Reading the recent report from The Health Foundation and its projections of levels of ill-health among adults in the near future, one could be forgiven for feeling extremely pessimistic about one’s own health and for the future wellbeing of the country.
The Health Foundation’s analysis, carried out in partnership with academics at the University of Liverpool, details how an additional 2.5 million people in England will be living with major illnesses such as cancer, diabetes, dementia and depression by 2040. The study predicts that 9.1 million people in England will have a major illness by 2040 – an increase of 37% compared with 2019. Individuals can expect to be living with major illness for 12.6 years in 2040 compared to an average of 11.2 years in 2019.
What makes this research even more concerning is that it confirms previous research, which shows that the poorest people in society are those who will experience the worst deterioration in their health. For example, Ageing Better’s 2022 State of Ageing report highlighted the existing 19-year gap in healthy life expectancy between the richest and poorest and this gap is only expected to grow. But this gloomy vision of future generations struggling and suffering through later life must be challenged.
Tackling societal issues
Overburdened public services are not an inevitable consequence of an ageing population; living longer does not have to mean extended ill-health. Much more must be done to tackle societal causes of poor health and this response needs to be delivered across society. It means reconfiguring the way we think about ageing.
Too often, short-term political cycles mean that politics delivers short-term responses on policy issues when we need to look at the bigger picture and deliver meaningful change over a longer time period. What we need is more prevention to reduce the need for more cures further down the line.
In 2019, Ageing Better worked with the Office for Health Improvement and Disparities on a consensus statement on healthy ageing.
The statement identified key principles for healthy ageing, including three principles that should guide the Government’s approach to tackling health risk factors:
- Putting prevention first – specifically, interventions targeted at an individual level such as strength and balance classes, smoking cessation support and treatment for alcohol dependence.
- Ensuring good homes and communities to help people remain healthy, active and independent as they age.
- Narrowing inequalities across the life course to ensure that everybody has the same opportunities to achieve a good education, good work, financial security, and a decent home.
Four years on, these principles remain equally important and relevant, if not more so. But are they any more apparent in Government policy than they were four years ago?
Our politics has undergone substantial turmoil in that time, and it feels as if short-termism continues to have its day. Failure to take more proactive and preventative action now to improve how we all age is a guaranteed recipe to building up insurmountable problems in the future.
The NHS is already buckling under the pressure. The social care system in this country has been predicted to implode by 2029. And the only reason it hasn’t already is because of the tireless work of unpaid carers who contribute the equivalent of more than four million jobs in the sector.
Both health and care services are likely to be overwhelmed by the numbers projected in the Health Foundation report. We need action now therefore to avoid that nightmare scenario becoming a reality.
This action goes far beyond increasing investment in health and social care to keep up with demand.
Investing more in preventative health programmes and work to promote ‘active travel’ and encourage physical activity can help the population move towards later life in better health.
Reforms must go further
We need to ensure that homes are safe, healthy and accessible and we need to improve practice at work. We also need to tackle inequalities and ensure that communities are inclusive.
The quality of housing can have a tremendous impact on health and subsequently impacts on the pressures felt by health and social care. The annual cost to the NHS attributed to low-quality housing is £1.4bn for first-year treatment costs alone. Spending £1 on improving warmth in ‘vulnerable’ households can result in £4 of health benefits; £1 spent on home improvement services to reduce falls is estimated to lead to savings of £7.50 to the health and care sector.
Poor housing costs lives. And it is the poorest and most vulnerable people who are paying the greatest price for years of government neglect and inaction. That is why we need a national plan to make all homes safe. This should include a mechanism for local delivery, such as Good Home Hubs – a national network of local one-stop shops for information and support to help people improve and maintain their own homes.
Previous research published by the Centre for Ageing Better reveals that making small changes to homes, such as installing handrails, ramps and level-access showers, alongside simple home repairs, could play a significant role in relieving pressure on the NHS and social care. The research also found minor home aids and adaptations can greatly improve the quality of life for people losing mobility. Studies show that people’s difficulties with ‘Activities of Daily Living’ can be reduced by 75% – these include washing, bathing, going to the toilet, dressing and eating.
As well as adapting existing homes, the failure to build sufficient accessible homes enabling disabled and older people to live independently and with dignity is short-sighted and a false economy. Currently less than one in ten homes in England provide the basic features for even the lowest level of accessibility. The Government needs to fulfil its 2019 manifesto pledge to raise minimum accessibility standards for new homes to help reduce future social care costs and pressure on NHS capacity. Staying in work can be extremely beneficial for employees’ health and wellbeing. But more support is needed from Government and employers to help employees manage health conditions in the workplace. This will become increasingly important as the number of working-age people with long-term health conditions rises.
Supporting employee health
Older workers are more likely than younger workers to be managing multiple long-term conditions, and health conditions are the main driver of older workers exiting the labour market before they reach state pension age. The Government’s recent support for Private Members’ Bills on carer’s leave and flexible working conditions is welcomed. Supporting carers to stay in work and to find the right balance between work and their caring responsibilities could help reduce demand on social care.
A recently passed Private Members’ Bill granted workers the right to five days’ unpaid carer’s leave.
But extending this to ten days of paid carer’s leave per year, and a right to up to six months of unpaid carer’s leave, will put this country on an even better footing to meet the needs of our changing demographics and growing ageing population.
Government could also make further efforts to reduce the stigma associated with disability through a public campaign to tackle ableism and ageism in the workplace, support part-time work, improve access to occupational health and introduce financial support for SMEs who support workers while on long-term sickness absence.
Community connection
To support people to age well, we also need to create local communities which are age friendly.
Creating communities where independence can be maintained for as long as possible can also help lower demands on social care services. This requires empowering, resourcing and directing local Government to respond to significant demographic changes and take action on issues that matter to local older populations, including public transport and digital exclusion.
This could be done through funding and support to ensure that every local authority has the resources it needs to become an Age-friendly Community – a community where people can age well and live a good later life.
Clock is ticking
All of these policies will develop significant change over time and will hopefully avert the worse-case scenarios for 2040 envisaged in the Health Foundation report.
But unfortunately, our current political era is marked by instability. The lifespan of a Government minister is measured in months, so few are prepared to stake their reputation for change measured in decades.
That is why we need other advocates for long-term, societal reform within the corridors of power. And that is why the Centre for Ageing Better believes we need a Commissioner for Older People and Ageing (COPA) for England to ensure older people that policymaking across Government considers the long-term needs of our ageing population. Wales and Northern Ireland already have commissioners who are improving the lives of older people and protecting their rights. England has an independent commissioner protecting children’s rights but no one with the legal power to do the same for older people.
Without such a figure, the concern is that the political lens will never look beyond the next election.
And that short-term thinking is guaranteed to ensure that the Health Foundation’s vision of 2040 becomes a reality.