In her Budget Statement the Chancellor of the Exchequer stated one of her aims was to cut waiting lists in the NHS.
According to a survey by the Times newspaper earlier this year it was estimated that there were on average 13,600 older people in hospital every day who did not need to be there awaiting social care, costing the NHS £2.9m per year. Therefore, one cannot resolve the problems of the NHS in isolation of social care.
The NHS and social care are in crisis and in need of radical reform, restructuring and cultural change to liberate the professionals from the constraining contract culture into an enabling leadership one. This requires the creation of whole task right sized multi-disciplinary teams aligned behind outcome able to plan, do and evaluate their own work which completes the learning cycle of constant improvement.
There is a wealth of empirical evidence into the social determinants of health which has demonstrated the correlation between income and demand upon the health services. One cannot go on throwing more money at the first aid camp at the bottom of the cliff without building a fence at the top. Treating the symptoms not the cause. A whole systems approach is required.
If the Chancellor really wanted to save money she would increase and not reduce the income of older people. Before the COVID19 pandemic killed 223,396 mainly older dependent people, 80% of the expenditure of health and social care was on older people. Britain has one of the lowest state pensions in the developed world with 2m older people living in poverty. To increase the state pension to lift all older people out of poverty would reduce demand upon the NHS and social care. It would also improve the quality of life of many and if older people did need long term care, applying the same financial assessment which has been in place since 1948 (when few people owned their own house) they would be able to pay more without having to take their house or capital into account which would also increase government revenue from inheritance tax.
This is looked at in greater detail and costed in my most recent book “Income inequality and poverty – the impact on health and social care”.
Before the Coalition Government abolished the “default retirement age” in 2012 many of today’s retired people were forced into retirement and condemned to spending the rest of their lives in poverty. No other group of people could be treated in this way. Imagine the outcry if people were denied employment on grounds of gender, race, religion or disability. And yet until 2012 it was perfectly legal to terminate or deny employment on grounds of age. Research has shown that redundancy had a more lasting debilitating effect than either divorce or bereavement. Enforced retirement was like redundancy only more so in that there was no hope of future employment. There was little wonder that there was so much depression amongst older people.
David Cameron’s Coalition Government introduced the “triple lock” (whereby the state pension increases each year by whichever is the greater of prices, earnings or 2.5%) which was designed to reverse 30 years of erosion since the earnings link was replaced by a prices link in 1980. In the ten years prior to the introduction of the triple lock earnings had gone up by 41.7%, RPI by 32.4% and CPI by 26.6%. Prices are about the cost of living. Earnings are about the standard of living and quality of life. For example, in the 1950s very few people had refrigerators – it would be very difficult to live without one now.
After ten years of catching up, by 2025 Older People had fallen further behind the wider population than they were in 2020. In 2020 the state pension was 24.5% of average earnings; in 2025 it was 23%. This was largely due to the suspension of the triple lock in 2022 /23. Older people got no benefit from the two pre-election cuts in National Insurance but have to pay more income tax due to the freezing of the tax-free personal allowance and recently lost their free television licence.
Concerns about the cost of an ageing population have led to raising the age of entitlement to the state pension (instead of linking it to retirement) and stopping the free television licence and winter fuel allowance. When what might have been required was an increased state pension to lift older people out of poverty and reduce demand on the NHS and social care.
This concern about the cost of an ageing population is driven in part by a mistaken belief that they no longer contribute to the economy when the majority of volunteers, trustees, carers and unpaid child minders are older retired people. The Centre for Care Research found that the economic value of the support provided by unpaid carers in England and Wales in 2025 was an estimated £162billion per year, 29% more in real terms than 2011.
* Chris Perry is a former Director of Social Services for South Glamorgan County Council, a former Director of Age Concern Hampshire, a former Non-Executive Director of the Winchester and Eastleigh Healthcare NHS Trust and a former presenter of an award-winning public affairs programme on Express FM.
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14 Comments
As all statisticians know, correlation is not the same as causation. In other words, the correlation that exists between income and demand for healthcare does not directly prove that having less income increases demand or, therefore, that increasing income will reduce demand.
For example, there is a correlation between sales of sun tan lotion and scarves – as demand for sun tan lotion falls, demand for scarves rises – but this does not mean that the fall in sales of sun tan lotion causes the increase in demand for scarves…both factors are caused by a third factor – the weather/seasonal change.
There are a number of interesting correlations as regards income and health. For example, the rate of all cancers (except skin cancer) fall as we move up towards higher income levels. Does this mean that increasing people’s incomes will reduce cancer rates? Well other correlations are relevant here, such as the rate of smoking cigarettes falls as you move up the income levels – and smoking directly causes cancer – and, of course, spending considerable amounts on smoking leaves less for buying quality food etc which impacts on the lowest incomes household most who are precisely the household who smoke at a higher rate!
To summarise, some argue that health outcomes are based on class/income/capitalism and not in any way on personal choices – I reject that as overly simplistic. Income is one factor in health outcomes but personal choices are hugely important and, for some reason, political parties appear afraid to acknowledge it.
“13,600 older people in hospital every day who did not need to be there awaiting social care, costing the NHS £2.9m per year”
According to my arithmetic this works out a £1.59 per day per person!
The annual budget of the NHS is about £180bn so £2.9m works out at 0.0016% of the total.
Either this isn’t such a big problem or someone has got their figures wrong!
Sorry my arithmetic is faulty too. The claimed daily cost is actually 58p per person on these figures! Slightly less in a leap year 🙂
It’s 2900000/(13600*365)
It’s easy to get it wrong with larger numbers and you have to count the right number of digits.
@Peter Martin
Back in 2016 the BMJ estimated that the NHS was spending £820 million in keeping older patients in hospital unnecessarily (https://www.bmj.com/content/353/bmj.i3019), so I suspect that the OP meant £2.9 billion not million; it always pays to check figures quoted here.
@Peter Martin. Thank you for pointing this out Peter. The “m” should have been a “b”. i.e costing £2.9b per year.
@Jenny Smith. There is a wealth of empirical evidence into the social determinants of health which have established a causal link between income and health. Higher income is linked to better health outcomes because it allows for access to essentials like quality housing and healthy food, while lower incomes are associated with increased stress, poorer food, poorer housing and poorer health outcomes. Poverty and malnutrition go hand in hand.
Chris Perry…We have an obesity epidemic among children. it’s poor parenting.
If children are too obese to partake in school sports , are unable to read or write , cannot meet their own personal bathroom needs , have extensive dental decay – it’s bad parenting.
From what I saw regarding older people unnecessarily being in hospital and thus “bed blocking”, the key blockage is the social care a discharged patient may need which prevents them being discharged into the same environment they lived in directly prior to hospital admission.
With “day” surgery we forget that whilst a operation can now be completed with much less trauma, often the surgery is still major and can require 2~4 weeks of recovery (where recovery includes time when you are regarded as being medically unfit to drive).
So I suggest we need to firstly look at improving “convalescence (social) care”, if we really want to start reducing the log jam in the NHS.
Whether increasing pension etc. would reduce the number of elderly people in hospital I’m not so sure about.
@Chris Perry
As you will know, the causal link between income and health is stronger for reductions in
income than for increases in income. In other words, when income reduces and a cuts to spending are required, this can result in less healthy food being eaten as well as greater problems with anxiety and depression. However, increases in income do not tend to lead to a switch to more healthy food options and may, indeed, lead to increases in the consumption of alcohol which is now easier to afford.
My point in raising this is to avoid readers wrongly concluding that increasing incomes is a wonder treatment that can somehow fend off illhealth when the reality is far more complex and nuanced.
@ @ Jenny Smith. Exactly. Many of today’’s older people, if they retired before 2012, were forced into retirement and condemned to spending the rest of their lives in poverty. Those who retired subsequently did so a on a greatly reduced income and have seen their income reduced still further as a result of recent and repeated Government action by this administration and the previous one. Therefore, we both agree there is a causal link between this and the demand upon the NHS.
If we increased all old age pensions to a living wage level, it would be partially self funded, because there would be far less, or even nothing paid to pensioners in supplementary pension and many other means tested benefits. And for those who will undoubtedly complain that this would give too much to the better off, there could also be tax adjustments.
How much longer are pensioners to be treated so badly? As for those who think the triple lock is unaffordable, Chris Perry points to the real truth, that even with the triple lock, pensions have still fallen behind even the poor level they were in 2010!
@MickTaylor. Absolutely, Mick. Thank you.
@ Chris Perry,
No problem. Being a bit of a nerd, at least my wife says so 🙂 , I do like to check the figures. There’s a lot quoted, on the internet especially, on all kinds of things to prove one point or another. Some don’t make any sense at all and I suspect they are are simply made up.
So, unless they come with a specific reference, I’d say its better to just ignore them or do some research to verify them.
Your £2.9 bn sounds more like it though. This means the cost of the NHS provided social care is 1.6% of the total. It would still cost something even if local councils provided the care, so the total cost to all taxpayers would still be substantial.
I agree it’s worth trying to fix the problem though.
@ Chris Perry,
” To increase the state pension to lift all older people out of poverty would reduce demand upon the NHS and social care……”
I’m not saying we shouldn’t increase pensions but it probably isn’t correct that it would save money in the way you suggest. When the NHS was first established, there was a similar argument that the costs of the service would gradually fall as people became healthier due to better medical care.
It didn’t quite work out like that.
From an macro-economic perspective it would be better if we all fell off the perch soon after we retired. But economics isn’t everything as I’m sure most of us would agree – especially if we are hoping to get our money’s worth from our pension contributions.