1. Securing the future Funding health and social care to the 2030s
Member briefing on the headline findings

2. Securing the future: Funding health and social care to the 2030s
NHS spending has more than doubled as a share of national income since
Yet it is manifestly failing to keep pace with demand.
The NHS Confederation commissioned the Institute for Fiscal Studies and the Health Foundation to assess future demand facing health and social care.
The study looks at demand over the next fifteen years and assesses what funding will be needed to meet it.
This slide pack sets out the key findings.

3. The report in a minute
NHS & Social Care system faces fundamental pressures from a growing and ageing society over the next 15 years.
Additional funding of at least 3.3% required just to maintain the status quo, with frontloading of 4% for the first five years.
Modernising the NHS would require an additional 4% per year (5% for the first five years) & social care requires 3.9% per year over the period to
Modernising the NHS would require additional investment of £56 billion by This will realistically require significant increases in taxes.
When asked, public say they are willing to pay more in taxes for an improved NHS.
Projected tax rises for the modernised NHS scenario still only take the UK to the lower middle ranks of the EU15 on tax burden.

4. The Health Foundation modelled for two scenarios
The minimum needed to maintain the status quo
Maintain the range and quality of current services as of
Anticipates demographic factors.
Little to no adoption of major new advancements in biomedical technology.
The funding needed to modernise and secure modest improvements
Improving the range and quality of services provided, placing the UK on par, or slightly ahead of other European countries.
Adoption of some new advancements in biomedical technology.
Health service meets rising expectations. Improved public satisfaction.

5. The minimum needed to maintain the status quo
NHS increases of 3.3% a year over 15 years.
Increases of 4% a year for first five years to tackle backlog caused by low growth since 2009.
Adult social care spending will need to rise by around £18 billion by from to to meet demand.
Increased NHS funding of around £95 billion between and 2033/34.
Spending would rise from 7.3% of national income to 8.9%

6. The funding needed to modernise and secure modest improvements
NHS funding to increase by 4% a year over 15 years.
5% a year for first five years to address waiting times and mental health parity.
Spending to rise from 7.3% to 9.9% of national income.
Adult social care spending needs to rise from £23.5bn today to £41.5bn, 3.9% a year to
Overall health and social care spending likely to have to rise by 2-3% of GDP.

7. Public attitudes on NHS funding
Almost unanimous view that the NHS is in the midst of a funding crisis.

8. Chapter 1: UK health and social care spending
Average 3.7% real terms growth in healthcare spending since 1948.
Growth of 1.4 per cent per year over the last eight years is slower than at any time in the NHS’s history.
Age-adjusted per capita health spending has risen by just 1 per cent since 2009/10.
Public spending on adult social care has fallen by 1.5 per cent a year since 2009/10.
Health spending as a percentage of public spending has increased from 9 per cent in to 29.6 per cent in 2916/17 (inc. spending on social care and related areas).

9. Chapter 2: What does the NHS spend its money on?
70 per cent increase in the number of hospital doctors over last twenty years.
However, the UK has fewer practising doctors per 1,000 people than any other EU 15 country.
Number of GPs per 1,000 population has fallen since 2010, along with spending on primary care.
In 2016/17, £52.1bn was spent on staff costs in the hospital and community health services sector in England.
NHS is a much better service on nearly all measures than 20 years ago - lower waiting times, improved survival following cancer, heart attacks and stroke.
The NHS is more productive now than it was in the past, with significant increases in productivity in the last eight years.
Length of stay in hospital is much shorter, with more day cases and advances in surgery and anaesthesiology meaning less invasive operations and faster recovery.

10. Chapter 3: Future pressures
Estimated 4.4 million more 65 year olds, including 1.3 million more over 85s by 2033/34.
The number of people aged 65 and over is growing three times faster than the number aged under 65.
Spending in acute hospitals to treat people with chronic diseases would need to more than double.
Social care funding will need to increase by 3.9 per cent a year to meet the needs of an ageing population and working age people living with disabilities.
An extra 179,000 staff over the next five years, rising to 639,000 full-time- equivalent additional staff by 2033–34.

11. Chapter 3: Future pressures
To modernise the NHS, resource spending in England would need to increase by a projected 4.7 per cent a year and capital funding 11.0 per cent over the next five years.
Even without modernisation, spending in England would need to increase by a 4.1 per cent for day-to-day running costs and 2.3 per cent for capital.
Demographic and non-demographic pressures would see healthcare spending across the UK increase from £154bn in 2018/19 to £278bn in 2033–34 if the NHS is modernised.

12. Chapter 4: Options for funding health and social care
Appears little scope for further cuts to other public funding to increase the money for NHS and social care.
Higher borrowing is a short term, but not longer term possibility.
Limited scope for significant additional charging and selling estates and recouping charges from migrants would provide little revenue.
Solutions are likely to require increased taxation through the three main taxes – Income, National Insurance and VAT.
Tax rises of least 2 per cent of national income (£40bn on today’s terms) will be required by the mid 2030s. This is high by UK standards, but not EU15 standards;
If a hypothecated tax could be introduced in a way which led to a predictable funding stream for the NHS there might be a case for it.

13. Chapter 4: Options for funding health and social care
Meeting pressures under the “modernised NHS” scenario would increase expenditure on health and social care by 3.0 per cent of GDP by
The “status-quo scenario” would only be sufficient to maintain services at 2015/16 service levels and require additional 1.1 per cent of GDP by 2033/34.
Expected pressures mean raising that revenue while keeping public spending as a share of GDP constant, would require cuts to other public spending areas of 3.0 per cent of GDP or 10.0% of total non-health spending.
Increasing taxation to pay for a modernised NHS would increase government spending as a share of GDP to 39.6 per cent. This is higher than at any point since the 1980s, but would remain lower than many other European countries.
Projected tax rises for the modernised NHS scenario still only take the UK to the lower middle ranks of the EU15 on tax burden.

14. Conclusion
NHS and social care is facing considerable increases in demand in the period to 2033/34.
Modernised NHS scenario would require an additional £64bn in today’s terms – equivalent to +3.0% of GDP by 2033/34.
Maintaining the status quo would require equivalent of £24bn today which is +1.1% of GDP by 2033/34.
Cutting spending in other public services areas looks difficult and tax rises are likely to be necessary
Current & future governments face hard choices about NHS and social care and how we pay for them.
Failing to address funding pressures is likely to lead to further deteriorations in the quality of services.
Projected tax rises for the modernised NHS scenario still only take the UK to the lower middle ranks of the EU15 on tax burden.
Click here to download the report and executive summary.