an economic perspective

Demand for both health and social care in England is rising significantly. This is partly as a result of an increasing population, but in particular due to the inexorable ageing of that population.

Significant and very welcome improvements in standards of living and medical care over the last century have resulted in a higher number of people surviving into old age. In 1948, when the NHS was founded, 48 per cent of people died before the age of 65. Today that figure is down to 14 per cent.  By 2030 it has been estimated there will be 51 per cent more people aged 65 and over in England compared to 20103 and that by 2037 the number of those over 80 will have doubled to 6 million.

Having an ageing population is a huge asset for the country. It expands the available workforce, and offers a wealth of experience. And while many older people enjoy a well-earned retirement, that often includes other forms of contributing to society, for example through volunteering. Millions of active grandparents also provide hugely valuable support for working families, which also has knock-on benefits of supporting the family and hence wider social cohesion. In 2013 it was estimated that the value of grandparental childcare in the UK was £7.3 billion. A report for the Department for Work and Pensions found that 54 per cent of families received regular help from grandparents to provide childcare after the mother returned to work

People over 65 account for 80 per cent of hospital admissions that involve stays of more than two weeks, according to the King’s Fund. And, as they go on to say, the cost of their stay tends to incur greater costs: “Older people are more likely to stay a long time in hospital, to be moved while there, to experience delayed discharge, and to be readmitted within a month as an emergency”.

As the population grows older, ageing-related diseases, such as dementia and Parkinson’s disease, are becoming more common and people’s needs are more likely to span across the divide between health and social care. The growth in the older population also coincides with huge spending pressures on adult social care, despite councils’ best efforts to protect budgets. Councils spent £14.6 billion on adult social care in 2013/14 – 35 per cent of local government spending.  As one of the biggest service users, older people in particular will be affected by the cuts. Over 65’s currently account for 51 per cent of local authority spending on adult social care.

The Health and Social Care Act 2012 radically redistributed the national and local management of public health services, transferring responsibilities for public health budgets to local authorities and creating Health and Wellbeing Boards and Directors of Public Health. This was driven by an attempt to make commissioning more locally-driven and produce better health outcomes, more efficiently.

A new BMA report 26.9.16 warns that the UK’s fragmented health and social care system is failing older patients as it is unable to cope with the increasing pressure from an ageing population with more complex needs. This follows warnings from the King’s Fund and Nuffield Trust that vulnerable, older people in England are having to fend for themselves because government-funded care is being scaled back, with spending on care by councils falling by a quarter in real terms in the five years up to 2015.

“Growing older in the UK”, the BMA’s series of expert-authored briefing papers on ageing and health, highlight the increasing demand and inadequate resources facing the UK’s health and social care system. It is estimated that four in 10 people aged over 65 years old and seven in 10 over 85 years olds have a long-term illness. Out of sixteen million adults admitted to hospital in England in 2014-2015, almost half (47%) were aged over 65. The report calls for more to be done to support and improve people’s health and wellbeing as they grow older in the UK, including:

  • Action to tackle the social isolation of older people through a focus on ‘social prescribing’ – connecting people to non-medical and community support services.
  • A focus on tackling the under-diagnosis and under-treatment of mental health conditions in older adults, to help ensure that parity of esteem between older people’s physical and mental health becomes a reality.
  • A focus on developing a ‘carer friendly health service’, whereby carers are identified, provided with adequate information and advice, and their expertise listened to and respected. Carers should also be supported to look after their own health, as well as that of the person they are caring for.
  • Developing an environment where older people are valued for the many ways they contribute to society throughout their lives, and where everyone is supported to maximise their potential as they grow older.

Professor Parveen Kumar, BMA Board of Science chair, said:

“The UK’s ageing population is being failed by a fragmented and over-stretched health and social care system. Far more needs to be done by the government to support greater co-ordination and integration of health and social care services and ensure that these services can cope with the growing needs of older patients. In particular, we must tackle the under-diagnosis and under-treatment of mental health conditions in older adults, to make sure that their mental health is treated as importantly as their physical health. We know that only a small proportion of older people with depression seek treatment, with research suggesting that although 20-40 per cent of older people in the community show signs of depression meriting treatment, only 4-8 per cent consult a GP. We owe it to these patients to turn this around.

We must also consider the families and loved ones who may be caring for those who are growing older. In the UK today, there are a staggering 6.5 million people providing a level of unpaid care to a relative, close friend or neighbour. The replacement value of carers’ support is worth a staggering £132 billion a year – that’s equivalent to a second NHS. Caring is something that most people do, but which they are not prepared or trained for, and which can have a significant impact on carer’s lives in terms of work, health, income, family and other relationships.

We must ensure there is a focus on a carer friendly health services which supports carers not only to look after their loved one, but to look after their own health and wellbeing as well. With demand on health and social care services increasing, the government must outline long-term solutions that provide the security that older people need and deserve.”