interviews

A positive picture

Lord Filkin, who chairs the House of Lords committee on public service and demographic change, speaks to NHE about recognising the positives in an ageing population.

Our population is changing; living longer and presenting all the consequences that comes with extended life. But is this something to be viewed as a challenge for public services, particularly the NHS, or a sign of great progress to be met with enthusiasm and gratitude?

The House of Lords committee on public service and demographic change is investigating how the ageing population is affecting the state’s ability to support its citizens, and the degree to which people growing older presents a “potentially very optimistic” future.

NHE spoke to Lord Filkin, chairman of the committee and a minister in the former Labour Government, about the issues at hand, and how to take a positive view of the challenges facing the UK.

The committee is gathering evidence to try to understand the nature, scale, certainty and predicted timescale of the major challenges and opportunities expected from the changing population. The conclusions of the inquiry will highlight whether public services are currently operating at an optimal level and if change is necessary, as well as the question of public or individual responsibility for funding of the services.

‘An enormous bonus’

Lord Filkin said: “The big picture for many of us is that we’re recognising that we’re going to live ten years longer than we probably would have done.

“Obviously that begs the question of whether we’re going to live ten healthy years or not, but if we were optimists and we took a life-time view of our health and care we probably would have an enormous bonus of having many more years of interesting, enjoyable and rewarding life. That’s the great positive story we must never lose sight of.”

Whilst it is certain that life expectancy is increasing, it is yet to be seen how much longer this will continue. Today there are around eight million people who will live until they are 100, and others are living to older and older ages – the oldest person alive in the UK as of October 2012 was 112.

Chronic onset

In terms of impact on the health service, the important factor to consider is how many people will live with chronic or acute illnesses, and for how long. There are “big bonuses” if the onset of such illness can be pushed back, Lord Filkin said, and such progress should be seen as positive despite cost implications.

He added: “I think we will assume there will be a continued level of medical and technological innovation, which will cure some illnesses and manage others.”

Of course, there are wider issues than just the health of older people, and pensions, employment and housing will all affect the ability of the NHS, and public services more generally, to cope with increased demand and complications.

Capping the costs

Considering the cost of social care, and the Dilnot cap which has been recommended to Government, Lord Filkin said: “Clearly Dilnot is a very important decision and we await what the Government says on that. Assuming the Government does agree to introduce Dilnot, it has the effect of minimising the exposure of some people to very high social care costs, it caps our exposure.

“It doesn’t, by itself, bring a lot more money into the social care system. We’re still going to have to address this question – if the quality or extent of care in the social care system is not suffi cient or adequate now, what’s it going to be like in 10 years’ time? How do we then deal with that?”

Again, social care does not exist in isolation, and the much-discussed push for integration means that such care will impact on hospital services and vice versa.

When asked if such integrated working was achievable, Lord Filkin answered: “It’s got to be in some sense. But one’s also got to have some realism about what the state can do and what the state can’t do.

“Undoubtedly most people think the way public expenditure currently operates will need to get better – more effective, more productive – to cope with these demands, but also many people will say that we can’t expect that, for any given level of tax, the state can do it all.”

Drip-feed awareness

This necessitates a debate over what elements of care the state will fund, and what it will not, which could allow individuals to make their own preparations and management for the future. A greater understanding of this provision could therefore make it more likely for individuals to take regard for this in their saving and planning.

Lord Filkin said: “Obviously if everyone had a healthy diet and took lots of exercise, the personal benefi ts and the public expenditure benefi ts would be considerable. But we all know that; it’s making it happen that’s a bit more difficult!”

However, he suggested that public health messages were starting to ‘drip feed’ down into the public consciousness, making us realise that “some of its in our own hands, if not all of it”.

This greater awareness is not enough on its own, and new ways of working will be needed to meet the challenges of a changing population, Lord Filkin suggested. He said that even if the system has enough resources to cope, there are “big questions” about the way the health service is currently structured, and the way it works with social care and with individuals, that he suggested “will probably need to change to address these increasing demands”.

In terms of a time-limit for intervention in this area, he suggested: “Both at the level of the state and at the level of the individual, we’ve all got some thinking to do.”

Long-term view

Politicians and individuals alike tend to focus on immediate problems rather than those in the future, Lord Filkin highlighted, but pointed out that taking the challenges ahead into account in current planning means it is more likely they will be manageable.

“We can’t plan it all and you can’t forecast it all, but you can at least get some understanding of the way it’s moving and how society is changing.

“Society has been ageing for centuries, but it is quite remarkable how signifi cant some of the changes taking place now are, and we’re all aware of that.

“What we haven’t looked at necessarily is what the implications are for public policy and public services, and individuals in the round.”

Longer-term and wider-ranging studies of this sort will help to provide a far deeper understanding of how health and social care could work better together, and how the scale of the challenge will increase in ten years’ time.

Lord Filkin said the committee will, at the very least, be making “some sort of argument to the public and to the Government about the great opportunities and the challenges that this implies”.

Busting the burden

Sir Keith Pearson, co-chair of the Commission on Dignity in Care, said earlier this year that some carers and nurses treated older people with “contempt”, during the launch of the commission’s report. It singled out as ‘unacceptable’ language like ‘bedblockers’ which made elderly people feel like a burden on the health service through no fault of their own. An Age UK survey last year showed a third of over-65s feel like they are viewed as a “nuisance” by health professionals.

Lord Filkin said: “It would appear that historically there has been some systemic bias against older people and I think the Government is quite clear that that is to be challenged. It isn’t whether you’re old or not: it’s whether you would benefi t from the treatment or not.”

Considering the impact of housing quality – another topic the committee took evidence on – on older people, he said: “If they’re not living in their own home, they’re either in a care home or in and out of hospital. Clearly we cannot afford to have the level of unplanned admissions of people with chronic illnesses into hospitals that we’re currently seeing. It is both horrible for people and highly ineffi cient.”

On this note, Lord Filkin added that while there is awareness of this issue, he did not know yet whether the system’s incentives were properly aligned to deliver appropriate health and social care support.