Keir Starmer’s health plans will need to address my sweet tooth…

Keir Starmer, preparing for office, is setting out his stall on policy and last week addressed Labour’s plans for the Health Service which essentially means England as Health is devolved. But any policies by a UK government at Westminster will affect us here if only in future Health Service investments and policy direction. The current health service, which for us includes social care, seems insatiable when it comes to funding so throwing money at this problem alone is not going to solve anything yet the clarion call from all vested interest groups is more money. Financial investments, even significant ones, seldom result in improved outcomes for patients as new money is quickly absorbed by structural deficiencies in a system that has been deprived of funding over the life of the current UK government. Money is needed but so too is radical transformation.

Finances were tight when Labour conceded to the Tories but since the Cameron Coalition days there has been a year-on-year real terms reduction in health service investment. Over these years this has created many of the problems that we now face. Covid, and the way the service responded to the pandemic, was unhelpful but not the main cause of the problems. Yes, money and investment have a part to play but radical transformation much also happen.

Sir Keir has said nothing about the NHS and what needs to be done that has not been said before. It is clear what steps need to be taken to reach a new accommodation between the citizens of the UK and the governments who provide strategy and funding for its health services. Compton said it, Bengoa repeated it, yet some of the very politicians who supported the Bengoa recommendations in the NI Assembly were the very politicians recently blocking service transformation in South West Acute Hospital and Antrim Area Hospital. But let’s not get side-stepped into local issues as can often happen in health matters and let’s focus on Labour’s plan.

For Sir Keir to quote Nye Bevan might reassure the Red-Labour supporters that the NHS is in safe hands but he chooses to ignore and deny the significant societal and demographic changes that have come about since the late 1940s when the health of the population and the type of service required was very different to the public health challenges we face today. To commit to have a service free at the point of access may reassure voters but fails to recognize how the practice of medicine has advanced as has public demand and expectation.

Sir Keir is right when he cites disease prevention as a key element of improving general health and reducing dependence on the Health Service. Disease prevention is the most cost effective way to increase not only the years of life but the years of healthy life for individuals and improve the efficiency of the Health Service. We have increased life expectancy to over 80 years today from 68 years when the Health Service was first introduced and that is to be applauded. Yet too many live out the last twenty years of their lives in poor health and as a result are highly dependent on Health and Social Care Services. Diabetes is a good example where 90% have the condition mainly due to lifestyle often, or mostly, beyond their personal control. And the same applies to cardiovascular disease, mental illness, cancers and respiratory diseases which make up the bulk of the disease burden.

In disease prevention the issues are relatively simple, we need to: stop smoking, take more exercise, improve nutrition and reduce stress. It’s not that simple I hear you say but sorry it is that simple. The problem is that we don’t seem able to do any of these.

We have greatly reduced the prevalence of cigarette smoking over the last 20 years but diet and exercise has gone in the opposite direction with obesity increasing in all age groups. In making healthy choices the individual has many barriers and the less well-off you are the higher and more impenetrable these barriers become.

The market is off course the main barrier to better healthier choices. Fast-foods and highly processed foods for example are cheap, highly palatable and easily accessible and their impact when consumed frequently causes ill-health and adds significantly to the disease burden. Sadly, too few of us appreciate the link between what we eat and how healthy we are never mind take active steps to improve it.

A few years back a well-known sandwich company lost an appeal against the Irish Revenue who required VAT to be paid on their sandwiches. The ruling that the sandwich bread-roll was 10% sugar making it confectionary, rather than bread, was a disappointment for the company. Off course the sandwich company did not accidentally come up with this sugar content it was designed in tasting panels and consumer groups that created a product people would buy again and again and would believe that, as it was a sandwich, it was somehow healthier than other options. Reducing sugar content to avoid VAT didn’t seem a commercial option. I could give many similar examples.

I fear Sir Keir’s plans to improve the NHS through; increased funding, transformation and disease prevention will fail because his government, like the current UK government, will fail to make the necessary financial investment, deliver some difficult transformation and refuse to regulate the fast-food and processed-food industries that are profiting out of the destruction of healthy lives.

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