Health and Social Care in England

Lord Filkin Excerpts

Thursday 11th July 2013 Lords Chamber

[Lord Filkin]

My Lords, my short speech will build on the work done by the House of Lords report, Ready for Ageing?, which we look forward to debating when we receive the Government’s response, which I expect will be next week. I will say a few things, building on what the noble Lord, Lord Patel, set out so clearly.

It is unarguable that the NHS and social care will face a massive increase in demand and cost. It is axiomatic, even though not done, that we have to have a major service redesign, as Sir David Nicholson said today. However—and this is different—it would be naive to think that the process of massive service redesign, given the time and complexity of doing it, will by itself fund the significant gap consequent on the increase in demand. We will, therefore, have to have a debate, not only about service redesign but also about how we fund the NHS going forward.

For my part, I hope we abide by the principles of the fundamental services being free at the point of use. That requires us to have a wider debate about the welfare settlement of our society, given the very considerable increase in demand and costs consequent on our ageing society. That, in short, is what I will say, so your Lordships can nod off if you do not want to hear the rest.

Those who have glimpsed the report will know it, but I will try to encapsulate the situation on ageing now. In the current decade there is going to be a 40% increase in the number of people aged 85-plus: it is not a future change. The numbers who are 85-plus will increase by 100% in the two decades 2010 to 2030. Largely consequent on that, we will see a quite remarkable increase in the number of long-term conditions experienced by those older people.

We were staggered to find that there is no public forecast data on demand of that sort published by the Department of Health or the NHS. We therefore had to ask eminent academic epidemiologists to do forecasts for us, by applying current and forecast incidence rates to the future certainty of the age cohorts that we know. The illustrations showed increases of between 45% and 90% in the five main chronic conditions in the long term. The number of those with multiple conditions will increase from 1.2 million in 2008 to 1.9 million in 2018, and those needing social care and daily assistance will increase by 90% between 2010 and 2030. It is therefore clear that there will be a massive increase in demand and it would be of great help if NHS England, if not the Department of Health, would put out some clear evidence on why demand increases are likely. It will help an honest public debate across society.

I will not go on but it is obvious that because the number of long-term conditions will increase massively—they drive roughly 70% of health and social care costs—there will also be a massive increase in those costs. I agree with the noble Lord, Lord Patel, that David Nicholson is clear in what he said today but is underestimating the scale of the challenge. Nuffield and others state that £40 billion-plus is more likely to be the sort of funding gap that we will face by 2021-22, if you consider health and social care together.

We should therefore beware of the myths being portrayed, whereby if we do what we have to do—integrate health and social care, increase prevention, shift from an acute focus to a community and primary-focused model, and get more older people out of hospital—that in itself will crack the funding problem. It will not do so because all those changes will take a considerable time, even if there is stronger political leadership on these changes than we have seen from any political party so far. These are big systemic changes that will take 10 years and require investment. The benefits will not always be cashable and there will be double running costs while the changes are being made. Thinking that they will produce short-term savings is naive, although I do not for a second belittle the importance of going for those big changes.

If one looks at the context of continuing public deficits in 2015-16 and high levels of public sector debt, a difficult challenge is facing whichever Government address these issues. They have to be looked at in the wider context, and I agree with the noble Lord, Lord McColl, that the more that we can get at least some attempt at cross-party discussions about the reality of this situation, the better for our society.