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Health timebomb: Life-threatening conditions could collapse NHS

By Lisa Smyth

Life-threatening conditions such as diabetes, coronary heart disease, high blood pressure and strokes are set to rise in Northern Ireland by over 30% in the next decade.

A damning report into the future state of the health of people across the province has warned a range of chronic health conditions are to increase dramatically in coming years.

According to the new study carried out by the Institute of Public Health (IPH) in Ireland, an additional 145,000 people across the province will suffer from a chronic illness by 2020, which experts have warned could push the already over-stretched health service to breaking point.

The figures have been released as the health service in Northern Ireland faces its biggest financial threat in years and it is believed initiatives to help patients manage chronic conditions could be axed as part of an additional £113m savings the Department of Health, Social Services and Public Safety must find.

The report has called into question the effectiveness of the Government’s multi-million pound public health strategy — aimed at educating and promoting good health — at a time when every penny counts.

“This report shows some frightening statistics,” chair of the British Medical Association’s Northern Ireland Council Dr Paul Darragh said.

“The figures point to an alarming increase in the numbers of people living with hypertension, coronary heart disease, stroke and diabetes.

“We are facing a chronic disease epidemic over the next 10 years due, in part, to the increasing ageing population and levels of obesity in Northern Ireland.

“This poses a huge challenge to our health and social care system and economy.

“The predicted rise in chronic diseases will place greater demands on GPs and primary care services, as well as our local hospitals as more unwell patients need to be treated.

“This is unsustainable given the increasing financial constraints that the health service is facing.

“Prevention programmes have already proved successful in reducing the death rate from heart disease in Northern Ireland.

“We need to give an increased role to primary prevention of these chronic debilitating and ultimately life-terminating conditions. Our children, our future, deserve no less”.

Poverty, unemployment, the environment, smoking, alcohol consumption, diet and physical activity are known risk factors for chronic disease and these are distributed unevenly across society.

The IPH study found that socio-economic circumstances strongly affect the prevalence of chronic conditions in an area.

For all the chronic conditions considered in the study, people living in more deprived areas are more likely to be affected.

Andrew Dougal, chief executive of NI Chest, Heart and Stroke (NICHSA), said while messages conveying the importance of a healthy lifestyle in preventing chronic conditions has been well received by the middle-class, more must be done to educate and assist people living in poverty.

“We see a need for much more funding for long-term conditions,” he said.

“NICHSA has developed a self- management programme for people with long-term conditions and we would hope that will be made available across Northern Ireland.

“Showing people how to manage their condition greatly reduces the number of unnecessary admissions and readmissions to hospitals.

“Investing in the voluntary sector provides value for money but unfortunately when budgets are cut the voluntary sector is usually the hardest hit but I believe that is a false economy.”

Health Minister Michael McGimpsey said he is committed to ensuring the best quality and value health and social care services for Northern Ireland but is faced with the challenge of having to fight for the health service as demand is growing at a much faster rate than funding.

“What this report highlights is that, certainly in the short to medium term, chronic conditions will continue to rise and place increasing demands on our already stretched service,” he said.

“In the last two years, there has been an increase of over 20% in demand for hospital services yet our funding has only increased by 0.5% in real terms.

“This is further compounded by the fact that my department is already working to deliver efficiency savings of some £700m.

“Recently, I have been tasked with delivering further savings of £113m. This is while trying to close a funding gap of almost £600m in health spending which Northern Ireland faces when compared to England.”

Emphasis needs to be on prevention

Placing more emphasis on prevention and tackling health inequalities would reduce cases of heart disease, stroke and type 2 diabetes by 80%, it has been claimed.

Chief executive of the Institute of Public Health in Ireland Dr Jane Wilde said cases of chronic illness could be significantly cut by the elimination of major risk factors such as obesity and stress.

Her comments come as a leading Northern Ireland GP called on people to make simple changes to their lifestyle which could ultimately save their lives.

Dr Theo Nugent, a member of the British Medical Association’s Northern Ireland Council, recently addressed the Department of Culture, Arts and Leisure on how to encourage more people to exercise.

“It is important to get the message across that making small changes can significantly reduce the risk of suffering from a chronic illness,” he said.

“A major factor of improving health is exercise and I believe we need to be working to demystify exercise so it is no longer associated with elite athletes.

“It can be accessible to everyone.

“Doing something like leaving the car at home and walking to work can make a huge difference and is easy to achieve. You don’t have to pay for expensive gym membership and you don’t need lots of specialised equipment.”

And continuing on the theme of prevention, Dr Wilde said: “Chronic diseases cause early death, immense suffering and reduce quality of life.

“Prevention makes sense. Policy makers and Government need to place much stronger emphasis on prevention and tackling health inequalities.”

“We already have Government policies and strategies to promote healthier lifestyles and strengthen the early assessment and diagnosis of chronic conditions.

“These are welcome but all the evidence suggests that we need much broader focus.

“We need to think about prevention right across the life course, to focus particularly on early childhood and the needs of vulnerable and disadvantaged people.

“Understanding current need and future prevalence and how it varies with factors such as age, sex, geography and local socio-economic circumstances is essential for good planning and monitoring of chronic disease management.

“We need a full debate about how we achieve much greater success in prevention.

“Already we have shown the dramatic fall in the death rates for heart disease.

“This means thinking about what services we want, how prevention can be more effective and how we can ensure that at all ages we do what we know works well.”

Report latest in long line of stark warnings for people of province

The report by the Institute of Public Health (IPH) is the latest stark warning of the health timebomb facing men, women and children in Northern Ireland.

Last November it emerged two-thirds of men and 50% of women across Northern Ireland are expected to be clinically obese by 2050.

The figures were contained in a report drawn up by the Stormont health committee which warned the health complications linked to obesity could lead to the collapse of the health service.

The Stormont health committee proposed a series of recommendations to tackle the growing problem of obesity in Northern Ireland — including compulsory physical education classes for all schoolchildren, restrictions on advertising foods with high levels of salt, sugar and fat, and the traffic light labelling system becoming the norm on all food sold across the province.

Speaking at the time, Jim Wells, chair of the committee, said: “One of the points that has been raised in the debate is the fact that this generation could have a shorter life span than the previous generation because of obesity and that would be the first time this has happened.

“We are quite literally eating ourselves to death. This is a ticking timebomb and action must be taken urgently to address this issue. The health service will collapse under the strain if action is not taken.”

Just two months earlier, Northern Ireland's chief medical officer Michael McBride revealed the impact of obesity causes around 450 deaths every year and reduces life expectancy by up to nine years.

Obesity is a major contributing factor to a range of chronic diseases, such as hypertension and type 2 diabetes.

Both the Northern Ireland Chest, Heart & Stroke Association (NICHSA) and British Heart Foundation have called for a single, consistent food labelling scheme using the traffic light system to help consumers make healthier choices when buying food.

Prognosis for 2020

The key findings for Northern Ireland are:

High blood pressure:

In 2007 nearly 396,000 people (28.7%) had high blood pressure.

By 2020 this is expected to rise to nearly 482,000 people — an additional 86,000 people (a 22% increase in less than 15 years).

Coronary Heart Disease (CHD):

In 2007 over 75,000 people (5.4%) had ever had CHD.

By 2020 this is expected to rise to over 97,000 people — an additional 22,000 people (an increase of 30% in less than 15 years).

Stroke:

In 2007 almost 33,000 people (2.4%) had had a stroke.

By 2020 this is expected to rise to over 42,000 people — an additional 10,000 adults (an increase of 29% in less than 15 years).

Diabetes |(Type 1 and Type 2 combined):

In 2007 over 67,000 (5.3) people had diabetes.

By 2020 this is expected to rise to over 94,000 people — an additional 27,000 people (a 40% increase in less than 15 years).

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