The point of economic growth is to meet increasing healthcare demand

Healthcare can feel like being on a treadmill. Despite more funding and staff, the never-ending nature of demand feels overwhelming, which can rapidly turn into doubts about the sustainability of the NHS.

Like most strong narratives, there is a core of truth; demand is growing and changing, which consumes ever more resources. Although we understand that the population is evolving and medical progress is changing how the health service responds, too often, the policy is on the back foot, trying to catch up in a system better suited to the needs of the past than the future.

How do we get onto the front foot? That starts with really understanding the changes that are coming. We have known for a long time that the ageing population will increase the demand for health services. But the next two decades will see the baby boomer generation reaching retirement age in large numbers while the working-age population is largely stable.

Policy documents routinely acknowledge demographic change, but are we ready for the scale and nature of the changes ahead? New research from the Health Foundation and the University of Liverpool provides a sobering assessment of the scale of the challenge.

Looking at 20 of the most common long-term conditions and the trends in risk factors such as smoking, obesity, alcohol and exercise, the number of people who will be living with major illness is projected to reach 9.1 million people by 2040 – an increase of 2.5 million people compared to 2019.

Most of this increase is a result of the population ageing. The age at which people develop major illness is projected to remain stable at around 70 years over the next two decades. But as medical science and healthcare improve, people are expected to live longer. As a result, the amount of people’s lives spent living with major illness will increase. While living longer is something to celebrate, this will have profound implications for the NHS and other areas of public policy.

The prevalence of 19 of the 20 conditions is projected to increase, including increases of more than 30 per cent in the number of people living with cancer, diabetes and kidney disease. The exception is coronary heart disease, where prevalence is projected to fall due to declining smoking rates and access to more effective drugs.

Rising obesity is a key driver of ill health, as many people reaching old age will have spent prolonged periods of their lives with obesity. This is offsetting improving trends in some of the main causes of poor health, including fewer people smoking and lower cholesterol levels.

Focusing on prevention and innovation is vital for reducing the impact of illness and improving people’s quality of life. But it will also increase life expectancy, so it won’t necessarily reduce the overall demand for healthcare.

Supporting people to live well with illness will become an increasingly key function of healthcare and other services. The new workforce plan is therefore very important. For the NHS to thrive and survive, we will need more staff, not just to tackle the current shortages but crucially to prepare for this rising demand. But the changes in demand that flow from the ageing population will require different care as well as more care.

Much of the growth in illness is for conditions such as anxiety and depression, chronic pain and diabetes, all predominantly managed in primary care. This reinforces the need to invest in primary care, which has fallen from 11 per cent to 9 per cent of health spending over the last 15 years.

The scale of the demand growth ahead is sobering; the number of people with major illnesses will increase by 37 per cent over the next two decades. But it is important to recognise that for individuals, families, and communities, this is more good news than bad; people are living longer, and technology and medical advances are helping people to live well with illness.

However, it almost certainly means that health spending will continue to increase. This is not unique to England; it’s true for all high-income countries with an ageing population. The sustainability of rising health spending is primarily determined by economic growth.

But if the economy does grow, there isn’t anything fundamentally wrong with spending some of the proceeds of growth on meeting rising health demand. In many ways, this is the point of economic growth and prosperity, allowing more people to live for longer and to live those lives as productively and enjoyably as possible.