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We must meet the needs of an ageing country We must meet the needs of an ageing country
(7 months later)
The purpose of looking to the future, said the French writer and industrialist Gaston Berger, is to disturb the present. Last week, in an admirably detailed House of Lords report, Britain was told it was "woefully underprepared" to cope with the expected rapid increase in the number of older people in the population. Led by Lord Filkin, a special committee of peers blamed successive governments for the inertia that has resulted in an imminent crisis in resources; stretched health and social care services and growing unfairness in who carries the main burden of cost for this demographic "agequake". The response of government and opposition so far to Ready for Ageing? has been disgracefully muted to the point of indifference.The purpose of looking to the future, said the French writer and industrialist Gaston Berger, is to disturb the present. Last week, in an admirably detailed House of Lords report, Britain was told it was "woefully underprepared" to cope with the expected rapid increase in the number of older people in the population. Led by Lord Filkin, a special committee of peers blamed successive governments for the inertia that has resulted in an imminent crisis in resources; stretched health and social care services and growing unfairness in who carries the main burden of cost for this demographic "agequake". The response of government and opposition so far to Ready for Ageing? has been disgracefully muted to the point of indifference.
The report couldn't make it plainer. The postwar welfare state was predicated on full employment followed by a brief retirement. Now we are moving to a society in which centenarians are increasingly common and a third of life will consist of retirement. Yet services, pensions and social care continue to be moulded by the outdated 1950s model. We are in desperate need of a national strategy that includes a radical reconfiguration of health and social care to create a seamless single service; a major shift of investment from acute hospital services to prevention and care in the community and an innovative use of the skills of millions of baby-boomers in their last decades.The report couldn't make it plainer. The postwar welfare state was predicated on full employment followed by a brief retirement. Now we are moving to a society in which centenarians are increasingly common and a third of life will consist of retirement. Yet services, pensions and social care continue to be moulded by the outdated 1950s model. We are in desperate need of a national strategy that includes a radical reconfiguration of health and social care to create a seamless single service; a major shift of investment from acute hospital services to prevention and care in the community and an innovative use of the skills of millions of baby-boomers in their last decades.
The report warns of a "series of miserable crises". What it doesn't spell out is that a society in which the young forfeit their prospects because access to education, skills, housing and income are increasingly unattainable as older citizens remain relatively cushioned strains the social contract to the point of crisis. In an interview with the Guardian, a frustrated Lord Filkin said of the government's position: "… when you ask what's the plan to address this changing pattern and need [the reply] is essentially, 'we don't believe in top-down Stalinist control…'"The report warns of a "series of miserable crises". What it doesn't spell out is that a society in which the young forfeit their prospects because access to education, skills, housing and income are increasingly unattainable as older citizens remain relatively cushioned strains the social contract to the point of crisis. In an interview with the Guardian, a frustrated Lord Filkin said of the government's position: "… when you ask what's the plan to address this changing pattern and need [the reply] is essentially, 'we don't believe in top-down Stalinist control…'"
This policy of pass-the-parcel counterfeit localism is not good enough. How can a holistic national strategy be knitted together by 200 clinical commissioning groups and numerous health and wellbeing boards, not to mention financial services, housing and care providers and employers' organisations all acting independently without a common framework? Government and citizens urgently have to prepare better for older age and our "future selves"; this requires co-ordinated action on all fronts, physical, mental, financial and practical. It requires a different ethos that sees older people as assets, not liabilities, and that tackles ageism.This policy of pass-the-parcel counterfeit localism is not good enough. How can a holistic national strategy be knitted together by 200 clinical commissioning groups and numerous health and wellbeing boards, not to mention financial services, housing and care providers and employers' organisations all acting independently without a common framework? Government and citizens urgently have to prepare better for older age and our "future selves"; this requires co-ordinated action on all fronts, physical, mental, financial and practical. It requires a different ethos that sees older people as assets, not liabilities, and that tackles ageism.
In some quarters, that amounts to a revolutionary change in attitude. As Duncan Selbie, chief executive of the newly created Public Health England, that comes into operation on 1 April, rightly says, Britain is obsessed with hospitals, spending billions on expertise and equipment when what is required is much greater effort to keep us out of hospital. The Nuffield Trust, for instance, predicts that an ageing population in an unchanged NHS will cost an extra £54bn from 2011 to 2022 – for a country that already has empty coffers. The Lords report calls for a number of measures including a review of universal pensioners' benefits such as the free bus pass and an improved scheme to allow retirees to sell equity in their homes. Whatever the merits or demerits of such proposals, neither is likely to appear in this week's budget, an occasion traditionally and mistakenly too beset by short termism to address our more profound and long-term issues.The evidence of what lies ahead is startling. Between 2010 and 2030, it is predicted there will be a 50% increase in people aged 65 and over to 15.5 million and a doubling of people aged 85 and over to 4.5 million. In the 1900s, only 4% of the population lived much beyond the age of 60.In some quarters, that amounts to a revolutionary change in attitude. As Duncan Selbie, chief executive of the newly created Public Health England, that comes into operation on 1 April, rightly says, Britain is obsessed with hospitals, spending billions on expertise and equipment when what is required is much greater effort to keep us out of hospital. The Nuffield Trust, for instance, predicts that an ageing population in an unchanged NHS will cost an extra £54bn from 2011 to 2022 – for a country that already has empty coffers. The Lords report calls for a number of measures including a review of universal pensioners' benefits such as the free bus pass and an improved scheme to allow retirees to sell equity in their homes. Whatever the merits or demerits of such proposals, neither is likely to appear in this week's budget, an occasion traditionally and mistakenly too beset by short termism to address our more profound and long-term issues.The evidence of what lies ahead is startling. Between 2010 and 2030, it is predicted there will be a 50% increase in people aged 65 and over to 15.5 million and a doubling of people aged 85 and over to 4.5 million. In the 1900s, only 4% of the population lived much beyond the age of 60.
Today, the gift of longer life is a tribute to progress, but longevity is not always married to good health. More than 15 million people have long-term conditions such as diabetes, heart problems and arthritis. Health inequalities are growing and they hit the oldest hardest. The wealthier have an extra 10 years of life. While pensioner poverty has considerably diminished, one in six still lives on very little. A "care deficit" is also opening up. Families live further away, women are in paid work and informal care is harder to come by, while the Care Quality Commission says that too much paid care lacks the milk of human kindness. So what's to be done?Today, the gift of longer life is a tribute to progress, but longevity is not always married to good health. More than 15 million people have long-term conditions such as diabetes, heart problems and arthritis. Health inequalities are growing and they hit the oldest hardest. The wealthier have an extra 10 years of life. While pensioner poverty has considerably diminished, one in six still lives on very little. A "care deficit" is also opening up. Families live further away, women are in paid work and informal care is harder to come by, while the Care Quality Commission says that too much paid care lacks the milk of human kindness. So what's to be done?
Ready for Ageing? has a number of proposals, including a white paper on preparations for the demographic change, commissions of inquiry into pensions and financial preparations for older age, and commitments in all party manifestos for the 2015 general election detailing how parties aim to tackle longevity. It's a good beginning, but this is a crusade that urgently requires cross-party champions to lever rapid change.Ready for Ageing? has a number of proposals, including a white paper on preparations for the demographic change, commissions of inquiry into pensions and financial preparations for older age, and commitments in all party manifestos for the 2015 general election detailing how parties aim to tackle longevity. It's a good beginning, but this is a crusade that urgently requires cross-party champions to lever rapid change.
For now, policymakers prefer to distract with arguments that pitch young versus old in the terrain of who gets what from limited resources. Baby-boomers contribute significantly, not least in taxes and childcare provision. According to the charity Grandparents Plus, 60% of grandparents provide childcare for their families. However, inequality will undoubtedly creep in between generations as numbers of those aged 80-plus increase. Wiser investment in prevention and treating even the very old as active and engaged citizens in the community, not shut away in ghettoes, may keep this group independent for longer, freeing up vital resources for the young.For now, policymakers prefer to distract with arguments that pitch young versus old in the terrain of who gets what from limited resources. Baby-boomers contribute significantly, not least in taxes and childcare provision. According to the charity Grandparents Plus, 60% of grandparents provide childcare for their families. However, inequality will undoubtedly creep in between generations as numbers of those aged 80-plus increase. Wiser investment in prevention and treating even the very old as active and engaged citizens in the community, not shut away in ghettoes, may keep this group independent for longer, freeing up vital resources for the young.
So where do we go from here? Chronological age is no longer a guide to capabilities but income and employment are. Health inequalities must be reduced; more imagination is required in areas such as technology, housing, transport and planning. The middle-aged can no longer design only for the middle-aged. (Signs for optimism exist, such as the arrival of the car that parks itself and York's attempts to become a dementia-friendly city.) One size does not fit all. Extending a working life to 70 may seem like a good idea to a fortysomething policymaker but not to the 50-year-old already involuntarily without a job or the disabled person who has worked 30 years and is also a carer. Policies require flexibility.So where do we go from here? Chronological age is no longer a guide to capabilities but income and employment are. Health inequalities must be reduced; more imagination is required in areas such as technology, housing, transport and planning. The middle-aged can no longer design only for the middle-aged. (Signs for optimism exist, such as the arrival of the car that parks itself and York's attempts to become a dementia-friendly city.) One size does not fit all. Extending a working life to 70 may seem like a good idea to a fortysomething policymaker but not to the 50-year-old already involuntarily without a job or the disabled person who has worked 30 years and is also a carer. Policies require flexibility.
Carving out a different settlement that includes a far older population is virgin territory. It needs the application of innovative minds and much more central government drive and direction, not disregard. We are at a pivotal moment not only for growth, austerity and George Osborne's political reputation, but also for the choice between a society that invests and restructures to build a flourishing society in which the generations are integrated and mutually supportive or one that withers on the ageing vine.Carving out a different settlement that includes a far older population is virgin territory. It needs the application of innovative minds and much more central government drive and direction, not disregard. We are at a pivotal moment not only for growth, austerity and George Osborne's political reputation, but also for the choice between a society that invests and restructures to build a flourishing society in which the generations are integrated and mutually supportive or one that withers on the ageing vine.
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