I will make three points that the Health Bill should address. First, in the long run, the greatest threat of uncontrollable government spending levels is from escalating health and care costs if we fail to provide a solution to the growing crisis in social care—which is severely impacting on costs to the NHS—or deal with rising levels of ill health in an ageing population and rising levels of obesity, diabetes and disability, all of which are linked.
The excellent former Pensions Minister, Professor Steve Webb, provided me with figures, beginning in 2023-24, based on the proportion of GDP spent on health and pensions. The proportion of GDP spent on pensions at the start of this period was 5.6%. In 30 years, this figure is set to rise to over 7.3%, and over 50 years it is projected to reach 8.9%. Meanwhile, spending on health, as a proportion of GDP, is currently around 8%. In 30 years, this is projected to rise to over 11%, and over 50 years to nearly 15%.
This is almost double the proportion of GDP spent on health today. As we debate the structural reorganisation of our health services, we must not lose sight of the overwhelming demographic changes and financial realities that we will face. The escalating costs of health and adult social care are driven relentlessly by rising rates of obesity, diabetes, complex multiple morbidity and an ageing population living with higher levels of disability.
The True Cost of Smoking
My second and third points are both about limiting those rising costs. Smoking is still the single largest driver of preventable ill health and health inequality in the United Kingdom. It accounts for nearly half of the gap in healthy life expectancy between the richest and poorest communities. We have made great progress: recent ONS figures demonstrate that, across the UK, fewer than one in 10 people smoke. This achievement has required great determination to uphold good public health policy, with effective regulation to help prevent people taking up the habit and to help the Majority of smokers who wish to quit.
However, more can be done. I urge the Minister to commit to publishing a clear road map to a smoke-free country, underpinned by sustainable funding for that programme—including a targeted levy on tobacco industry profits that could raise billions of pounds for public health and address the funding gap. This money is needed by a healthcare system, not by the tobacco oligarchs who profit so much from products that kill half their customers and impose massive costs—both financial and well-being—on us all.
Thirdly, I highlight the growing costs arising from the complications associated with poorly controlled diabetes. Diabetes may already take up about 10% of the NHS budget, with 80% of those costs spent on the complications associated with it. By 2035, diabetes is projected to take up around 17% of the NHS budget. As this legislation abolishes NHS England and transfers its function centrally, we must guarantee that momentum is not lost in diabetes prevention, treatment and clinical innovation.
The Bill should place an explicit duty on the Secretary of State to promote innovation in diabetes care, specifically by accelerating the rollout of continuous glucose monitoring and hybrid closed-loop artificial pancreas technologies. Diabetes-related health inequalities, whether in access to insulin pumps or structured education, must be named as an explicit statutory consideration in the duty to reduce health inequalities.
With action on these issues, we can begin to close the looming gap between what the country can afford and what needs to be done for health and well-being in this country.