The UK and healthcare what challenges lie ahead?

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1 This presentation was delivered on 8 th February 2018, not for onward distribution The UK and healthcare what challenges lie ahead? Neil Parker NatWest Markets FX Market Strategist February 2018 The views expressed within this presentation are those of Neil Parker, Market Strategist, Desk Strategy, which is a part of the NatWest Markets business. This is not Independent Research, as defined by the Financial Conduct Authority. This material should be regarded as a marketing communication and may have been produced in conjunction with the NatWest Markets trading desks that trade as principal in the instruments mentioned herein. All data is as at 18 th January 2018.

2 Contents Global growth UK growth slow, but global growth picking up Interest rates - rising Inflation stubbornly above target Disposable incomes squeezed Labour supply worsening migration stats and a lack of domestic supply Demographics an ageing population and a falling birth rate, not an ideal combination Brexit still posing risks Housing market prices still mostly rising Government spending on welfare increasing in nominal and real terms 2

3 Global growth UK growth slow, but global growth picking up GDP f 2018f US Euroland Euroland UK UK India China Japan World Source: IMF World Econom ic Outlook, Oct 2017 The global economy s size by region $millions World 75,845,109 East Asia & Pacific 22,480,428 Europe & Central Asia 20,273,841 Euro Area 11,934,057 United Kingdom 2,647,899 Latin America & Carribean 5,299,866 Middle East & North Africa 3,144,798 North America 20,160,296 South Asia 2,892,481 Sub-Saharan Africa 1,512,596 figures are from 2015 or 2014 source: World Bank World Development Indicators database December

4 Interest rates - rising US Fed Funds Rate, % UK BoE Bank Rate, % EA ECB Refi Rate, % % First hike in a decade Month/year Source: Datastream 4

5 Inflation stubbornly above target (and high in comparison terms) UK consumer price index (CPI) (%y/y) UK CPI inflation currently stands at 3% y/y (Dec) - a full percentage point above target. In comparison US CPI is 2.1% y/y (Dec), Euroland CPI is 1.4% (Dec), Canada is 2.1% (Nov), China is 1.8% (Dec) and Japan is 0.6% (Nov). The fall in the GBP s value is unwinding from the calculation (in terms of higher import costs), but domestic inflation may be replacing it. Stubbornly high (above target) inflation in the UK could force the Bank of England s hand on monetary policy. Source: Thomson Reuters Datastream 5

6 Disposable incomes squeezed UK household disposable income (%q/q) UK household disposable incomes have been squeezed over recent quarters. A combination of factors, including inflation and taxation (indirect) are likely responsible. Will wage inflation rise above CPI/RPI inflation rates? What will the government s response to lower borrowing/higher VAT rates be? Source: Thomson Reuters Datastream 6

7 Labour markets tightening with lower rates of net inward migration Source: ONS, Thomson Reuters Datastream, NatWest Markets Could this mean higher wage inflation? 7

8 Demographics an ageing population and a reduced fertility rates (not an ideal combination) UK life expectancy UK total fertility rate (births per woman) UK Female life expectancy (in years) UK Male life expectancy (in years) Source: World Bank World Development Indicators Database, Dec

9 Brexit still posing risks 29-Mar UK trigger Article Apr 08-Jun 19-Jun 24-Sep EU Summit on UK's EU exit UK general election (hung parliament - Conservatives largest party) Formal negotiations begin between UK/EU German general election (CDU win, but coalition needed - talks ongoing) The Brexit negotiations are following this approach: 1) Negotiations on the UK-EU split + Negotiations on the bill for that split, based on the UK s financial precommitments. 15-Oct Q Oct Dec Q Mar-18 end Q Mar-19 Austrian general election (Coalition talks ongoing) UK Budget Council of Europe meeting (not enough progress made) Council of Europe meeting (phase 2 negotiations agreed) Phase 2 of negotiations to begin Italian general election to be held no later than this Conclusion of negotiations? UK to leave EU 9 2) Negotiations on transitional trade arrangements. 3) Negotiations on a future agreement on trade.

10 Housing market prices still climbing (mostly) UK Nationwide house price index (%y/y) Source: Nationwide house price index Dec

11 Government spending on welfare increasing in nominal and real terms State pension as a % of Total Managed Expenditure Total managed expenditure (TME) in the UK stood at 772.4bn at the end of FY 2016/17. Of that, welfare spending was 216.9bn (or roughly 30% over all the money the government spends). If you roll into that the NHS spending ( 119.1bn in 2016/17), then spending on welfare and the NHS accounts for 43.5% of TME, and is rising. Recent figures on receipts are encouraging (in terms of narrowing the deficit), but there is still a c 50bn gap between receipts and spending. Fiscal Year Source: Office for Budget Responsibility, NatWest Markets 11

12 Summary UK growth may have troughed and EUR growth may have plateaued. We expect the UK inflation rate to drop back as imported price pressures subside (but it currently remains stubbornly above target. Labour markets are tight, and migration is down. Productivity needs to rise. The UK monetary policy tightening cycle is likely to see two further tightenings this year. Brexit timescales are very tight. Global growth could provide some significant positive investment shocks, especially in a price/cost sensitive environment. The pressures on healthcare (from an ageing population and restrictions on government resources) present risks, and opportunities. 12

13 Disclaimer All data is accurate as of the report date, unless otherwise specified. This communication has been prepared by The Royal Bank of Scotland plc, and should be regarded as a Marketing Communication, for which the relevant competent authority is the UK Financial Conduct Authority. Please follow the link for the following information MAR Disclaimer Conflicts of Interest statement Glossary of definitions Historic Trade ideas log This communication has been prepared by The Royal Bank of Scotland plc, The Royal Bank of Scotland N.V. or an affiliated entity ( RBS ). This material is a Marketing Communication and has not been prepared in accordance with the legal and regulatory requirements designed to promote the independence of investment research and may have been produced in conjunction with the RBS trading desks that trade as principal in the instruments mentioned herein. This commentary is therefore not independent from the proprietary interests of RBS, which may conflict with your interests. Opinions expressed may differ from the opinions expressed by other business units of RBS. No part of the remuneration of the author(s) is directly tied to any transactions performed, or trading fees received, by any entity of RBS Group. This material includes references to securities and related derivatives that the firm's trading desk may make a market or provide liquidity in, and in which it is likely as principal to have a long or short position at any time, including possibly a position that was accumulated on the basis of this analysis material prior to its dissemination. Trading desks may also have or take positions inconsistent with this material. This material may have been made available to other clients of RBS before it has been made available to you and is not subject to any prohibition on dealing ahead of its dissemination. This document has been prepared for information purposes only, does not constitute an analysis of all potentially material issues and is subject to change at any time without prior notice. It is indicative only and is not binding. Other than as indicated, this document has been prepared on the basis of publicly available information believed to be reliable but no representation, warranty, undertaking or assurance of any kind, express or implied, is made as to the adequacy, accuracy, completeness or reasonableness of this material, nor does RBS accept any obligation to any recipient to update, correct or determine the reasonableness of such material or assumptions contained herein. RBS and each of its respective affiliates accepts no liability whatsoever for any direct, indirect or consequential losses (in contract, tort or otherwise) arising from the use of this material or reliance on the information contained herein. However this shall not restrict, exclude or limit any duty or liability to any person under any applicable laws or regulations of any jurisdiction which may not lawfully be disclaimed. The opinions, commentaries, projections, forecasts, assumptions, estimates, derived valuations and target price(s) or other statements contained in this communication (the Views ) are valid as at the indicated date and/or time and are subject to change at any time without prior notice. Views expressed herein are not intended to be, and should not be viewed as advice or as a personal recommendation. The Views may not be objective or independent of the interests of the authors or other RBS trading desks, who may be active participants in the markets, investments or strategies referred to in this material. RBS will not act and has not acted as your legal, tax, regulatory, accounting or investment adviser; nor does RBS owe any fiduciary duties to you in connection with this and/or any related transaction and no reliance may be placed on RBS for investment advice or recommendations of any sort. You should make your own independent evaluation of the relevance and adequacy of the information contained in this document and make such other investigations as you deem necessary, including obtaining independent financial advice, before participating in any transaction in respect of the securities referred to in this document. This document is not intended for distribution to, or use by any person or entity in any jurisdiction or country where such distribution or use would be contrary to local law or regulation. The information contained herein is proprietary to RBS and is being provided to selected recipients and may not be given (in whole or in part) or otherwise distributed to any other third party without the prior written consent of RBS. RBS and its respective affiliates, connected companies, employees or clients may have an interest in financial instruments of the type described in this document and/or in related financial instruments giving rise to potential conflicts of interest which may impact the performance of such financial instruments. Such interests may include, but are not limited to, (a) dealing in, trading, holding or acting as market-maker or liquidity provider in such financial instruments and any reference obligations; (b) entering into hedging strategies on behalf of issuer clients and their affiliates, investor clients or for itself or its affiliates and connected companies; and (c) providing banking, credit and other financial services to any company or issuer of securities or financial instruments referred to herein. RBS and its affiliates, connected companies, employees or clients may at any time acquire, hold or dispose or long or short positions (including hedging and trading positions) which may impact the performance of a financial instrument. In the U.S., this Marketing Communication is intended for distribution only to major institutional investors as defined in Rule 15a-6(a)(2) of the U.S. Securities Exchange Act 1934 (excluding documents produced by our affiliates within the U.S.). Any U.S. recipient wanting further information or to effect any transaction related to this trade idea must contact RBS Securities Inc., 600 Washington Boulevard, Stamford, CT, USA. Telephone: The Royal Bank of Scotland plc is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and Prudential Regulation Authority. National Westminster Bank Plc is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and Prudential Regulation Authority. The Royal Bank of Scotland plc is authorised to act as agent for National Westminster Bank Plc. The Royal Bank of Scotland N.V. is incorporated with limited liability in the Netherlands, authorised and regulated by the De Nederlandsche Bank and has its seat at Amsterdam, the Netherlands, and is registered in the Commercial Register under number Registered Office: Gustav Mahlerlaan 350, Amsterdam, The Netherlands. The Royal Bank of Scotland plc is, in certain jurisdictions, an authorised agent of The Royal Bank of Scotland N.V. and The Royal Bank of Scotland N.V. is, in certain jurisdictions, an authorised agent of The Royal Bank of Scotland plc. Securities business in the United States is conducted through RBS Securities Inc., a FINRA registered broker-dealer ( a SIPC member ( and a wholly owned indirect subsidiary of The Royal Bank of Scotland plc. For further information relating to materials provided by RBS, please view our RBSM Terms and Conditions. NatWest Markets is a marketing name of The Royal Bank of Scotland plc, National Westminster Bank Plc, RBS Securities Inc. and RBS Securities Japan Limited. Copyright 2017 The Royal Bank of Scotland Group plc. All rights reserved. Version

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