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IPPR - NHS bill set to rise by more than £50bn by 2030

Top NHS surgeon and former Health Minister, Lord Darzi sets out challenges faced by the NHS and social care in interim report of his independent review

New findings by IPPR for the Lord Darzi Review of Health and Care show that returning the NHS to its long run funding growth will require a year-on-year increase in annual expenditure. This additional annual cost will reach £50bn by 2030. Accordingly, funding would need to rise from £123bn in 2017 to £173bn by 2030.

As discussions of a long-term funding settlement intensify in the run up to the 70th anniversary of the NHS in July, these are the first projections that show the scale of the commitment that will need to be made. 

Pressures on social care are also set to accelerate. As a minimum, adult social care will require an extra £10bn per annum by 2030 just to maintain the existing system.

Even if both of these funding requirements are met, the report shows that the NHS will have to deliver productivity growth of one and half times its long run trend requiring fundamental reform of the system.

Professor Lord Ara Darzi, Chair of Surgery at Imperial College, will launch the final report including a proposed long-term funding settlement and a plan for reform of health and care in time for the NHS’s 70th birthday celebrations later this year.

In the decade ahead, a “baby boomer bump” is set to push the bill up further as the post-war generation require more and more health and care services. This is coupled with a continuing rise in long-term conditions, higher expectations of standards and onward march of science and technology that will continue over the decade to come.

The NHS and social care are already under pressure. The health service has already endured the most austere decade in its history, and funding for social care has declined in real terms almost every year since 2010.

Ten years on from his landmark 2008 report High Quality Care for All, Lord Darzi also found the quality of care across most areas of the health service has been maintained or improved. For example:

  • 1 year survival rate for all Cancers has risen from 67 percent in 2008 to 72 percent in 2015
  • Maternal and infant mortality rates have improved, down 5 percent and 2 percent per year, respectively, over the same period
  • There have been recent successes in reducing suicides down from 10.0 to 9.5 deaths per 100,000 people between 2008 and 2016
  • The proportion of patients receiving harm-free care has increased by approximately 2 percent since 2012, stabilising at just over 94 percent of patients

However, there are huge challenges faced by health and social care including the re-emergence of rationing, with waiting times on the rise. New analysis for the report shows that since High quality care for all in 2008 there has been:

  • A 5 percent fall in the number of people receiving publicly funded social care each year since 2010, despite a significant increase in the number of elderly people in need of it
  • A 5-fold increase in people waiting for more than 4 hours at A&E and 8-fold increase in the number of trolley waits over four hours, following a decision to admit.

Lord Darzi’s interim report contains a wide-ranging analysis of the changes in quality, access and cost over the past ten years. These analytics have been undertaken by Carnall Farrar, a consultancy with expertise in health analytics.

Professor Lord Ara Darzi, Chair of the Review said:

“NHS staff should be congratulated for the improvements they have made to the quality of care they provide. But it is getting harder and harder to access that care and the system is in financial distress.

While the prospect of a long-term funding settlement is welcome, it is vital that it delivers enough money to meet the demands of the decade ahead. Funding the NHS, while social care falls over is not an option.”

Tom Kibasi, Director of IPPR said:

“Our research shows that ‘taxpayer-funded – free at the point of need’ is the most efficient way to finance and organise the health service. Social and private insurance models in other countries are more-costly. That’s why those who say the NHS is unsustainable are wrong. It is a fundamental error of logic to say that something is unaffordable, so we should move to something more expensive. As the Review shows, the NHS provides high quality care—it is a service that we should be proud to invest in.”

Lord Prior, former Conservative Health Minister and Vice-Chair of the Lord Darzi Review said:

"Health and social care is facing a perfect storm, with the needs of a growing and ageing population rising faster than the available resource. As a consequence, waiting times are lengthening, more operations are being cancelled, health inequalities are increasing and more hospitals are going into the red. The system is under great stress. The Government needs to take heed of this report: it should commit to a long term, more generous funding settlement, invest heavily in integrated care and prevention and support urgently the new digital technologies described in the Life Sciences strategy."


Florri Burton, 020 7470 6154 / 07867388895,  


The full report The Lord Darzi Review of Health and Care: Interim report is available at: 

The final report for the Lord Darzi Review of Health and Social Care, commissioned and housed by IPPR, will be released later this year and will set out funding plan and proposals for major reform. The analytics for the Review have been produced by Carnall Farrar.

Professor the Lord Darzi of Denham PC KBE FRS FMedSci HonFREngholds the Paul Hamlyn Chair of Surgery at Imperial College London, the Royal Marsden Hospital and the Institute of Cancer Research. He is Director of the Institute of Global Health Innovation at Imperial College London and Chair of Imperial College Health Partners. He is an Honorary Consultant Surgeon at Imperial College Hospital NHS Trust.

Lord Darzi’s 2007 reform plan for London’s health services are credited with saving hundreds of lives by making huge improvements to stroke and major trauma, and his 2008 report High Quality Care for All was acclaimed by all parties for refocusing the health service on the quality of care, not just the quantity.

The financial projections produced for the Review are based on a detailed model produced by Carnall Farrar. The full methodology will be published in the report and has been reviewed by experts from the Health Foundation, Kings Fund, Nuffield Trust and former NHS finance directors.

IPPR is the UK’s pre-eminent progressive think tank. Our mission is to open up opportunity, power and prosperity to everyone through conducting rigorous research and generating big ideas. With more than 40 staff in offices in London, Manchester, Newcastle and Edinburgh, IPPR is Britain’s only national think tank with a truly national presence.

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