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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.