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.

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?