NHS: Long-term Sustainability

Lord Londesborough Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord Londesborough (CB)]

My Lords, I should first congratulate my noble friend Lord Patel on securing this critical debate and raising such challenging questions. Unlike many of today’s speakers, I am not a healthcare expert, but as an entrepreneur, employer and adviser to SMEs over the past 30 years, I have developed a particular interest in the health and productivity of our workforce, so I will start with the dismal subject of economics, as the long-term sustainability of the NHS hangs on the state of our public finances.

I sit on the Economic Affairs Committee, as does the next speaker, the noble Lord, Lord Davies of Brixton. Our current inquiry is also on the subject of sustainability, not of the NHS but of our national debt, which, at £2.7 trillion, has grown eightfold in just over 20 years. On current trajectories, neither the financing of our national debt nor our National Health Service can be considered sustainable.

Ever since the financial crisis 15 years ago, the UK has suffered from a low-growth, deficit economy. We consume more than we produce. That is an economic and health issue, the growing obesity burden being just one sign and inactivity another. Our tax revenues cannot keep up with our expenditure on public services, so we routinely resort to borrowing—an additional £100 billion or so added to the debt pile each year, to the point where last year’s interest payments on debt, at £120 billion, were only 30% less than our entire NHS budget.

Demographically, we have double trouble—an ageing population and falling birth rates. Our workforce has ceased to grow, in spite of immigration. The proportion of dependants is escalating. Without gains in productivity there is no real economic growth and no increase in our tax base, on which NHS funding entirely depends. This week’s data from the ONS makes for grim reading. The number of long-term sick off work has hit a record high of 2.8 million—an increase of 700,000 in just three years.

With an ageing and growing population, the demand on NHS services continues to outstrip our economic growth. Unless health tech or AI comes to our rescue, the next Administration faces the prospect of raising taxes further and borrowing more. What can be done to break this cycle? We must prioritise healthcare for both the long and short-term sick who have the potential to join or rejoin the workforce.

Following Covid, we now have a mental health pandemic. It is the biggest single factor behind the escalation in economic inactivity, yet the NHS is just not resourced to cope with this surge. There are many other conditions and disabilities that come high up on the list of causes of economic inactivity where waiting lists are growing or treatment is inadequate. These include musculoskeletal conditions, which have risen by 30% over the last three years—a reflection, perhaps, of an increasingly sedentary lifestyle.

Neurological disorders, which affect 11 million of us in this country, including me, are very high on the list and deserve far greater focus and resourcing. Shamefully, the UK has the lowest proportion of neurologists across Europe and the second-highest mortality rates. Indeed, the Economist estimates that in this field the consequential wastage of healthcare resource by non-specialist care, plus the social and economic burdens, are costing the UK £96 billion per annum. Against this figure, can the Minister say how much of the current NHS budget is devoted to treating neuro? I cannot find any reliable estimate of this figure.

Thanks to the Migraine Trust, I can share the data for just one of the most common treatable neurological disorders. The NHS devotes some £200 million to the treatment of migraine—a condition that alone costs £5 billion in lost working days. That is one example of a serious mismatch. We must make a much greater effort to align the NHS with the economy, for sustainability is a two-way street.