The explosion in diabetes has serious implications for the NHS –but for one group of people, those implications could be catastrophic
Has someone sat next to you on a train or bus lately and – without being impolite – taken up both seats? Noticed someone wheezing as they push their trolley round the supermarket – after a long stop at the cakes and puddings aisle? There are no two ways about: despite endless government initiatives and healthy eating campaigns, the population of the UK is getting steadily fatter.
Public Health England recently released figures showing that in 2015 62.9% of adults were overweight – 67.8% of men and 58.1% of women. A substantial proportion of overweight adults have a Body Mass Index (a simple tool to measure whether or not you are overweight) well in excess of 30 – the level at which someone is classed as obese.
In England the prevalence of obesity among adults rose from 14.9% to 26.9% between 1993 and 2015: while the rate of increase has slowed down, the trend is still upwards. Commensurately, the number of adults with a healthy BMI (officially, between 18.5% and 24.9%) has fallen by roughly ten percentage points for both men and women.
Most worrying, though, are the projections: by 2050 obesity is predicted to affect 60% of adult men, 50% of adult women and 25% of children.
Inevitably, a development like that will place a huge strain of the National Health Service. Life expectancy is increasing – but just because we are living longer, it does not mean that we are living more healthy lives. Modern medicine is keeping us alive: but the question is, can the country afford it? And what are the implications for people who have had conditions like diabetes from an early age?
The Diabetes Epidemic
Hand in hand with the increase in obesity has gone an increase in Type 2 Diabetes. A study by Cardiff University reported that the number of people in the UK with the condition has increased dramatically – from around 700,000 people to roughly 2.8m over the last 20 years. Some of this increase might be down to better detection rates, but unquestionably the bulk of it has been caused by overeating and a lack of exercise.
However – bearing out the comment above – the study also found that life expectancy for those with the condition was increasing, thanks to earlier diagnosis and the use of drugs such as blood pressure tablets and statins for blood cholesterol.
How much does diabetes cost the NHS?
According to the website www.diabetes.co.uk, the cost is staggering. The NHS spends £25,000 on treating diabetes every minute. It will probably take you around four minutes to read this article: in that time the NHS has spent £100,000 on treating diabetes – that is enough money to pay the annual salary of three staff nurses with several years’ experience.
In total, the NHS spends £14 billion a year on diabetes – roughly 10% of its overall budget. And with the number of diabetics projected to increase from 2.8m to 4m within ten years, the NHS may not be able to continue to fund the treatment.
At which point many people would simply shrug and say, “So what? It is their own fault for eating and drinking too much. If they have to pay for their own treatment then maybe they will cut back on Mars bars.”
…And nine times out of ten they might have a valid point. 90% of UK diabetics have Type 2 diabetes. But the other 10% have Type 1 diabetes – and their situation is wholly different.
What is Type 1 diabetes?
Type 1 diabetes is an autoimmune disease that causes the insulin-producing cells in the pancreas to be destroyed: in simple terms, the body attacks itself – and scientists are still unsure why this happens. The body is, therefore, unable to produce enough insulin to adequately regulate blood glucose levels, and the condition must be treated with injections or an insulin pump.
Typically, Type 1 diabetes is diagnosed much earlier in life than Type 2 – in fact, the two types were previous called juvenile-onset diabetes and adult-onset diabetes. Both types of diabetes have potentially serious implications for the long-term health of the sufferer – and both require costly, and ongoing treatment.
How much does Type 1 diabetes cost the NHS?
According to a report written by the York Health Economic Consortium, the treatment of Type 1 diabetes – including the resulting complications – accounts for 10% of total NHS spending on the disease. Despite Type 2 diabetes becoming more prevalent, the proportion of total spending on Type 1 diabetes is projected to remain constant at around 10% of the total cost.
This simple fact raises very serious questions not only for sufferers of Type 1 diabetes – but for anyone with a chronic condition which will require long-term treatment.
Here’s what Barbara Young, Chief Executive of Diabetes UK, has to say.
“Without urgent action, the already huge sums of money being spent on treating diabetes will rise to unsustainable levels that threaten to bankrupt the NHS. But the most shocking part [of this report] is that four-fifths of NHS diabetes spending goes on treating complications that in many cases could have been prevented.”
In simple terms, Barbara Young is saying that we cannot afford the ongoing treatment: that the campaigns to date have not worked and people need to take more responsibility for their own health. They cannot ignore their health and expect the NHS to pick up an unlimited bill for an indefinite period. Sooner or later the politicians will have to address this issue.
The long-term outlook
Long term there are only three possible solutions: people pay for their own health care, either directly or through some form of medical insurance; there is a massive rise in taxation – or a huge number of people in the UK eat less and exercise more. Right now, the third option looks the least likely.
But where does that leave Type 1 diabetes sufferers – and, by extension, anyone with a condition diagnosed in childhood? After all, being diagnosed with ‘juvenile-onset diabetes’ when you are seven years old is not a condition that “could have been prevented.”
Ultimately the UK must move to some form of insurance based healthcare and/or an NHS that is no longer ‘free at the point of delivery.’ The combination of demographics and advances in medicine make that all but inevitable. But where will that leave the 400,000 people in the UK with Type 1 diabetes? They will not be able to obtain medical insurance to cover the condition and – in far too many cases – they will not be able to afford to pay for the cost of treatment.
The same holds true for anyone with a long-term condition diagnosed at an early age. This is a nettle which the country has to grasp sooner rather than later: sadly, no-one in power shows any signs of doing so.