Ageing: opportunity or challenge?

The ageing of our population is rarely out of the news but planning for later life is not new. In Shakespeare’s time, King Lear’s declaration - ‘Tis our fast intent to shake off all cares and business of age, conferring them on younger strengths while we unburdened crawl towards death’ – represented a distinctive approach to retirement planning. It didn’t end well.

Five hundred years later the government is ‘woefully unprepared’ for the consequences of an ageing population, according to the verdict of an influential House of Lords report, Ready for ageing?, earlier this year. It warned that the success of increased longevity – ‘gift of longer life’ – will be dwarfed by a series of crises unless the implications for a wide range of public services, such as pensions, health care, social care and housing, are properly thought through. The government’s desultory response – an unimaginative recitation of ad hoc initiatives – does not inspire confidence that it has got the message.

Our life expectancy is rising by around five hours a day or nearly three months a year. The Office of Budget Responsibility’s latest forecasts confirm that, like most advanced nations, age-related public spending will take up a bigger share of our GDP. This raises big questions about how we make an adjustment and what it means for inter-generational equity during a decade of austerity.

These questions are not just abstract policy concepts. The consequences of not dealing with them touch the lives of millions. Nowhere is this more evident than in the NHS and social care system. Periodic fits of moral outrage when hospitals or care homes fail to provide safe, dignified care are symptoms of our failure to think through how good care for more and more frail older people with multiple conditions can be delivered in the fast-paced environment of modern, technology-driven acute hospitals. Likewise the care needs of escalating numbers of people with dementia – a direct consequence of longevity. The Care Bill and Dilnot are a step forward, but a long way from a truly reformed (not just a reorganised) care system.

The separate systems of health and social care are being left behind by 65 years of rising affluence and demographic and social change. Continuing health care is a glaring example. There are at least four ways in which nursing home care can be funded, even though people’s underlying needs are much the same. More people are falling into the no-man’s-land between means-tested social care and NHS services that are free at the point of use. The State’s offer if you have dementia looks very different to its offer if you have cancer.  Whereas most NHS care is publicly financed and free at the point of need, 90 per cent of social care is privately delivered and around half is funded by individuals themselves.

Navigating this complex and confusing maze of different entitlements can be a nightmare as Ray’s and Clifford’s stories testify. More of us will experience this for ourselves as we and our families enter later life. That’s why we’ve established the Barker Commission to see if there’s a better way of sorting out people’s entitlement to services , and how these are funded, in a way that reflect the needs they have now, not the defunct boundaries of planet 1948. The Commission is keen to engage with people who have firsthand experience of these issues and explore ideas about how they can be overcome.

There are some reasons to be cheerful. A familiar political Achilles heel is over-estimating what can be achieved in the short term and under-estimating what can be achieved in the long term. Though there are now 25 times more people aged 85 and over than there were in 1901, services have not collapsed. Short-term views that define ageing as a problem or burden ignore the extent to which older people are net contributors to society through continuing employment, volunteering, caring (including child care) and the important roles they play in civic society (the average age of elected councillors, for example, is 60). And some cohorts of older people are the wealthiest ever – 60 per cent of people aged 65 and over have household wealth of £250,000 (creating a risk that we drift into what JK Galbraith termed ‘private affluence and public squalor’). 

So to secure the opportunities of the ‘gift of longer life’ we have to face up to the challenges too – and think differently about how we organise and fund our health and care services for an ageing population.

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Comments

#40755 David Oliver
Consultant Geriatrician/Visiting Fellow
Royal Berks/Kings Fund

Excellent contribution to the debate as ever, Richard and for those who havent seen the Lord's Report "Ready for Ageing" it is an excellent basefile and took evidence from a very wide variety of experts. I just wanted to pick up on the point about catastrophising and the language that goes with it. I really dont want to hear any one using phrases like "apocalyptic demography", the "tsunami/burden/ticking time bomb" of ageing. "Challenge"? Sure. But the doom-laden language just reinforces ageist stereoptypical attitudes so well described in the Centre for Policy on Ageing Reviews on Ageism and Age Discrimination and so prevalent in our media and social zeitgeist. As Richard says, there has been similar doom-mongering for years, just as there has been about "feral youth" and we have survived.

Not only will many people work longer than traditional state retirement age and continue to contribute, but as the Sternberg Report showed, over 65s can make a net contribution not only the 1 million plus who do still work but also through unrecognised, unpaid caregiving and volunteering. Also, most people over 75 self rate their health as good or excellent, their self reported life satisfaction is higher than any age apart from late teens, and most are not ill, socially isolated or dependent on care. We also need to factor in the possibility of economic growth, current increases in birth rate, net immigration (often of younger economic migrants) and radical reform of the way we organise (and pay for?) care. Older people are citizens who have the same moral worth and human rights as the rest of us and have often made long contributions to our society - not somehow "other" - aliens in our midst whose increasing numbers provoke wailing and gnashing of teeth. And we need to stop portraying them either as "elite" elders (skydiving, running marathons etc) or "the elderly" (all ages from 65 to 100?) - passive, dependent, recipients of services, so that they are only visible if they can still look and behave like younger people.

David Oliver

#40758 Mike lauerman
Trustee
Numerous

A test of policy and other initiatives should whenever possible avoid splitting age cohorts eg public transport in which there is demand across all age ranges and there is a potential virtuous circle; access to leisure and library services similar ; joined up housing policy recognising the benefits of mixed age ranges in existing and planned developments. A plea for joined up policies!

#40759 Dr Alan Cleary
Member
The Law Society's National Committee Representing Disabled Professionals

Start by reading "The Imaginary Time-bomb" published 2002 to identify the real problem. The nub of it is Ageism and bias in employment not Age. Even senior staff of age-related charities are all young people.
Policy has simply shifted the unemployment burden from married women (or equivalents) and ethnic minorities to over 55's, disabled people and new graduates rather than eliminate the burden as in the past.

#40760 Roger Steer
Director
Healthcare Audit Consultants Ltd

The issue is that death is a great equaliser but the longer the life the greater inequality can develop as the rich get richer.
The issue therefore is not age per se but increasing inequality.
But the more politically significant the elderly cohort the more effective they become at defending their privileges , accumulated wealth and effectively the means to their offsprings life after death.
Their are two alternatives : countervail or take advantage.
Countervailing is old hat and difficult but taking advantage may offer new opportunities e.g. by increasing family responsibilities for mutual support; offering the elderly fiscal advantages from investing in retirement villages etc; increase the retirement age; surcharge pension pots etc.
But the most important thing not to do is to cap services to the elderly.
There is likely to be a buoyant level of demand and increased resources available. To try to resist would be counterproductive; cause distress and depress the economy and service sector.

#40761 Richard Powderhill
Disabled Senior Citizen

Having been rendered disabled in my 50`s, & now a pensioner, I am in the unbelievable position of having to take the local government to court for not obeying the Disability & Equality laws regarding stair lift repair & maintenance in the local borough. This is recklessly threatening the lives of 7000+ people, yet the attitude of the local social services us we`re not going to pay it, do what you like about it`. Psychiatric screening is the only answer to putting people in authority, there become daily hiatuses in the N.H.S. & Care organisations owing to none-medically qualified persons being employed, probably to `save money`. The latest is a `manageress` in the local ambulance service interfering with medical edicts saying to one patient she had cancelled the ambulance to an out patient clinic, `you don`t need an ambulance, run round the corner, & catch a bus!`, this to a man confined to a wheelchair for ten years. A SERIOUS RENAISSANCE IS OBVIOUSLY DUE.

#40763 Mike Nicholls
Retired Councillor

I question the common assumption that a trend that that has existed for the last 10 years will continue for the next 20 years or more. I know of no trend that continues in a straight line for that sort of time, except possibly scientific advancement. There is no reason to suppose that the present rate of increase in life expectancy will continue at the same rate indefinitely.

I would question the relative priority that is given to financing the care for the elderly compared with the preservation of works of art and antiquities. In the recent past the preservation of the nuclear bunkers have been approved and the restoration of the rotting German bomber, that was raised from the seabed, the cost of which will be several million. It would be far cheaper to build a replica if people feel it is important for the younger generation.

Then there is the money spent on saving works of art "for the nation" in most cases this means expending several million pounds on an item that
will be displayed in a London gallery where it will be viewed by a few thousand people, many of whom will come to see it simply because of the price. It may from time to time be on display in regional galleries, but the proportion of the population influenced by the work of art is tiny.

Social Care gets little recognition. I take part in Ugov polls. On 2 occasions I have had to point out that polls regarding health matters are incomplete, if they do not include the contribution from Social Care.

Taking dementia as an example. Diagnosis and early advice has improved and support towards the end of life is available, but there are still far too many carers, who have to be on hand 24/7 and receive no practical help, despite the provision of some money for this purpose.

There is a wide spread aversion to committing to any expenditure that appears to be open ended.

People are more important than things.

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