stevens is being so vocal -I am very confident that I could produce sponsors to what could prove an exciting campaign.