The cost of running the health service has ballooned, so here are some ideas – beyond paying your taxes – to keep it fighting fit

When the NHS began in 1948, it cost the modern-day equivalent of about £15bn a year to run. Now that cost stands at £136.7bn and is still rising amid regular predictions that a free-to-use health service will eventually become financially unviable.

So what can you do to ease the financial burden? Here are a few suggestions, some more practical than others.

Exercise, eat healthily, don’t smoke, don’t drink to excess

Facebook Twitter Pinterest The joys of exercise. Photograph: Alamy

This all might sound a touch obvious, and perhaps it is. But taken together, lack of exercise, poor diet, smoking and excessive drinking have a huge impact on the risk of ill-health and early death. If all four risk factors were removed, it could help prevent 40% of cancers and 75% of diabetes and cardiovascular disease, according to Public Health England (PHE).



A PHE study released in September found that diet and weight, physical activity, smoking and alcohol, as well as drug use, were factors associated with 40% of all the nation’s ill-health.

Cycle (or walk) to work

Facebook Twitter Pinterest One Danish research project concluded people were 40% less likely to die during the study if they cycled to work. Photograph: Bloomberg via Getty Images

Standard World Health Organisation advice is to get about 30 minutes of moderate exercise at least five times a week. Large numbers of Britons come nowhere near this mark: one government study found a fifth of all people saying they had not walked for more than 20 minutes a single time that year.



Many exercise-related resolutions centre around gyms, but research shows you’re much more likely to stick to the 150-plus minutes a week target if the activity is integrated into everyday life. And if it’s feasible, active travel – walking or cycling to work or education – is ideal.

Public health experts say cycling is especially good as it tends to at least occasionally push the heart rate above moderate levels of exertion when, for example, setting off from a traffic light or climbing a hill. The best-known study on the health benefits of bike commuting took place in Denmark. It charted the lives of more than 30,000 Danes of all ages over an average of 15 years, during which almost 6,000 of them died. Even factoring in things such as non-commuting exercise levels, it found those who biked to work were 40% less likely to die.

Thatch a roof

Facebook Twitter Pinterest The list of WHO-approved activities that promote health range from the obvious to the, frankly, random. Photograph: John Vallins/Alamy

Or take part in some traditional hunting and gathering. It may not sound overly useful to many Britons, but both appear on the WHO’s list of examples of the “moderate” activity that could constitute your 150 minutes’ exercise a week. Luckily for the NHS, so do dancing and housework. The point is that physical activity does not have to be overly strenuous to have a big impact.

Technically, “moderate” activity equates to three to six metabolic equivalents, meaning expending between three and six times as much effort as you would just sitting down. This is not a huge amount. Jogging can easily reach 10 or 12 METs.

Get a standing desk

Facebook Twitter Pinterest A Google employee works at her standing desk in Mountain View, California. Photograph: Winni Wintermeyer

Even if you pedal six miles to work following a breakfast of oats and fruit, the battle is not yet won. More recent research into physical inactivity has focused on the potential problems of sitting down too long, even for otherwise fit people.

It’s all connected to the notably big muscles in our legs. Failing to use these for long periods means cells can undergo a process known as downregulation, where they produce less of certain proteins. This is associated with poorer cardiovascular health and worse handling of glucose, increasing the risk of diabetes.

Simon Griffin, a professor of epidemiology at Cambridge University, uses a standing desk and wants to research how effective they are. “Most of the trials thus far show that they do increase standing during work time – the question is whether they increase energy expenditure over the whole day,” he says. “The key question is whether you’re less likely to cycle home, or play squash, or stand up at home. The answer is that they probably do help.”

Buy smaller plates

Facebook Twitter Pinterest Bigger plates and packaging encourage people to eat more. Photograph: Gary Calton/The Observer

Food portions getting bigger, whether in restaurants or ready meals, is known to contribute to levels of obesity. Theresa Marteau, a professor of public health at Cambridge, has led research showing people consistently consume more if they are presented with bigger portions, packaging or tableware.

So should we buy smaller crockery? This would help, but Marteau warns it’s unlikely to be a fix for many people. “Very often the people who are able to take control of their environment tend to be those who have greater social and psychological resources and are more likely to already be engaging in healthier behaviour,” she said.

Avoid sugary drinks (especially in childhood)

Facebook Twitter Pinterest The debate about a UK sugar tax, like that adopted by Mexico, rages on. Photograph: Anthony Devlin/PA

PHE, for obvious reasons, recommends a balanced diet and points people to its example “eatwell plate” for a guide on what to go for.

Pushed as to what should be excluded from our diets, the agency stresses that soft drinks should go, especially for children. Sugary drinks “have little place in a balanced diet, particularly for children”, a PHE spokesman says. “Sugary drinks like a can of cola could exceed the maximum sugar recommendation for a child.”

It is not just the likes of cola or lemonade. Fruit juices contain considerable sugar, and the latest advice is to limit children to one glass a day.



A study published earlier this month calculated that if the amount of sugar in soft drinks and fruit juices was cut by 40% over five years, this could prevent 300,000 cases of type 2 diabetes.

Campaigners want the government to introduce a UK sugar tax, as seen in Mexico, to discourage people from buying sugary drinks.

Mindfulness or meditation

Facebook Twitter Pinterest Researchers say meditation can slow down the cellular processes linked to ageing. Photograph: Dougal Waters/Getty Images

The NHS spends more on mental ill-health, including dementia, than on any other area of health.

Just as the causes and triggers for mental ill-health vary enormously, so do possible treatments.

While some patients will need professional help, some non-clinical interventions can be beneficial. Studies have shown that taking part in cultural or creative events, for example, can improve mental wellbeing.

Separately, some researchers say meditation can slow down the cellular processes linked to ageing. Public health experts are similarly excited about how mindfulness techniques can alleviate depression, the subject of a recent parliamentary report.

Choose your ancestors

Facebook Twitter Pinterest Inherited genetic factors shape an individual’s health. Photograph: Simon Stanmore/Getty Images

This is, of course, not entirely serious and utterly impossible. But it emphasises the extent of the different factors that shape an individual’s health.

Griffin says: “Individuals could choose their mother’s mother carefully. Their mother’s mother produces their mother’s ovaries, and they’re a function of their mother’s ovaries.

“They should also choose their mother and father carefully, and avoid being poor, avoid living in deprived areas, avoid working in a stressful, low-paid job, and avoid damp housing. They should be able to afford to pay for social activities and annual holidays, and avoid being a single parent.”

Die young

Facebook Twitter Pinterest Possibly the least popular option for easing your burden on the NHS: die suddenly at 67. Photograph: Andrew Milligan/PA

Again, not an active recommendation by public health experts, but it does make the point about what chronic disease really costs the NHS. It’s less about mortality – people dying – as morbidity: how healthy they remain while alive.

Amid an ever more overweight and physically inactive population, many people live for decades with potentially debilitating (and very expensive) long-term conditions, especially type 2 diabetes, which already costs the NHS around £10bn a year.

People are being diagnosed with type 2 diabetes younger and are then living longer, says Griffin. “That means they have 30 or 40 years of expensive chronic disease care. And now, perhaps because we do have better care, they’re going on to live long enough to develop expensive complications like renal failure, blindness and so on.”

He has a solution for the NHS’s morbidity crisis, albeit one that’s unlikely to gain many volunteers: “If you really want to save the NHS money, then actually you die of a very rapidly, or immediately, fatal condition the moment you reach your non-economically productive age.

“It would save a lot if, at 67, I had a heart attack and died from it immediately, without the ambulance being called, and without going into hospital.”

Do you have any other suggestions on how to save the NHS money?