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As a network, the ‘healthcare ecosystem’ is centred around the patient, and includes all relevant services (primary, secondary, tertiary and community care), staff (from doctors to security guards) and infrastructure (from hospitals and ambulances to IT systems). The rising cost of living has had a significant impact on the healthcare ecosystem. In many cases it is difficult to establish cause and effect, and some areas might have been affected more than others. However, as in any other ecosystem, changes in any part of the healthcare ecosystem can affect the entire structure.

1. Increase in the cost of living

Since early 2021 the rate of increase in the cost of living has been rising. Consumer price index inflation rose by 11.1% in the year to October 2022. High customer demand, supply chain issues, and Russia’s invasion of Ukraine have all contributed to rising costs of food, goods and energy.

At the autumn statement in November 2022, the UK government announced an £8bn increase in spending for health and adult social care. This includes a £3.3bn increase for the NHS and a £4.7bn increase for the adult social care system in each of the next two years.

The chief executive of the NHS, Amanda Pritchard, said that this spending increase “should provide sufficient funding for the NHS to fulfil its key priorities and shows the government is serious about its commitment to prioritise the NHS”. However, council deputy chair of the British Medical Association Dr Emma Runswick commented that the increase lagged behind inflation:

While the extra funding promised to the NHS is much-needed, even with this additional investment, it represents an increase to the Department of Health and Social Care budget of less than 5% next year, compared to this year. With inflation now topping 11% and set to remain high, it doesn’t take an economist to see this is an effective cut to health spending. Demand and pressures in our hospitals, GP practices and across the system have never been greater. This failure to match spending with the cost of providing care means services will inevitably be impacted and patients will suffer further.

The rising cost of living has increased pressure on the healthcare ecosystem and, according to former chief economist at the Bank of England Andy Haldane, “for the first time since the industrial revolution […] health is now serving as a brake in the rise of growth and wellbeing of our citizens”.

2. Effects on the public

In a survey published in the British Medical Journal in May 2022, 55% of respondents reported a negative impact on their health from the increase in the cost of living. Out of those, 84% attributed this to rising heating costs, and 78% to the rising cost of food. Commenting on the findings, Andrew Goddard, the then president of the Royal College of Physicians, expressed concern that this could get worse:

The cost of living crisis has barely begun, so the fact that one in two people is already experiencing worsening health should sound alarm bells, especially at a time when our health service is under more pressure than ever before.

2.1 Energy prices

The government’s annual fuel poverty statistics report, published in February 2022, showed that 3.16 million households in England were in ‘fuel poverty’ in 2020, with projections that this number would decrease to 3.06 million in 2021 and 3.03 million in 2022. However, this was published before the war in Ukraine pushed up energy prices. In addition, the charity National Energy Action estimated that 6.7 million people in the UK have been in fuel poverty since April 2022, and their projections indicate that this number could rise to 8.4 million by April 2023.

The effects of a cold home on human health can be severe. Cold air inflames the lungs, and lower temperatures lead to narrowing of blood vessels and arteries, limiting blood flow and reducing oxygen flow to the heart. As a result, cardiorespiratory diseases, such as asthma, heart disease and stroke, can emerge or worsen. The World Health Organisation housing and health guidelines have set a minimum of 18°C as “a safe and well-balanced indoor temperature to protect the health of general populations during cold seasons”, with a higher minimum indoor temperature for vulnerable groups, including older people, children and those with chronic illnesses.

Cold homes contribute to excess winter mortality and can add considerable pressure to the healthcare system. It has been estimated that 10% of excess winter deaths in England and Wales are directly attributed to fuel poverty, and 21.5% are attributed to cold homes. In 2019, the Local Government Association estimated that the NHS spent a minimum of £2.5bn treating cases directly linked to cold and damp homes.

2.2 Food (in)security

The rising cost of living has also impacted food security, with the UK annual rate of food and non-alcoholic drinks inflation reaching 16% in October 2022. A survey by the Independent Food Aid Network in November 2022 found that 94.5% of food banks reported a demand rise. All of them attributed this to the increasing cost of living, with 91.8% reporting that they are now supporting people that have never needed support before. At the same time, 75% of these foodbanks also reported a decrease in supplies. According to data from Citizens Advice, the number of people asking them for referrals to food banks or other charitable support in England and Wales has increased from 110,000 in October 2021 to 170,000 in October 2022 (a 54.5% increase). Projections indicate that this number could surpass 210,000 by December 2022.

Food insecurity is related to the adoption of unhealthy, high-energy and low-nutrient diets, and is linked to a number of adverse health outcomes, such as obesity, type 2 diabetes and a range of cardiovascular, cancer and liver diseases. The NHS Confederation has stated that “greater food insecurity could create unmanageable pressure on already stretched NHS budgets”. In England, the NHS spends £19.6bn annually to treat malnutrition, and forecasts indicate that spending on treating obesity could rise to £9.7bn annually by 2050. In a House of Commons debate in April 2022, the parliamentary under secretary of state for health and social care, Maggie Throup, argued that the department “takes malnutrition extremely seriously, and it is an issue that we are determined to continue tackling”.

3. Effects on NHS services and staff

The British Medical Journal reported in September 2022 that due to the rising cost of living, “many NHS staff are quitting the NHS for better paying jobs, creating more hard-to-fill vacancies”. At the same time, NHS vacancies reached their highest level since records began, with 132,139 vacancies across the sector. In a survey by NHS Providers, 81% of trust leaders were concerned about the physical health of their staff, 99% were concerned about their mental wellbeing, and 95% were concerned about their financial wellbeing, especially for those in the lowest pay bands. In addition, 93% were concerned about recruitment and 68% reported a severe or significant impact from staff leaving the sector.

Unions representing NHS staff from a range of professions have planned strikes across the UK in the winter of 2022–23, calling for pay rises to meet the rate of inflation. The unions have also highlighted that NHS staff shortages have a significant impact to patients. Ambulance workers have noted that this situation has contributed to delays in response times, with fears it might even have led to the death of some patients. The GMB national secretary, Rachel Harrison, said that “by not paying staff properly, ministers are leaving the NHS unable to recruit and retain enough workers, putting patient safety at risk every day”. Similarly, Unite general secretary Sharon Graham told Sky News that “crushing [NHS] staff shortages mean patients’ lives are now at risk”.

In the autumn statement, the UK government recognised the issue of NHS staff shortages, and announced that the Department of Health and Social Care will publish an independently verified review of the amount of healthcare professionals needed to run services efficiently in the next five, 10 and 15 years.

4. Effects on the infrastructure

Another effect of the rising cost of living is its effect on NHS infrastructure. Some NHS trusts in England are expecting a more than 200% increase in their energy bills, with estimated costs at £2mn a month. Rory Deighton, senior acute lead at the NHS Confederation, told the British Medical Journal:

This isn’t an abstract problem, as the gap in funding from rising inflation will either have to be made up by fewer staff being employed, longer waiting times for care, or other areas of patient care being cut back.

In September 2022, the UK government announced an energy cap for non-domestic customers, including public services, until April 2023. The NHS Confederation has welcomed the government’s support, but added that the provisions are not enough, given that “money spent on rocketing energy prices is money that cannot be spent on patient care”. In the autumn statement, the UK government announced a review of the energy cap policy for non-domestic customers, to take place in 2023. Although the aim of the review is to decide the level of the government’s reduced support on energy bills after April 2023, public sector customers are excluded from this review.

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Cover image by Ian Taylor on Unsplash. This article has been amended to include figures from National Energy Action that were released post-publication.