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UK health policy

First NHS mandate neglects obesity

The mandate, introduced by Secretary of State for Health Jeremy Hunt, sets out the areas the government wants the NHS to concentrate on improving.
Mandate sets out NHS' priorities for next two years, does not mention obesity
Philip James: "Decisions are made on the basis of political philosophy, not facts or expert analyses"
Department of Health: "It would be invidious to pull out individual specialties"

The UK’s Department of Health have released the first National Health Service Mandate, a document which sets out the government’s vision for the health service over the next two and a half years.

However, the 29-page document fails to mention obesity once.

“The Department of Health has become far more politically controlled with this government. Decisions are made on the basis of political philosophy, not facts or the accumulated wisdom of expert analyses.” Professor Philip James, president, IASO

The mandate document, which the UK government describes as “historic”, commits the NHS to making improvements into premature death from cancer and heart disease, and enhancing quality of life for people with long-term conditions like dementia, diabetes and depression, but says nothing about the government’s plan to use the NHS to deal with the obesity epidemic.

The document itself set no new explicit targets, and is intended to be a broad, albeit legally binding, overview of the areas in which the government wants the NHS to improve. However, it is intended to provide an impression of what the government sees as the NHS’ priorities up until the next general election in March 2015, and does mention several conditions, like dementia, as particular concerns.

The mandate mentions several common comorbidities of obesity, including diabetes, hypertension, and cancer, as priorities for the improvement of treatment and care, but leaves it to individual clinical commissioning groups to decide how to deal with them.

Professor Philip James, president of the International Association for the Study of Obesity and honorary professor of nutrition at the London School of Hygiene and Tropical Medicine, said: “I think they are just behind the times. David Cameron has already made it clear in public as well as privately that he regards obesity as the individual's problem so all they need to do is eat less and exercise more. He is evidently not used to reading expert reports or even listening to experts.”

James has been vocal in his criticism of the UK government’s obesity policy in the past, particularly the previous secretary of state for health Andrew Lansley’s voluntary “responsibility deal” with large food companies, which he said resulted in industry “writing policy” for the government, and the ongoing reorganisation of the NHS. 

“The Department of Health has become far more politically controlled with this government,” said James. “Decisions are made on the basis of political philosophy, not facts or the accumulated wisdom of expert analyses.”

A spokesperson for the Department of Health said: “There’s no mention of all sorts of things. It would be invidious to pull out individual specialties in the mandate.”

The mandate states that its objectives are focused on areas that are “of greatest importance to people”, and list the following areas as those of greatest concern:

  • preventing ill-health, and providing better early diagnosis and treatment of conditions such as cancer and heart disease, so that more of us can enjoy the prospect of a long and healthy old age;
  • managing ongoing physical and mental health conditions such as dementia, diabetes and depression – so that we, our families and our carers can experience a better quality of life; and so that care feels much more joined up, right across GP surgeries, district nurses and midwives, care homes and hospitals;
  • helping us recover from episodes of ill health such as stroke or following injury;
  • making sure we experience better care, not just better treatment, so that we can expect to be treated with compassion, dignity and respect;
  • providing safe care – so that we are treated in a clean and safe environment and have a lower risk of the NHS giving us infections, blood clots or bed sores

The only time that obesity is mentioned is in a supporting “equality analysis” document, when it notes that one in five children born in the UK are obese by the time they reach the age of three. 

According to the NHS’ own data, 22% of men and 24% of women were obese, and 44% of men and 33% of women were overweight, in England in 2009.

2012 report found that bariatric provision in the UK was unequal, with access to surgery often defined by location, rather than need. The Royal College of Surgeons reported recently that UK hospitals are underprepared for obese patients, with limited access to suitable equipment and policy.

The charity Diabetes UK has said that the incidence of diabetes in the UK, primarily type 2 diabetes, will rise rapidly in the near future, driven by obesity. They believe that the burden of the disease “could bankrupt the NHS within a generation”.

Reception

The mandate has generally been well-received by health policy professionals. 

Sir Richard Nicholson, chief executive of the NHS Commissioning Board, said: “Our aim and passion is to deliver a better NHS on behalf of patients and the public. The mandate enables us to do this. It marks a major step on the road to the more liberated and innovative NHS that can be more responsive to its patients.”

The chief executive of the NHS Confederation, Mike Farrar, said: “We are pleased the Government has listened to the views we put forward on behalf of the health service. It was really important that the Government avoided stuffing the mandate to the gunnels with detailed targets for every condition under the sun. While that might have looked superficially attractive, it would have meant more top-down prescription and less innovation and responsiveness to local needs.”

Even the normally caustic Andy Cowper, of Health Policy Insight, described the mandate as “not actually too bad”.

The government’s secretary for health, Jeremy Hunt, said: “Never in its long history has the NHS faced such rapid change in our healthcare needs. This mandate is about giving the NHS the right priorities to deal with those challenges. We do not want an NHS that focuses on narrow performance indicators but instead looks at true measures of whether all of us are receiving the highest quality of care.”

However, the Labour party have described the document as nothing more than a “wish list”.

The mandate also directs the NHS to give equal priority to mental and physical health, and pledges that everyone should be able to have access to several GP services online, including appointment booking, repeat prescription ordering, and the ability to talk to your GP.

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