Loneliness and the cost to the NHS

The World Health Organisation has recognised loneliness as a “priority public health problem and policy issue”, with growing attention from governments worldwide, including the UK’s. While its links to poorer mental health, cardiovascular disease, and mortality are well established, its economic impact on the NHS has been less researched, until now.

Using data from over 23,000 adults in Wave 13 of Understanding Society (2012-23), a group of us at the University of Exeter analysed how loneliness relates to healthcare and costs.

Measuring loneliness

Understanding Society has measured loneliness since Wave 9 (2017-19), but we used data from Wave 13 (2021-23) to avoid the potential distortion of responses caused by the Covid pandemic.

Loneliness is measured in two ways:

• a single-item measure asking: How often do you feel lonely? – with three response options: hardly ever or never, some of the time, and often
• a three-item scale, known as the UCLA Loneliness Scale: How often do you feel you lack companionship?, How often do you feel left out?, and How often do you feel isolated from others? Each question uses the same three response options: hardly ever or never, some of the time, and often.

Participants’ health is assessed using:

• Short Form-12 (SF-12), a 12-item questionnaire covering various aspects of health, including general health, pain, physical functioning, mental health, and vitality
• General Health Questionnaire (GHQ), a 12-item scale measuring psychological distress with questions such as ability to concentrate, lack of sleep, and enjoying day-to-day life
• The Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS), consisting of seven statements related to mental wellbeing, such as feeling optimistic, dealing with problems, and thinking clearly.

The use of healthcare resources was assessed by tracking the frequency of three types of services over a 12-month period: GP appointments, outpatient visits, and inpatient visits. Estimates for the cost of NHS services for 2023 from the Personal Social Services Research Unit were:

• £49 for a 10-minute appointment with a GP
• £217 for a visit to hospital as an outpatient
• £1,111 per day to be a hospital inpatient.

We calculated total NHS costs by applying these cost estimates to the number of times people reported using the three categories of service.

Findings

We found that:

• 40% of people reported feeling lonely at least some of the time, and of these 8% said they felt lonely ‘often’.
• Lonely individuals are more likely to experience poor physical health and mental health, and mild depression.
• They also make greater use of NHS services, including more frequent GP visits, outpatient care, and hospital admissions.

In terms of the cost to the NHS:

• For those feeling lonely often, there is an extra cost to the NHS of between £813.35 and £885.49 per person per year.
• If we include those who feel lonely ‘sometimes’, the additional cost is between £352.39 and £409.42 per person per year.

We also found that the cost impact varies with age, forming a U-shaped curve: it is higher among young adults (16-24) and older adults.

Policy implications

Loneliness is not just a social issue. It’s a significant public health and economic concern. Our findings mean there is a strong case for:

• increasing the country’s investment in young adults’ healthcare
• making loneliness a priority in NHS strategy and prevention efforts
• targeted action to reach ethnic minority groups and underserved populations.

As loneliness continues to affect so many, addressing it is vital, not just to improve wellbeing and health-related quality of life, but to recognise that loneliness comes with substantial costs, to people, and to society. We hope our research will encourage new approaches to help people build connections, improve wellbeing, and ultimately reduce the burden on health services.

Read the research

Authors