National Health Service

Lord Filkin Excerpts

Thursday 14th January 2016 Lords Chamber

[Lord Filkin (Non-Afl)]

My Lords, I thank the noble Lord, Lord Turnberg, for this extremely important debate. I declare an interest as chair of the Centre for Ageing Better, a new What Works Centre that does what it says. I will focus on the implications for the NHS of an older population and I shall seek to look 10 years forward, as I think it is essential that we do so in order to address this question.

The starting point is that we are living longer, and this is a cause for enormous celebration and thanks. There are people in this Chamber and in our society who are alive now who would not have been without the changes and successes of medical science. So we should address this as a fantastic opportunity to consider how we benefit from longer lives, rather than seeing it as a disastrous crisis.

Nevertheless, we have to face up to the scale of change and challenge. The ONS tells us that in 10 years’ time there will be 40% more people aged 85-plus. We know what that implies for the NHS in terms of demand and cost. We know that it means many more people with long-term conditions—there are some estimates in Ready for Ageing? if noble Lords want illustrations—and we know from the five-year forward plan that long-term conditions drive 70% of NHS costs. So one way or another there will be a major increase in the proportion of GDP that we spend on health and social care over the next 10 years. Wanless estimated about 11% of GDP; the King’s Fund report by Barker estimated about 12%. Those give us the scale of increases in GDP spending that we are likely to make by one means or another.

What should we do? I agree with the noble Lord, Lord Fowler; it is not the model that is wrong. The model of the NHS is fundamentally equitable and relatively efficient and low-cost compared to others. The question is essentially: how do we fund an NHS and a social care system to address this?

Prevention is critical; it has been talked of, so I will say only two sentences on it. Wanless said in 2002 that unless we address prevention we will hit a crisis; the NHS Five Year Forward View said that we have now hit that crisis because we failed to address prevention properly. At present there is no ambition, plan, leadership or social debate about how we will make the major shifts in personal attitudes and behaviours that will avoid self-inflicted damage and cost to individuals and the public purse later on. Many lives are poorer because of that, so we have to address it, and although it will be slow to make change, it is fundamental to success.

In conclusion, on how we as a society pay for between 11% and 12% of our GDP on health and social care to benefit from longer lives, the question is clearly how we do it in a way that is fair to all people. We need to recognise that many of today’s pensioners are better off than ever. Pensioner poverty has been largely eradicated, and pensioners have a very privileged tax and benefit status—I celebrate that personally. However, in truth the question is: what is the political agreement with the public? Is it essentially, “We will protect you in a privileged tax and benefit position” or “We will commit as a society and as politicians to protect the quality of health and social care that you will need in an equitable way in our society so that you will benefit from your longer lives”?