The Crisis in the NHS. Can it Be Solved?

The nurses are on strike, the ambulances are on strike. A&E departments are full to overflowing. Is there any hope? Will it ever get better? Is there a way to fix it?

Sadly, many of the problems are entirely predictable. Hospital beds have been reduced by 43% since 1987 (from 299,000 to 142,000). You might wonder what they were thinking. And now, surprise, surprise, there are not enough beds. The number of medical students in training was reduced between 2012 and 2017 and now there’s unfilled vacancies for consultant posts and GP practices across the country.

But all this hides a much bigger problem. It’s not just the NHS. Most health services across the world are in danger of bankruptcy. Some countries use tax to fund the health service (like the NHS) whilst others use insurance. But in the end it makes little difference because insurance systems need to be increasingly propped up by additional government cash. Every system is under immense pressure. However, on average, European countries have spent about £40 billion more annually in the last decade and this does make a difference.

But it’s not just about money. The USA has the most expensive healthcare systemin the world. Health spending in the USA has tripled from 6% of GDP in 1970 to 17.9% of GDP in 2020.

Does this make it the best health service in the world? No. Health outcomes in the US are worse than in most European countries (their life expectancy is only 28th in the list of developed countries). And what’s more scary is that 35% of the adult population (64 million people) can’t pay their medical debts. So throwing money at health care isn’t the answer.

You might ask what is driving most health services into bankruptcy. The answer is very simple: the inexorable rise in chronic disease.

And it’s not a small increase. In 1980, 30% of adults (in the US) had chronic disease. Now it’s 60%. And 12% have five or more chronic diseases.  It’s the same in the UK. It means we have double the amount of illness to treat (but half the hospital beds).

How successful are we at treating chronic disease? Not very. None of the medicines that we use cure these chronic diseases, the drugs merely treat the symptoms. That means long-term expensive drugs.

What makes up these chronic diseases? Chronic metabolic disease (which includes diabetes, fatty liver, cardiovascular disease and hypertension) make up 75% of the cost and these are largely preventable. Take diabetes. This has increased 300% during the last three decades. It alone takes up 10% of the NHS budget. This increase has paralleled the increase in obesity which in turn has paralleled the increase in processed food.

And yet this disease is preventable and treatable – not with drugs but with diet. Dr David Unwin, A GP in Southport, has reversed over 120 cases of type 2 diabetes in his practice with a low carbohydrate diet. If this was done in every practice it would save £277 million a year. This is no fluke: the online Virta program in the USA, using a ketogenic diet has reversed 60% of cases of type 2 diabetes within a year.  Fatty liver is another disease which like diabetes can be reversed with diet but not with drugs.

You can’t fix health without first fixing food. We already know this from research studies.

Much research has already been done on populations living on unprocessed food. The best known researcher was Weston Price who studied many isolated communities. Wherever he went he found good health. The diseases of western civilization such as heart disease, diabetes and cancer were absent. These populations needed neither doctors nor dentists. The common factor in all these communities was they lived on entirely natural food. Their health costs were zero yet their health was superb.

Contrast that with ourselves. Our health costs are rapidly becoming unaffordable; our health is poor and getting worse. Our children are getting sicker earlier (we are seeing an epidemic of type 2 diabetes and fatty liver in children and adolescents).

Weston Price noted how quickly the health of these isolated populations he studies deteriorated when exposed to processed food.

The massive Global Burden of Disease study confirmed this and identified poor diet as the number one cause of disease worldwide, reducing life expectancy by nearly 10 years (nearly double the effect of smoking).

Just 1% of the Chinese had diabetes in the 1980s but once they got a taste for processed food things changed rapidly and diabetes sky-rocketed reaching 11.6% by 2013. They now can’t build hospitals fast enough.

If you visit a supermarket 70% of foods sold are processed and 90% of these have added sugar and most will have a variety of other chemicals. The UK has the highest intake of ultraprocessed foods in Europe at 50% (compare Portugal 10%). And we know that every 10% of our food that is ultra-processed this increases  mortality by 14%. With this diet, poor health is guaranteed and inevitable. No amount of spending on doctors or hospitals can compensate for it.

The crazy thing about this situation is we are paying good money to make people ill and bankrupt our health services. The most subsidised foods (sugar, corn – used for high-fructose corn syrup and soya) are the key components of junk food. The taxpayer subsidises these junk food and then pays again for the health costs. What would happen if we removed these subsidies and subsidised healthy food instead? One study estimated that subsiding fruit and vegetables in the US would save $40 billion in health costs (,eCollection%202019%20Mar) . To move the subsidies from unhealthy to unhealthy foods would cost little  and would make a huge difference to our health.

So could changing our diet solve our health problems? Is there any evidence? A study by UCSF, using fatty liver as a model, found that removing 20% of sugar from the American diet would save $10 billion annually and removing sugar by 50% would save $31.8 billion.

Mexico put a 10% tax on sugary drinks and a 5% tax on junk food. Not much tax but a big effect. The study estimated it would save 19,000 lives, prevent 200,000 cases of diabetes and reduce health costs by $982 million over a decade.

PLoS Med,2016; 13(11): e1002158

At the moment we have a health system that is unsustainable. But we do have answers. But will we act on them?