Question to the Department of Health and Social Care:

To ask the Secretary of State for Health, with reference to the letter from the Minister of State for Health to the hon. Member for Brighton Pavilion of 7 December 2017 on nurses pay, what the evidential basis is for the Minister’s statement that changing public expectations are a cause of increasing pressure on the NHS.

There is general consensus that a number of factors are likely to drive increases in healthcare activity and associated spending. These factors include but are not limited to long-term demographic changes. For example, in its Fiscal Sustainability Analytical Paper on Public Spending on Health (2016), the Office for Budget Responsibility (OBR) found that health spending is driven by a multitude of factors, broadly grouped under demographic factors, changes in income and other cost pressures. Using a range of evidence to inform their analysis, the report found that historically, spending in healthcare has been driven, amongst other factors, by changes in the population size and structure, changing morbidity, technological and medical advances as well as an overall increase in national income. In respect of income, the OBR highlights that, as a “normal good”, people tend to demand more healthcare as their incomes rise. These drivers are commonly cited in the literature, including by international institutions such as the Organisation for Economic Co-operation and Development and the International Monetary Fund. It is difficult to separate their effects as they are not independent from one another.