Change NHS
Ten Year Plan for NHS England
Plant-Based Health Professionals UK response

Submit an organisational response
Deadline: 17.00 Monday 2 December 2024

Plant-Based Health Professionals UK is a member-led education and advocacy organisation whose aim is to embed whole food plant-based nutrition and lifestyle medicine into healthcare curricula and clinical practice within the UK. We comprise over 1000 members including surgeons, GPs, dietitians, nutritionists and nurses. We advocate for integrating lifestyle medicine into clinical practice, supporting health professionals with education and resources, and raising public awareness about the benefits of plant-based diets for human and planetary health.

This response to the consultation on the 10 year health plan for England is based on existing scientific literature and recommendations around nutrition and lifestyle medicine for prevention of chronic conditions. We have provided additional links at the end of this document, which include references and further details.

We welcome any further opportunities to engage, inform and support development of the 10 year health plan.

The NHS’s ten-year health plan presents a crucial opportunity to drive change by addressing the pandemic of chronic diseases in the UK as well as transforming sustainability practices within healthcare. The health sector plays a pivotal role in advancing the government’s mission to build an NHS fit for the future and enhance resilience. Central to achieving this is embedding preventative health into the NHS’s ten-year plan. This focus can reduce the burden of chronic illnesses and lead to improved health outcomes, while also addressing the challenges of the climate crisis.

Transform Healthcare Practices and Nutrition education for all: There is currently a lack of strong knowledge among healthcare professionals, including dietitians, and the public about the role of diet and lifestyle in preventing and managing disease. We recommend embedding nutrition and lifestyle medicine into healthcare education and clinical practice to tackle this. Empowering individuals and communities to adopt healthier plant-rich diets alongside other lifestyle interventions such as regular exercise and stress management should be a priority. This will help reduce the risk of chronic diseases, improve quality of life and reduce the burden on the NHS.

Prioritise Health Equity by improving access to healthy plant foods
Address the inequity in our current food system to make healthy plant-based foods accessible and affordable for all, helping to reduce health disparities and promote social justice. Many individuals, particularly those on low incomes, cannot afford or access healthy plant-based foods, exacerbating health disparities. People who work in slaughterhouses are some of the most disadvantaged and marginalised in our society and only do so because they have very little option for earning a living wage. Prioritising a plant-based food system, moving subsidies away from meat and dairy to foods that promote health and wellbeing, and ending factory farming would improve the health and lives of people and animals. Current adherence to UK Eatwell Guide (EWG) is virtually nil (less than 0.1%).

Support environmental sustainability in the face of a climate emergency
Along with other areas of government, advocate for a shift to a plant-based food system to address the climate crisis and biodiversity loss, protecting both planetary and human health.

The ten year plan must consider how to adapt to providing continuity of service delivery in the face of mounting environmental pressures. Rising temperatures, more frequent extreme weather events, the spread of infectious diseases, and air pollution pose escalating health risks that will significantly increase patient demand on health services. To address these challenges, a coordinated response across the health sector is essential. For example, equipping healthcare professionals with the knowledge and tools to manage climate-related health issues through targeted education, training, and resource allocation.

The three shifts:

1. Moving more care from hospitals to communities;
2. Analogue to digital;
3. Sickness to prevention

In answering the following questions on the 3 shifts:

• references to specific examples or case studies are welcomed.
• indicate how you would prioritise these and
• at what level you would recommend addressing this at, i.e. a central approach or local approach.

Question 2: What does your organisation see as the biggest challenges and enablers to move care from hospitals to communities?

This means delivering more tests, scans, treatments and therapies nearer to where people live. This could help people lead healthier and more independent lives, reducing the likelihood of serious illness and long hospital stays. This would allow hospitals to focus on the most serious illnesses and emergencies. More health services would be provided at places like GP clinics, pharmacies, local health centres, and in people’s homes. This may involve adapting or extending clinics, surgeries and other facilities in our neighbourhoods, so that they can provide things that are mostly delivered in hospitals at the moment. Examples might include: • urgent treatment for minor emergencies • diagnostic scans and tests • ongoing treatments and therapies.

We must ensure all healthcare professionals working in community settings receive training around nutrition and lifestyle interventions to support health outcomes such as exercise. This training should include an understanding of plant-based diets which can support sustainable, healthy, and culturally appropriate dietary patterns. Recent research indicates that only about half of Registered Dietitians—the most highly trained nutrition professionals in this field—feel confident in guiding individuals toward healthy plant-based diets that prioritise whole foods. This has to change in order to see a shift from hospital care to community care.

Question 3: What does your organisation see as the biggest challenges and enablers to making better use of technology in health and care?

Improving how we use technology across health and care could have a big impact on our health and care services in the future. Examples might include better computer systems so patients only have to tell their story once; video appointments; AI scanners that can identify disease more quickly and accurately; and more advanced robotics enabling ever more effective surgery.

Promote patient-led digital care

Digital technology tools and apps have the potential to improve patient education, reduce inappropriate or unnecessary investigations and treatments, reduce the impact of patient travel to the clinic setting, and decentralised care out of hospitals and into communities and homes. Digital technologies can also improve access to care for rural populations as well as anyone with certain accessibility needs.

There is a huge opportunity for NHS-led digital apps to improve education around healthy eating and lifestyle practices as well as providing a useful accountability tool. For example, interventions such as the NHS Couch to 5K intervention. This particular app demonstrated significant success in promoting physical activity among beginners. A similar intervention could be designed to encourage a shift to plant-based dietary patterns.

Question 4: What does your organisation see as the biggest challenges and enablers to spotting illnesses earlier and tackling the cause of ill health?

There are a number of challenges and enablers to early detection of chronic conditions and addressing the multiple contributing causes of ill health:

Unhealthy diets high in animal-sourced foods and ultra-processed foods: Diets high in ultra-processed foods and processed meats and low in healthy plant-based foods are the leading cause of chronic disease and premature death in the UK. There is now overwhelming evidence that shifting towards a plant-predominant food system would significantly improve national health outcomes, address health inequalities and is essential for meeting our climate and nature targets. Addressing dietary risk factors provides the opportunity to improve quality of life and reduce the need for healthcare interventions, whether pharmaceutical or surgical. This would relieve pressure on our overburdened healthcare services.

Resistance to change in healthcare: Education and interventions around healthy diets and lifestyle medicine face resistance due to insufficient awareness of their impact on human health within mainstream healthcare. Most physicians in the UK receive very little nutritional education despite national health guidelines already including plant-based diets as part of the prevention and treatment for these illnesses. A plant-based diet has numerous benefits for human health, including significant reductions in the risk of chronic conditions such as cardiovascular disease, overweight and obesity, diabetes, and certain cancers. Improving education around nutrition, lifestyle medicine and areas such as culinary medicine would help empower health professionals to pass on this important, life-enhancing knowledge to their patients.

The greatest enablers to achieving this are:

1. Enable and encourage healthy plant-based foods through plant-based by default menus
   According to the 2023 Lancet Countdown report, over 38,500 deaths in 2021 were associated with excessive consumption of red meat and dairy, and nearly 36,000 deaths were associated with insufficient consumption of nutritious plant-based foods (including fruit, vegetables, legumes, wholegrains, nuts and seeds). Together, these accounted for 32% of all diet-related deaths that year.

   Showcasing the benefits of a plant-based diet within healthcare settings should be part of educational efforts to change dietary habits of the UK public. This would not only provide immediate cost savings to the NHS, but also give longer term healthcare benefits for patients, while drastically cutting carbon emissions.

   In the UK, healthy, nutritious food costs twice as much as unhealthy, often ultra-processed foods. In the UK in 2020, approximately 70,000 deaths were linked to inadequate consumption of nutritious plant-based foods and nearly 42,000 deaths were associated with overconsumption of dairy, red meat, and processed meat. Reducing meat consumption while increasing plant-based foods would bring significant reductions in chronic disease risks while also decreasing greenhouse gas emissions.

   The health sector should lead the way by introducing plant-based by default menu hospitals for patients and staff to increase the uptake of fruit, vegetables, wholegrains, legumes, nuts and seeds to prevent ill health and support recovery. This initiative, termed Plants First Healthcare, does not restrict choice and patients can opt for meals with meat and dairy too. The proposed changes would help get the NHS on track to achieve its pledge of net-zero emissions by 2045. Plants First Healthcare also aligns with the priorities of Lord Darzi’s recent report on the state of the NHS in England, specifically a ‘Greener NHS’ and the focus on ‘the power of prevention’ which has been a long-term NHS policy intention.

   The NHS has almost 1.3 million employees and serves around 140 million meals to hospital patients each year. Switching to a plant-based menu could reduce food-related carbon footprint by more than 50%. £633 million is spent on inpatient food provision, yet studies have shown that a plant-based diet would actually cost a third less in the UK. In addition, economic modelling suggests billions in health-related cost savings for the NHS. To begin implementation, hospitals can work directly with Greener by Default and their newly appointed UK healthcare manager for free.

2. Emphasising Health Promotion Over Disease Management: To improve public health, we must focus more on promoting health and prevention rather than simply treating disease. The World Health Organization defines health as physical, mental, and social well-being. However, many in the UK face challenges such as poor living conditions, fuel poverty, polluted air, limited green spaces, lack of public transport options, and diets rich in ultra-processed foods and saturated fats, all of which contribute to poor health outcomes. Creating healthier environments can also reduce the UK’s carbon footprint and improve climate resilience. Key measures include energy-efficient, affordable housing; accessible public transport; urban planning that supports walking and cycling; increased green spaces; and affordable access to healthy plant foods. This shift requires coordinated action across government sectors to address climate change, protect health, reduce diseases, enhance mental and physical wellbeing, and strengthen connections with nature. A joined-up approach can lead to healthier communities and a more sustainable future.

3. Increase access to green space and encourage nature-based prescribing: In the NHS. nature-based interventions are valuable strategies for preventing ill health, supporting patients to recover from illnesses, and promoting good mental and physical health and wellbeing. Participation in nature-based activities can have a positive effect on psychological, social, physical, and intellectual outcomes. Existing evidence suggests that nature prescribing programmes have the potential to save the NHS £100 million per 1.2 million people.

Ideas for change

We’re inviting everyone to share their ideas on what needs to change across the health and care system. These could be: • Ideas about how the NHS could change to deliver high quality care more effectively. • Ideas about how other parts of the health and care system and other organisations in society could change to promote better health and/or improve the way health and care services work together. • Ideas about how individuals and communities could do things differently in the future to improve people’s health.

Question 5: Share specific policy ideas for change. Indicate how you would prioritise these and what timeframe you would expect these to be delivered (e.g. within 12 months, 2-5 years, more than 5 years)

Here, we outlined specific policy recommendations that we believe should form part of the ten year plan to create a health service fit for the future and will support delivery of the three shifts to improve health and care services in England.

Within the next twelve months

1. Adopt a plant-based by default menu across healthcare as a pilot in a number of select hospitals to reduce healthcare costs, improve health and meet sustainability targets.
2. Reaffirm commitment to deliver a net-zero health service by 2040 for all it controls and 2045 for all it consumes and publish an annual report on progress in reducing emissions in NHS England
3. Revise the NHS Eatwell Guide to prioritise plant-based protein for human and planetary health. The current Eatwell Guide has not been updated since March 2016.

Within the next five years

4. Implement educational requirements across all areas and levels of healthcare to ensure health professionals are educated and informed on lifestyle medicine interventions that can manage, prevent and sometimes reverse chronic health conditions
5. Commit to providing plant-based meals as the default menu option in all healthcare settings, and stop serving processed meats to patients
6. Implement the recommendations of the Green Surgery Report
7. Implement standardised monitoring frameworks and integrate datasets to enable more accurate prediction of health risks and ensure sufficient adaptation measures are in place to maintain resilience of the health service
8. Ensure access to active travel and public transport routes to hospital and care settings for staff, patients and visitors

To achieve within the next ten years

9. Provide sufficient capital investment and funding over the next decade to decarbonise NHS infrastructure, estates, and services to achieve the target of 80% emission reductions by 2032
10. Develop green spaces on NHS sites as key health infrastructure to improve population health and deliver green social prescribing

Areas that require action across broader areas of government

11. In 2025, publish a new national food strategy that promotes and supports plant-based diets and advocates for dramatically reducing red meat and dairy consumption
12. Protect, restore and regenerate nature and biodiversity in urban landscapes and ensure everyone has access to green space within 15 minutes of their home
13. Mandate a new Clean Air Act to legislate clean air as a human right and meet the WHO-recommended limits of air pollutants by 2030

References

Many of the recommendations provided in this response are based on the references below:

Clifford Astbury et al. 2023, Policies to prevent zoonotic spillover: a systematic scoping review of evaluative evidence, Clifford Astbury C et al.  Global Health. 2023 Nov 8;19(1):82. doi: 10.1186/s12992-023-00986-x. https://pubmed.ncbi.nlm.nih.gov/37940941/

Cella et al. 2023, Joining Forces against Antibiotic Resistance: The One Health Solution. Cella E et al. Pathogens. 2023 Aug 23;12(9):1074. doi: 10.3390/pathogens12091074. https://pubmed.ncbi.nlm.nih.gov/37764882/

Dybvik JS, Svendsen M, Aune D. Vegetarian and vegan diets and the risk of cardiovascular disease, ischemic heart disease and stroke: a systematic review and meta-analysis of prospective cohort studies.Eur J Nutr. (2023) Feb;62(1):51-69.

Huang et al. 2020, Association between plant and animal protein intake and overall and cause‐specific mortality. Huang J, Liao LM, Weinstein SJ, Sinha R, Graubard BI, Albanes D. JAMA Intern Med. 2020;180:1173–1184. https://doi.org/10.1001/jamainternmed.2020.2790

Lancet Countdown 2024 https://s41874.pcdn.co/wp-content/uploads/Lancet-Countdown-2024_United-Kingdom.pdf

Metoudi M, Bauer A, Haffner T, Kassam S. A cross-sectional survey exploring knowledge, beliefs and barriers to whole food plant-based diets amongst registered dietitians in the United Kingdom and Ireland. J Hum Nutr Diet. 2024 Nov 3. doi: 10.1111/jhn.13386. Epub ahead of print. PMID: 39491806.

Mulcahy E, Evans R, Brookes F, Fredrikkson G, Pattnaik A. The Lancet Countdown on Health and Climate Change Policy Brief for the UK. 2023. https://s41874.pcdn.co/wp-content/uploads/UK-Lancet-Countdown-policy-brief-2023-v1-1.pdf.

Office for Health Economics. Could plant-based diets transform health care spending? (2024)

Plants First Health Care
https://plantsfirsthealthcare.com/

Poore, J., & Nemecek, T. (2018). Reducing food’s environmental impacts through producers and consumers. Science, 360(6392), 987–992. DOI: 10.1126/science.aaq0216

Scarborough, P., Clark, M., Cobiac, L. et al. Vegans, vegetarians, fish-eaters and meat-eaters in the UK show discrepant environmental impacts. Nat Food 4, 565–574 (2023). https://doi.org/10.1038/s43016-023-00795-w

Springmann M, Clark MA, Rayner M, Scarborough P, Webb P. The global and regional costs of healthy and sustainable dietary patterns: a modelling study. Lancet Planet Heal 2021;doi:10.1016/S2542-5196(21)00251-5.

Springmann, M., Van Dingenen, R., Vandyck, T.et al. The global and regional air quality impacts of dietary change. Nat Commun 14, 6227 (2023).

The UK Eatwell Guide, 2016, NHS England https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/the-eatwell-guide/

Thompson, A. S., Tresserra-Rimbau, A., Karavasiloglou, N., Jennings, A., Cantwell, M., Hill, C., Perez-Cornago, A., Bondonno, N. P., Murphy, N., Rohrmann, S., Cassidy, A., & Kühn, T. (2023). Association of Healthful Plant-based Diet Adherence With Risk of Mortality and Major Chronic Diseases Among Adults in the UK. JAMA network open, 6(3), e234714. https://doi.org/10.1001/jamanetworkopen.2023.4714

Watts et al. 2022, Delivering a ‘Net Zero’ National Health Service, NHS England Net

Zero Expert Panel, 2022 https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2022/07/B1728-delivering-a-net-zero-nhs-july-2022.pdf