To ask His Majesty’s Government what assessment they have made of the UK’s declining birth rates in an ageing population, and the impact of this demographic shift on the workforce, demand for public services and economic growth.
My Lords, I am grateful for the opportunity to debate this important topic in your Lordships’ House. “Demography is destiny” is an old saying that has never felt more urgent. The UK faces a demographic shift that threatens an unfolding economic crisis. This issue has concerned me for nearly two decades. In 2009, I published a peer-reviewed paper, which was described as a landmark paper, on this topic. Since then, I have continued to debate and address this subject nationally and internationally. I am particularly pleased that today’s debate benefits from the contribution of so many learned noble Lords. Today, I will address the impact of our ageing population, falling fertility rates, the economic barriers preventing family formation and why equal access to fertility treatment and gender equality need to be central to our long-term growth.
Deaths are now projected to outnumber births in the UK every single year. By 2034, pensioners will outnumber children by 3 million. Since 2010, UK fertility rates have fallen by 25%, the steepest decline in the G7. These are not just social statistics; they are fiscal ones. PwC estimates that population ageing could reduce UK GDP by £429 billion by the year 2100, while public health funding is forecast to nearly double as a share of our economy by 2074.
We face a compounding crisis of rising healthcare and pension costs alongside a shrinking workforce. Nowhere is this more visible than in our National Health Service. When it was founded in 1948, only 11% of our population was over the age of 65. Today, the figure is nearly 20%. The number of over-85s, the highest users of our healthcare, has doubled in two decades. At the same time, 2 million people over 65 have unmet care needs, while over 150,000 social care posts sit vacant every single day. These pressures extend across the workforce. Economic inactivity rates rise from 17.4% at the age of 50 to nearly 70% by the age of 66. By state pension age, more than two-thirds of people have left work. We are losing experienced workers precisely when we can least afford to. Pension and retirement reforms can help to address this.
I turn to declining birth rates. The UK fertility rate fell to 1.39 in 2025, far below the 2.1 needed to sustain our population. The consequences are reshaping our communities. Maternity units are closing and so are primary schools across our country. That is simply because there are fewer children. Declining birth rates are a global phenomenon. Some of that reflects a cultural change, yet many people still want children or want more children but cannot afford to have them. That gap between aspiration and reality, known as the fertility gap, is a policy failure. We do not want to create economic conditions that make parenthood unaffordable or fail to provide fair access to fertility treatment, and we do not want to create political infertility. As the UK fertility expert on the panel for the Economist impact report Fertility Policy and Practice: a Toolkit for Europe, I can say that the evidence is clear: child-friendly policies pay for themselves.
My Lords, I declare an interest as chief executive of the Kemnal Academies Trust. I am also a non-exec director at Queen Victoria Hospital NHS Trust. I thank the noble Baroness, Lady Nargund, for securing this vital debate; it is a pleasure to listen to her expertise on this topic. As a pioneering fertility specialist serving the NHS for more than three decades, she has done more than most people to raise the cause of reproductive health and to bring these questions to a wider audience.
In my contribution I want to connect this topic to Alan Milburn’s interim report on young people and work. We heard a little about that this morning, with the Question from the noble Baroness, Lady Stedman-Scott. The two topics are tightly linked. The effects of the demographic transition are, at the heart of the matter, a quite simple ratio; there are fewer working-age people supporting a larger population that relies on public services and benefits. The noble Baroness, Lady Nargund, has already quoted the key statistics on this, so I need not repeat them, but I am struck by that particularly gloomy one: that we are projecting that deaths will continue to outnumber births for the foreseeable future. So we must debate measures to lift fertility, support families and reduce the cost of raising children, and the Government have a promising suite of measures in place for this.
But whatever we do now, the shift in age structure we have spoken about is already baked in for decades. Short of dramatically increasing migration, which seems politically challenging, there is nothing we can do to change the underlying demographic facts in the medium term. I guess it is a strange way of putting it, but it takes 18 years to make a new worker. The international evidence so far seems to suggest that we can slow but not reverse the decline in fertility.
What we can change is how many of our working-age population are actually working and how much they produce when they do work. So, our immediate response belongs in the realm of productivity and participation. On productivity, the UK’s track record since the financial crisis offers little grounds for optimism, but we must keep trying. This leaves participation. Here, Milburn’s report gives us fresh cause for worry: not only will we have fewer young people, but fewer of those we do have are entering work. Over 1 million 16 to 24-year-olds are not in education, employment or training, and more are economically inactive than are unemployed, often because of poor physical and mental health. This is double blow: these young people are not working, and many of them will need to lean on the same services that are already stretched by the ageing population. England is projected to need around 470,000 more social care workers by 2040, according to the Darzi report, even as the working-age population to fill those roles shrinks. So we have fewer workers and greater need, and both terms of that ratio are moving against us.
I thank my noble friend Lady Nargund for raising this important issue; it was a good illustration of the expertise that is brought before this House. I recognise the important work that she has done in this area, looking at the barriers to parenthood and the need for family-friendly policies. We need to prioritise long-term thinking, but I want to highlight that falling fertility is also a story about women’s choices. There is a certain symmetry to our debates; the previous debate was about women who want to have children and what we can do to help them, but it is also a choice not to have children.
This is not just a UK issue, of course; we know that the global fertility rate has roughly halved since the 1960s. The standard explanations focus on housing costs, debt, technology and the general pressures of modern life. Those things exist and they are influential, but the evidence is that they are not necessarily the primary explanation. The other explanation is that women now have far greater control over their reproductive lives, and they are exercising it. I do not have the presumption to speak on behalf of women; I simply read the consistent evidence on the pattern of falling fertility.
Fertility decline is not concentrated among women facing the greatest economic pressure. If costs were the main driver, you would expect the sharpest falls among the least well-off. This is not what we see. What cuts across all groups is access to contraception and, equally important, the freedom to use it. The timing of the decline in fertility tracks closely with the expansion of women’s reproductive autonomy, not with any particular economic shock.
Education reinforces this. Better-educated women exercise more choice over how many children they want, when to have them and how many they actually have. It is not that education makes women want to have fewer children, but it is associated with more effective control over that decision. When teenage birth rates fall decade after decade across every country, as they have, that is not young women being unable to afford children; it is a decline in unintended pregnancies. This must be progress, not failure. The conclusion is that much of this decline in fertility simply reflects what women, given genuine choice, actually want. To that extent, it should be welcomed and not seen necessarily as a problem to be solved.
My Lords, as we have heard, declining birth rates carry profound economic and social consequences. The story of human origins in the Book of Genesis begins with a God-given mandate to populate the Earth, and supports the basic goodness of family life. The Christian tradition has consistently affirmed the value of children. The baptism liturgy declares that children are a blessing and a gift from God. That conviction remains important, not only for people of faith but for society as a whole. Children represent continuity, connecting us with the generations that have gone before us and giving hope for the future. They are a gift to the whole community, not only to their parents and others who may raise them.
It is important, however, to understand the complex factors behind declining birth rates, which, as mentioned by the noble Lord, Lord Davies of Brixton, include women’s choice but also fearfulness about the future, difficulties in combining career and family and financial pressures. The expense of housing, student loan repayments and the rising cost of living all contribute to delaying family formation. Couples now marry later, start a family later and often have fewer children than hoped for, not least because, by the time financial circumstances may seem more favourable, biology may well be less co-operative.
As I have said before in this Chamber, we are witnessing the unravelling of an unwritten social contract: namely, if you obtain a decent education and work hard, you should be able to save for a deposit, buy a home, start a family and provide stability for your children until they can do likewise. For many young adults today, that promise feels increasingly out of reach. It takes many years to save for a deposit, and two stable salaries are then typically needed to pay the mortgage, with an average house now costing 7.6 times the average salary, rising to 10.6 in London. High house prices also limit the ability of younger generations to build housing wealth and financial security, contributing to the growing crisis in intergenerational equity. While there are limits to what the state can and should do, there is much within a Government’s power to address some of the barriers that I have described, and to legislate in such a way that supports families of varying shapes and sizes, as outlined so clearly by the noble Baroness, Lady Nargund, in her opening speech.
My thanks, too, to my noble friend for opening this debate.
My Lords, it seems ironic that some of the very same politicians who framed the falling birth rate as a crisis have also pledged to bring back the two-child benefit cap. Meanwhile, the far right peddles racist conspiracy theories about white European populations being replaced and proclaims that having babies is a woman’s patriotic duty.
In contrast, my starting point is women’s choice. Most of us do not want a Handmaid’s Tale-style future, with the state pressurising women into motherhood. Instead, we should celebrate how better education and access to contraception and abortion services has helped women take more control over reproductive choices. In a free society, it is not for government to dictate whether we have children or how many. But government policies can either support citizens’ choices or push them beyond reach. Ordinary people have suffered years of austerity and pressure on wages, and they were told that they had no right to expect job security, let alone a secure home.
I pay tribute to this Government’s Employment Rights Act and Renters’ Rights Act, which guarantee a more stable life, including for those who want to start a family. Policies that recognise that families come in all shapes and sizes are important too. A quarter of families are headed by a single parent, who are overwhelmingly mothers—I was one of them—so action on equal pay and childcare really counts.
The paid parental leave system, which this Government have inherited, is among the worst in Europe. That makes it harder for new mothers to stay in the workforce, or relegates them to second-class status, holding back economic growth. New fathers and other parents get a raw deal too. While many employers top up statutory paternity pay, blue-collar workers are much more likely to rely on the statutory rate, and self-employed dads get nothing at all. The UK’s parental leave system is still rooted in the 1950s idea of the sole male breadwinner and emotionally detached fatherhood—a model of masculinity that only the so-called populist right still aspires to. All the evidence is that women and men want to share parenthood more equally, and giving new babies more time with their parents is one of the best forms of early years investment. Change is urgent.
My Lords, I am most grateful to my colleague, the noble Baroness, Lady Nargund, for having secured this debate, and to the noble Baroness, Lady O’Grady, for having introduced the business of intergenerational solidarity. I want to concentrate on the other end—not on birth but on this older population, because it makes a civic contribution through volunteers and through its economic impact.
The total economic impact of volunteers is to save the country around £27.4 billion per annum. Those over the age of 85 in employment bring in £6 billion to £8 billion in income tax revenue annually, and 1.7 million people earn around half what younger earners gain in employment. So they are working and earning less, but they are bringing in tax and certainly not being a burden on the state.
But there are families where the child cannot be looked after in the conventional way, and I will focus on kinship for a moment. In the 2021 census, most children living in kinship care—that is 60%—lived with at least one grandparent. The 2025 survey showed that nearly half the respondents were aged over 60 and more than one in eight were aged over 70. Seven out of 10 kinship carers are grandparents to at least one child in their care. They are taking a huge burden off the state in many ways, yet they suffer significant practical and financial problems, often using their own savings to look after these children. They have found that, if they go for a special guardianship order, they jeopardise their pension going into the future. For some, it is better financially to remain as kinship foster carers because they get a foster care allowance, but that does not provide as much stability for the child. So I hope that the issue of kinship care will be looked at seriously by the Government because we could improve it and the contribution of kinship carers is enormous.
Looking at volunteers—I declare that I am president of Attend—for Attend alone we have 400 groups across the country working in hospitals. They are led by officers who are usually between 70 and 90 years of age. They work many hours voluntarily. There are about 20,000 people actively supporting their community by belonging to one of these groups, and for each of them there are 10 others who are ad hoc volunteers coming in to provide support across their community. Through Attend alone, we have about 20 young people every year gaining work experience as volunteers in order to strengthen their CVs and move forward later—that volunteer contribution is essential.
My Lords, I congratulate my noble friend Lady Nargund on securing this debate, and I note how busy she seems to have been today. I have a strange feeling that she is only just getting started in your Lordships’ House—let us see what happens next. This debate is a veritable banquet of related policy issues. I intend to address those which are to do with the ageing demographic.
I declare an interest as the chair elect of SCIE, the Social Care Institute for Excellence, founded by your Lordships’ House around 2003. I follow distinguished Members of your Lordships’ House in chairing this organisation. I am also a non-executive director of Whittington Health, where I am the maternity lead. I am going to talk about the demographic impact of our ageing population. It is important to say, as other noble Lords have said, that having a population of so many people living longer is a matter for rejoicing. It creates issues, but it is something for which I think we should all be grateful.
It is indeed the case that 14.2 million of us will be living longer by 2034, and 9.1 million of that number will have a serious illness. So, I am very pleased that the NHS 10-year plan addresses the UK’s ageing population by shifting the health service’s focus from reactive hospital treatment to proactive integrated care in local communities and tackling the unsustainable rise in demand from major illness by promoting preventive care, better digital access and stronger social care.
The plan has various elements. On neighbourhood health services, it will decentralise care by expanding multidisciplinary teams in our local communities. On digital integration, it will enhance the NHS app to empower patients to manage their own care. I appreciate that raises issues of digital exclusion, but those are issues we need to tackle. We should not underestimate the fact that those of us who are older are perfectly digitally capable given the chance to be so—although I have to say the phone on my desk has stopped working again, but I promise I will solve that problem. On preventive healthcare, the NHS will shift from reactive to predictive care by leveraging genomics and health risk scores to intervene earlier.
My Lords, I, too, thank the noble Baroness, Lady Nargund, for her choice of subject—what a neatly symmetrical pairing it was. I wish I could have been here for the earlier debate.
I am one of the ageing—or, I admit, aged—generation, a very lucky generation, a post-World War II baby boomer, who never considered not having a job, leaving university with a huge debt, having to go on working longer than I would want, if I could, or not having stable housing. These are all factors relevant to choices today. We are also a generation, to follow the noble Baroness, Lady Thornton, acutely aware of the importance of social care.
I tend to think in terms of the classic family of parents and 2.4 children, as it was. The replacement rate per woman, I understand, would be 2.1, but the total fertility rate fell last year to less than 1.4. There are many aspects to this issue. I stumbled over a couple of articles recently, and I have picked up on a couple. In the US, people in red states seem to be having more children than those in blue. I am not advocating following Elon Musk, but there is certainly a political hue—which echoes the noble Baroness, Lady O’Grady. Viktor Orbán said before his non-election, “We need Hungarian children”, announcing a lifelong exemption from income tax for women with four or more. The more you read about this, the less men seem to feature in the comments. There are also lots of historical references one might make.
There were factors that I had not anticipated, which I got from an article in the FT that cited sources from a range of academic research. One American university published a paper looking at birth rates through the lens of the rollout of 4G mobile networks in the US and the UK—this takes on the point that the noble Baroness, Lady Nargund, made. The number of births fell first and fastest in areas that received high-speed mobile connectivity earliest. Researchers argue that smartphones reduce young people’s in-person socialising. Another academic commented:
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Youth worklessness is a tragedy on its own terms; it is a waste of potential and a source of future division and alienation. If the first rungs of the ladder are being chopped away, we should not be surprised that fewer people are deciding to climb that ladder. This topic shows that the combination of growing worklessness and an ageing population is a threat to all our futures. The Work and Pensions Secretary who commissioned Milburn’s review called it a cause of our times. Connected to the demographic challenge before us, we could come to see it as the defining cause of our times.
So, I have two questions to put to the Minister. Will he assure us that the Government will respond to the recommendations in the second phase of the report with the urgency and vigour they demand, as echoed by the noble Lord, Lord Blunkett, earlier? Finally—and here, I repeat the comment of the noble Baroness, Lady Nargund—given all these threads coming together, is it time for a wide, coherent, cross-governmental demographic strategy?
In the time remaining, I will add two further thoughts that bear on this issue. First, the last 100 years demonstrate that human society can deal with massive economic and demographic change. I often ponder what Lloyd George, when he introduced his state pension, would have thought about the possibility of having the current, much better, state pension when circumstances, on the criteria that we are talking about now, have made it massively more difficult. But, of course, we have overcome them over time. It is important that we understand that, while people often say time is a healer, it is also an enabler: it enables us to confront these changes.
Finally, there must come a time, now or in the future, when we say that enough is enough. Growth, whether economic or in the population, is not good in itself; it is what you do with what this world provides that really counts.
I am heartened by the Government’s commitment to family hubs. At their best, they can provide valuable help and support for all parents and families. However, they remain something of a postcode lottery. If they are to make a difference across our communities, they should be accessible and attractive to all families, not only those experiencing crisis, and they should be embedded in a wider ecosystem of support, involving voluntary organisations, and community and faith groups.
Secondly, the Government’s family test should be strengthened. It is too weak at present: inconsistently applied and insufficient to ensure that the effects of policy on family relationships are properly considered across government. I therefore urge the DWP to review the family test, strengthen its application and make it a statutory requirement, so that the well-being of families is embedded more firmly across government decision-making. This would signal to prospective parents that their choice to have children will be supported by the state. I therefore ask the Minister whether any steps have been taken to review the family test, considering concerns about declining birth rates.
Demographic change presents us with serious challenges, but it also invites us to reflect on the kind of society that we wish to build. If we value families, if we welcome children as a blessing and as a source of hope, and if we want future generations to flourish, we must ensure that those who wish to marry, establish a home and raise children are not prevented from doing so by barriers that could be avoided.
Similarly, living longer lives should be seen as a measure of human progress. It becomes a crisis only if we fail to put in place policies necessary to support a happy old age, not least tackling the UK’s stark class inequality in healthy life expectancy. The last thing we need is divisive proposals that stoke intergenerational wars. That brings me to the recent report from the Centre for Social Justice, Baby Bust. It argues that “too many retirees” believe that
“they have ‘paid for’ their pension rather than understanding that it is funded by current taxpayers”.
The centre could have usefully added that this generation of taxpayers has an interest in protecting a decent state pension, because one day they will claim it too. The state pension is, in fact, a prime example of intergenerational solidarity.
Reading the report, you might also think that the UK’s state pension provision is generous. It is not. UK spending on state pensions as a percentage of GDP is well below the OECD average. Of course, we must prioritise economic growth to support an ageing society. Many argue that technology is the answer, and it has been calculated that the introduction of AI alone will deliver multibillion-dollar productivity gains. I would welcome the Minister’s views on ways to ensure that those gains are shared fairly, and on how big tech can pay its fair share towards the decent public goods and services that our ageing population has earned.
I also point out, as president of the Chartered Society of Physiotherapy, that falls avoidance is absolutely essential. If we avoid falls among older people and we connect them with other people, often through volunteering, we avoid loneliness and the problems of people saying that they feel that they are a burden. When people feel that they are a burden, they avoid seeking help early and present with problems later. One of the big problems in this older group is hidden alcohol abuse. These are all aspects that we must address if we are going to address the demographic challenges we face.
The plan also envisages social care alignment, which I will spend my last couple of minutes talking about. It emphasises the urgent need to accelerate social care reform to ensure smooth hospital discharges and, more importantly, sustained support at home. It emphasises shifting care closer to home and building a neighbourhood health service. That is not achievable unless we can really place social care on an equal footing with healthcare.
Social care’s role is vital in effectively delivering neighbourhood health and early support. That is why the Casey report is very important. However, I ask my noble friend the Minister whether the interim report expected this year will address the necessary transition to equal status for social care fast enough to allow this delivery to happen. Will the plan also fulfil the commitment to incorporating lived experience in the design of neighbourhood healthcare development? Will the voluntary sector, social enterprises and community organisations also be involved in the delivery of the neighbourhood healthcare we need to develop and build to ensure a soft landing for the future?
“To meet a person you are going to marry”—
they should have said “partner with” instead of “marry”—
“requires filtering through a lot of people”.
He added:
“If you spend lots of time socialising with your peers in the real world, your standards … are anchored in the real world. If you spend your time on Instagram”—
I confess that I do not know whether that is an out-of-date reference—
“your standards are anchored to an artificial sense of what is normal”.
But what is less startling to me is the connection with immigration. It is obvious that the UK’s need for people should not be detached from people’s wish or need to be in the UK—or vice versa. Reform UK says that we need “to cut immigration drastically”, and that:
“At the same time, to fix that population crisis, we’re trying to encourage British people already here to have kids”.
There is a lot to analyse in that, which I do not have time for, but one of their leader’s suggestions is that only “British-born” families should have the two-child benefit limit lifted. We already have a situation in which a lot of people are looked after in care homes and hospitals by the very people who are demonised. The Government and the media should be welcoming them, and lead the way in doing so, because we are in danger of the penny dropping far too late. The following words are not original; I should credit John Harris, who wrote them in the Guardian. He said,
“pulling up the drawbridge as birthrates crashed is the absolute definition of folly”.
No conversation about declining birth rates is complete without addressing assisted reproduction. We still have a postcode lottery for IVF provision, with nearly 70% of ICBs funding only one cycle of treatment. I welcome our Government’s neighbourhood health hubs as an opportunity to improve the early diagnosis of reproductive conditions to facilitate faster treatments of infertility. I have argued repeatedly that the introduction of a national tariff and a price cap for IVF would increase access within the existing budget.
Peer-reviewed research has shown that public funding for IVF delivers an eightfold return on investment to our Treasury, taking into account the lifetime economic value of a child born in the United Kingdom. Furthermore, it promotes the creation of diverse and inclusive families by helping single women and same-sex couples. I therefore ask my noble friend the Minister: should equal and fair access to fertility treatment be recognised as an economic priority?
We cannot speak about demographic decline while leaving families to navigate parenthood alone. Raising a child to the age of 18 now costs around £260,000 for a couple and £290,000 for a single parent. Nearly 40% cite the cost of raising children as a reason for delaying having family; people call it a second mortgage. The UK has the fourth most expensive childcare in the world, and only 11% of employers offer it.
I welcome the Government’s measures in the Renters’ Rights Act and the Social Housing Bill, which matter not only socially but economically. Our statutory paternity leave remains among the lowest in Europe. I also welcome our Government’s review on parental leave, and I urge them to extend paternity leave and pay so that it is viable for all families. Immigration has an important role to play, but immigration alone cannot rebalance these demographic imbalances.
Finally, there is also a digital challenge. Recent research cited in the Financial Times found that the first areas in the UK to receive 4G also saw birth rates fall earliest and fastest. Young people are socialising less and forming fewer long-term relationships. If we are serious about reversing demographic decline, we must also examine the impact of technology on connection, relationships and family formation.
There is no single solution to this challenge, but the thread connecting all of it is economic growth. At the heart of any solution must be family-friendly policies that promote gender parity, support work and parenthood, and create financial security. These are not costs to the Exchequer; they are investments in our future prosperity. This requires co-ordinated cross-governmental action. Will my noble friend the Minister therefore consider the appointment of a dedicated government lead to address this issue? “Demography is destiny” need not become our nation’s fate, but only if we act now. I look forward to my noble friend’s reply.