Health and Social Care in England

Baroness Jolly Excerpts

Thursday 11th July 2013 Lords Chamber

[Baroness Jolly]

My Lords, I thank the noble Lord, Lord Patel, for securing this debate on such an important issue. I declare an interest that I suspect is shared by many other noble Lords: this debate is about my care down the line. I would like to examine the challenges facing us on future health and care funding, the public expectation of the future delivery of these services and how the public can be seen as part of the solution, not the problem.

Our population is ageing and the gap between pension age and life expectancy is increasing. Thus, the ratio of taxpayers to pensioners is decreasing. According to the ONS, the population of over-65s will increase by an average of 1.8% a year between 2014 and 2021. Coupled with other factors such as the rising population, this will create an increase in demand for NHS services of 4% a year. I appreciate that there are other figures but those were the results of my research. Pension entitlement has caused pensioners as a proportion of spending to increase from 17% in 2010 to 21% in 2015. This proportion is likely to increase with fewer working-age people to fund it. However, we must remember that older people generate some £40 billion for the UK economy, and this will increase to £70 billion by 2030.

It is important to contrast the views on welfare entitlement as a whole between generations. Recently, the Economist highlighted that more than two-thirds of people born before 1939 consider the welfare state one of Britain’s proudest achievements, whereas less than one-third of those born after 1979 say the same. Polling by YouGov shows that those aged 18 to 24 are more likely than older people to consider social problems the responsibility of individuals rather than of the Government. They will become the taxpayers who fund our health and social care system in the future and will make the political decisions, yet their views on the state’s responsibilities to individuals are markedly different from those of baby boomers entering retirement now, so things will have to change.

Clearly, there must be a debate on where the public’s priorities lie. By 2061, non-health departments will have had to reduce their proportion of net government spending from 80% to 50%. This 50% would apply to education, pensions, benefits and defence. So how do we fund future health and social care? What behaviour and attitudes need to change? I think we all agree that we cannot continue as we are. If it is funded purely out of taxation, excluding all efficiency savings, for every 1% increase in healthcare spending as a percentage of GDP—that is around £15 billion—it would add to the tax bill of every household in the UK another £570 a year. To put this in context, a 1p increase in income tax would yield only an extra £5.32 billion per annum for the Treasury, so it would require a 3p rise for each extra percentage point. The sums are now beginning to sound really scary.

Obviously, there are efficiency savings to be found, such as extra investment in preventive care and the use of technology, which, as a recent Deloitte report for Scope has shown, achieves average returns of 30%, which would reduce the number of people entering the system at crisis level. Do we cut big-ticket spending items, such as Trident, which is projected to cost £20 billion, or High Speed 2, estimated at £32.7 billion? Do we means-test access to primary care? Do we cut pensions in return for better social care? Do we encourage planning for old age to include care and pensions? Here I must make clear that I am repeating questions that others have asked, not making personal or party recommendations.

We also need to ask what we can do for ourselves. One thing we will not be short of is human resource—and fairly fit human resource. The Olympics last year in London made volunteering acceptable and even cool. Volunteers were given the inspiring descriptive title of Games makers. They were given a role description, managed brilliantly and changed the face of the Games. They were the envy of the world. The voluntary sector is already active. It knows that older people can be the solution and not the problem. What better legacy of the Games could there be than using that sort of model to support the health and care sectors?

The issues are complex and the stakes could not be higher. We need to have a long conversation involving the public, all political parties and policymakers, the voluntary sector and care professionals, and we need to start it sooner rather than later.