The UK government recently unveiled a fifteen-year staffing plan for the National Health Service (NHS). Currently, one in ten NHS posts remains unfilled. Meaning there are about a hundred and ten thousand vacancies in the NHS.

The government has proposed a 15-year NHS staffing plan that includes:

 

• ramping up the places for medical doctors within medical schools to 15,000 per year

• increasing by 50% the GP trainee places for junior doctors

• increasing to 24,000 per year the medical school places for nurses and midwives

• increasing the number of nursing associates training places to 10,000 by 2031

As laudable as the above initiatives might appear, they will not solve the NHS staffing problems. They’re simply good prescriptions but to the wrong diagnosis. Increasing NHS man power is necessary but not sufficient to tackle the NHS staffing crisis. This is because the NHS staffing crisis has little to do with man power shortage.

The problem of NHS staffing crisis is structural. Except the government tackles the structural issues bedevilling the healthcare sector, any proposed initiative will simply be band aid.

There are five root causes of the NHS staffing crisis:

• limited preventive healthcare initiative,

• an outdated healthcare business model,

• inability to make effective use of technology,

• outdated healthcare regulations,

• outdated medical school training.

In this article, I will address the first of the five. I will address the rest in subsequent articles.

Limited Preventive Healthcare Initiatives

The ‘H’ in NHS stands for health. However, the NHS’ current business model focuses on medical care instead of healthcare. Most people’s understanding of health care is limited to the activities that occur when they visit their medical facilities. Activities such as the diagnostic processes of giving blood, scanning, undergoing X-ray, biopsy or other tests, then receiving test results and prescription.

Those activities are aspects of medical care not healthcare. Medical care accounts for only around 10% of healthcare. The remaining 90% of healthcare involves lifestyle choices such as diet, exercise, living environment and financial capabilities.

However, because we are used to using both phrases interchangeably, most people conflate health care with medical care. As a result of the confusion between health care and medical care, the large percentage of healthcare resources are spent on prescription and treatment rather than prevention and recovery.

While prescription and treatment increase the unending demand for healthcare professionals, prevention reduces the demand. But prevention is difficult for politicians to sell to the public. Politicians know Brits are emotionally attached to their NHS. So, instead of offering solutions that will effectively resolve the NHS staffing crisis, they propose solutions that make good sound bites.

First Thing First

Step one for tackling NHS staffing crisis is to reduce the need for medical professionals by instituting effective preventive healthcare measures.
The world-renowned Dr. Albert Schweitzer once said, “The witch doctor succeeds for the same reason the rest of us succeed…Each patient carries his own doctor inside him. They come to us not knowing the truth. We are at our best when we give the doctor who resides within each patient a chance to go to work.”

So, the most effective strategy for reducing NHS staffing crisis is to do what Dr. Schweitzer recommended, activate the doctor that resides inside each patient?

Activating the doctor inside patients first requires an understanding of the root cause of the diseases that plague them. According to Hippocrates “Disease sprang from natural and physical causes from the patient’s environment, diet, and daily habits rather than Divine punishment or evil spirits.” So, he recommended, “Let food be thy medicine, and let thy medicine be thy food. He who does not know food cannot understand the diseases of man.”

I alluded to the fact that 90% of healthcare involves lifestyle choices such as diet, exercise, living environment and financial capabilities. For the sake of brevity, I will focus on diet in this article because our diet accounts for the lion share of our lifestyle choices.

Die Young As Late As Possible

In his book “Can Medicine be Cured” author Seamus O’Mahony wrote that from the 1800s up to the 1930s the major killer diseases were tuberculosis, tetanus, syphilis, rheumatic fever, pneumonia, meningitis, polio, and septicaemia. By the middle of the twentieth century, almost all of those diseases were either eradicated or brought under control.

According to WHO, the major killer diseases that currently plague humanity are: heart disease, stroke, chronic obstructive pulmonary disease, lower respiratory infections, neonatal conditions, trachea, bronchus, lung cancers, Alzheimer’s disease and other dementias, diarrhoeal diseases, diabetes mellitus, and kidney diseases.

In contrast to the diseases that plagued humanity in the 18th and 19th centuries, the major diseases responsible for the death of millions each year are diseases of affluence directly linked to our lifestyle. I am sure most people reading this paragraph will frown at the suggestion that the diseases we suffer are diseases of affluence. They will prefer the genetic explanation.

I empathise with the genetic lottery explanation and wish that was the overwhelming cause. But alas that is not the case. In the extreme minority of cases, some people are dealt a bad gene. However, in the majority of cases, lifestyle choices are the root causes of our illnesses. So, what does that mean for NHS staffing crisis? It means if the UK government is serious about tackling NHS staffing shortage, it needs to first tackle the reasons people make bad lifestyle choices.

The UK population is currently 67 million and the doctor patient ratio in the UK is currently 1 to 31. The UK population will grow to about 71 million by the time the government’s 15-year plan is fully implemented. This means that by the time the current plan is implemented, the need for NHS staff would have increased. Meaning the government at the time would need to develop another 15-year plan to tackle NHS staffing crisis. As of this writing, the NHS waiting list remains as high as three million. It’s only going to continue to grow.

How to Effectively Tackle the NHS Staffing Crisis?

I will suggest the UK government starts with preventative healthcare measures. But prevention is not a vote winner. Which government would like to focus on a plan that is not a vote winner irrespective of its effectiveness? Those who argue that preventative healthcare measures do not work or that the population will refuse to comply might want to consider the smoking ban.

The smoking ban has had a massive impact on smoking habits. Smokers did not voluntarily submit to the ban. Slowly, very slowly, smokers realised the high cost associated with the habit, so many were forced to quit.

Just like smoking, there are several lifestyle regulatory measures the government could enact that would drastically reduce the unnecessary deaths and suffering people currently endure. That would reduce the need for additional NHS staff.

I realise implementing a number of those measures even though good for the national health, would be political suicide. So, no government would want to vote itself out of office. However, there is one measure the government could enact that could almost half the rate of diseases and its associated deaths and reduce the need for additional NHS staff. That measure is sugar restriction.

The root cause of almost all the diseases that plague humanity today is metabolic syndrome. Metabolic syndrome as defined by the NHS’ own website is the medical term for a combination of diseases including: diabetes, high blood pressure (hypertension) and obesity. It is these diseases that result in coronary heart disease, stroke and other conditions that affect blood vessels.

And the deep rooted cause of metabolic syndrome is sugar. In his book ‘Fat Chance’ author Robert Lustig revealed that there were 151 million diabetics in the world in 2000. Projections suggested that number would increase to 221 million a decade later, but the actual numbers were a staggering 285 million. That is 64 million in excess of the projections. Four years later the number was 422 million. By 2019 the number had reached 469 million; by 2020, it was 537 million. Currently the projection for 2030 is 568 million.

The primary pathology for diabetics is insulin resistance. Insulin resistance is a metabolic issue that results in cardio metabolic disease. When the human body is incapable of regulating blood sugar, it becomes insulin resistant. Meaning the body becomes resistant to the effect of insulin.

Some symptoms of insulin resistance include increased belly fat, increased inflammation, increased cortisol, increased stress hormones, abnormal cholesterol, fatty liver, and lower hormone levels.

Insulin resistance also drives cancer cells and shrinks the hippocampus. The hippocampus is part of the limbic system that plays a critical role in the consolidation of information from short-term to long-term memory, and is responsible for navigation in spatial memory.

Insulin resistance is directly linked to sugar intake, and sugar and refined starch are drivers for abnormal metabolic function. Sugar is the primary cause of all chronic diseases including cancer, dementia, and diabetes. Diseases that result from the body’s inability to regulate blood sugar.

The Epic interact study revealed that for every single sugar-sweetened beverage consumed, the risks for diabetes is increased by 29%. Considering the fact that the average person consumes 2.5 that amount of beverage daily, the risk of developing type-2 diabetes rises to 72%.

An analysis of data from Food and Agricultural organization statistics database for type-2 diabetes worldwide during a ten year period showed that the predictor for diabetes changed with sugar availability. The data showed that the consumption of an extra 150 calories in food resulted in diabetes prevalence only 0.1% of the times. However, if the same 150 calories came from sugar-sweetened beverage, the diabetes prevalence went up 11 fold or 1.1%. The studies found that the higher the amount of sugar consumed and the longer the sugar is consumed, the higher the risk of developing type-2 diabetes. Studies done at Harvard showed that sweet molecules in sugar suppresses three of the enzymes involved in fatty acid beta oxidation process.

Forty-five percent of all adults and 25% of children suffer from fatty liver disease. A new phenomenon that appeared after 1980. An individual with fatty liver disease is three times more likely to develop diabetes. Children develop liver fat from sugar consumption. Sugar is a mitochondrial toxin that has poisoned the entire food system. Cheaper professed foods, which are the predominant types of food available on the market are high in sugar and low in fiber. Adding fructose to the diet causes the liver to store increased fat which negatively impacts the liver and the entire metabolic functioning of the body. In addition to fatty liver and fatty liver disease, sugar also contributes to irritability, violent behaviour, cognition problems, adult dementia, tooth decay and heart disease.

Why Did I Focus on Sugar?

As I am writing this article, France is ablaze. The police killing of a teenager from a deprived neighbourhood ignited the sweltering tension hiding under the surface of French society. To placate the community, French authorities have promised a billion Euro to be spent in deprived communities in France. But this is not the first time there has been rioting in France, and this is certainly not the first time French authorities have poured billions into deprived communities with no tangible result.

After the death of George Floyd and the resultant global demonstrations, the US and other Western governments poured billions into deprived communities in a bid to placate community members. What was the result of those billions spent? Nothing changed. Then there are the climate change protests and the ‘end poverty’ campaigns that simply end up enriching a handful of people.

Why don’t those initiatives work even though they are good intentioned? It’s because of two reasons. One, they do not tackle the deep rooted structural issues. Two, they are not directed at specific outcomes.

I started this article with the news of the UK government 15-year NHS staffing plan. I said I believe it would not work because they failed to address the deep rooted structural issues facing the NHS. Then I introduced the role of sugar in fermenting diseases. I alluded to the fact that there are lots of negative lifestyle choices breeding illness. However, to attempt to tackle all of them would be to tackle none. So, instead of trying to tackle every single thing responsible for illness, I have decided to choose the most important one which is sugar.

In the book ‘Theory of Constraint’ author Eli Goldratt, said any system, no matter how complex it might appear, has a single constraint that if removed, will resolve all the bottlenecks confronting the system. I believe the single constraint responsible for ill-health is sugar. Solving the sugar problem will have a massive impact on the health of the nation.

In his book ‘Only the Paranoid Survive’ author and former Intel CEO Andy Grove introduced the concept of strategic inflection point. Strategic inflection point according to Grove, is a point of fundamental change in a business or industry.

The healthcare industry is at a strategic inflection point. As I pointed out earlier, the diseases that plagued humanity a century ago have been eradicated. The healthcare industry is confronting a new set of diseases in the form of chronic diseases. These diseases are thriving and exploding as there are more people in the world to infect, people are more sedentary, and processed foods have essentially become the staple diet.

The architecture of our current healthcare infrastructure was designed to treat different type of patients. So, instead of prescribing treatments that worked for the 18th or 19th century healthcare environment, the UK government needs to prescribe treatments that takes into account the demands of the 21st century healthcare environment.