Summary of the QNI response to the DHSC Consultation on Long Term Conditions
29 June 2023
The following comments were provided to the DHSC consultation on Long Term Conditions that closed on 27th June 2023.
Health promotion and education by nurses in the community (as opposed to large media campaigns) have been scaled back over recent years. Re-introducing a broad education and health promotion strategy among practitioners will be hugely beneficial in terms of teaching and supporting people to make healthy lifestyle choices. The nursing role is essential in the delivery of a healthcare strategy including the specific areas described below.
The DHSC strategy lists six general conditions, in all of which lifestyle factors play a big role. UK healthcare expenditure is higher for treatment than for prevention, but we need to invest in prevention, beyond screening and vaccines. Reference: Healthcare expenditure: UK health accounts: 2020 (Office for National Statistics).
Activity and Health
It cannot be ignored that easy access to processed foods and a sedentary lifestyle are having a very detrimental impact on the health of many individuals. Public Health England reported in 2020 that 1 in 6 deaths in the UK are linked with physical inactivity.
When we talk about life expectancy, we need to consider the quality of life the person is living, not just extending life. In the UK, on average, people spend 20% of their lives in poor health. So, healthy life expectancy is around 60-62. References: National life tables – life expectancy in the UK: 2018 to 2020 (ONS 2021); Health state life expectancies, UK: 2018 to 2020 (ONS, 2022)
Exercise and activity enhances the immune system. Reference: Zheng et al. (2015) Regular exercise enhances the immune response against microbial antigens through up-regulation of toll-like receptor signalling pathways. Exercise outperforms Metformin in preventing the onset of type 2 diabetes (Lez et al., 2012)
The latest figures from NHS Digital show that 2,831,015 people in England are pre-diabetic. Diagnoses of early onset diabetes in the UK is rising faster than anywhere else in the world. The younger people are when developing diabetes, the longer they are hyperglycaemic, and more likely to develop complications with the disease. This must be factored in, in terms of future nursing. The top attributable factor for type 2 diabetes worldwide is obesity.
Reference: Xie et al. (2022) Global burden of type 2 diabetes in adolescents and young adults, 1990-2019 systematic analysis of the Global Burden of Disease Study 2019. BMJ
Diet and Healthy Eating
There must be an unremitting ambition and strategy to reduce the amount of processed food in school dinners. Currently, we do not believe the England School Food Standards sets an upper limit on the amount of ultra-processed food that is fed to children. 1 in 10 children are obese when they join school (around 5-years-old). 2 in 10 children are obese by year 6 (age 10-11) in the UK. 75% of the calories in British school lunches are made up of processed food (Parnham et al., 2022)
We have seen a growth in the number of rapid grocery home delivery services. These services promote unhealthy food/drinks/vape available 24 hours. They are also concentrated in poorer neighbourhoods. Rinaldi et al., (2022) Understanding the online environment for the delivery of food, alcohol and tobacco: An exploratory analysis of dark kitchens and rapid grocery delivery services.
We know that home cooking is associated with higher-quality meals and healthy weight, and this should be encouraged as part of a national health education strategy. Reference: Mills et al. (2017) Frequency of eating home-cooked meals and potential benefits for diet and health: a cross-sectional analysis of a population-based cohort study.
We would support tighter regulations around advertising of unhealthy products on TV, billboards and online. Reference: Yau et al. (2022) Changes in household food and drink purchases following restrictions on the advertisement of high-salt and sugar products across the TfL network: A controlled interrupted time series analysis.
Hospital, Long Covid and Mental Health
Deconditioning – as nurses, we know what a stay in hospital, even a short one, can do to the body of someone who was previously independent. The same way we decondition with a hospital stay, we can become deconditioned with a sedentary lifestyle. This will have many knock-on effects for all the systems in our body, including the mind. Muscle mass and bone density declines. Thrombosis becomes more likely. Mentally, reduced serotonin is linked to a decline in mood.
Long Covid continues to have an impact. While the immediate impact of the pandemic and initial infection has lessened the lasting effects of the disease continue to be discovered. Smell and taste impairment has a significant yet under-recognised impact on people’s quality and enjoyment of life and hence mental health.