Editorial: Time for a full review of the needs of the elderly

Responses to demographic change have been piecemeal and badly co-ordinated


The picture of Britain painted by the Census is unequivocal: not only are we more diverse than ever before, we are also older. There are now more than 10 million people over the age of 65, the proportion of the population that is 85-plus has shot up by nearly a quarter in a single decade, and the trend is only accelerating.

Warnings of a "demographic time bomb" are far from new. But despite the dire predictions of ever-rising numbers of the elderly relying on a dwindling cohort of working-age adults, so far all attempts to deal with the consequences have been piecemeal, unco-ordinated or simply put off. That so many people are living longer should be celebrated not bemoaned, and the tendency to cast the elderly as a burden is as misleading as it is offensive. But the issues raised by a change in Britain's age balance are complicated ones.

The Dilnot review of social care funding is a case in point. While the proposals to cap the amount an individual must pay met with broad agreement among politicians and experts alike, progress towards a firm policy has been glacially slow. There are now hints of an imminent deal, but with a price tag approaching £1bn it is unclear where the austerity-racked Treasury will find the money. Nor is that the only demographic black hole in the public finances. There are also the Government's yawning pension liabilities to consider. The Coalition has made a start, instituting controversial plans to crimp public sector entitlements, streamline state pensions and raise the retirement age; but such plans are far from a solution.

Nor do the problems of an ageing population begin and end with cost. The inadequacy of our institutions is no less of a challenge. Looking after the elderly requires a mix of social care and health services; as things stand, however, it is split between local councils and NHS bodies that are often incoherent and may not even cover the same geographical area.

Meanwhile, the NHS is struggling to treat rising numbers of age-related, chronic complaints, such as diabetes, in a system centred on district hospitals and designed to cater for the acutely ill. There has long been talk of a new-look NHS, with more specialist clinics and lots of domiciliary care; but progress is, again, so slow as to be almost imperceptible.

Individually such changes are tricky enough. But there is a broader issue here. An older Britain requires an across-the-board rethink of many of the basic services of the state. Yet different institutions – councils, the Treasury, the NHS – continue to pursue what reform agendas they have in isolation from one another. We cannot afford to continue in so haphazard a manner. What is required is a wide-ranging review of Britain's changing demography and its implications. That means cutting across the public sector's organisational silos, setting out full estimates of the changing profile of the Exchequer's finances, and considering everything from medical research priorities to the suitability of existing housing stock to future demands on public transport.

It also means tackling social prejudice. There may be more old people than ever, but they are too often sidelined, neglected or even abused. Not only are such attitudes shameful in themselves, they also raise practical problems. Raising the retirement age, for example, is only feasible if older people can work. Yet entrenched ageism leaves even those in their mid-50s often struggling to overcome the assumption that they are on the employment scrapheap.

It is a characteristically youthful blindness to assume old age to be a phenomenon that only affects other people. The Census may only have confirmed what we already knew about British society. But it is still a stark admonition to grow up and get our affairs in order.

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