Opinion: How will we care for an ageing population?
Dr Jane Townson, chief executive of the Homecare Association, assesses how the health and care system can meet growing demand from an ageing population
When my great-grandmother was born in 1879, there were only 60,000 people aged over 85. In 25 years’ time, there will be 3.5 million people aged over 85, with one in four over 65.
The health and care system cannot meet demand now, so how will we manage in future?
Our options are to increase supply of care, reduce demand for care, or both.
- Increase supply of care
Skills for Care analyses requirements for care workers by comparing the number of posts in adult social care in each local authority area in England with the corresponding number of people aged 65-plus in the population. In 2022/23, on average, for every six people aged 65-plus, one adult social care post was required. Assuming nothing changes, 440,000 new posts, will be needed by 2035. There are currently 152,000 vacancies, and the UK-based workforce has been steadily shrinking since 2020/21, so how likely is it we can turn the situation around?
Many have written extensively about ways to improve recruitment and retention of care workers. Neil Eastwood’s book on the subject, Saving Social Care, is full of evidence and practical tips. The best employers are implementing the advice but continue to struggle. Reasons for this include competition from other sectors, which can offer greater security of income, higher pay, and better terms and conditions of employment. The inherent variability in demand for home care makes it hard to offer full-time contracts in an economically viable way, particularly when public sector fee rates are too low to cover costs.
Care providers have turned to international recruitment to plug gaps. While this works well for some, there are concerns about ethics, practicalities and financial viability. Most countries will need more care workers in future and labour shortages are a global phenomenon. Overseas labour is thus not a sustainable solution.
As a society, we must invest far more in care services and in developing our UK workforce if we are to receive help when older or disabled.
In October last year, Skills for Care announced plans to develop a new and comprehensive workforce strategy for adult social care, which is long overdue.
If citizens and the government in the UK are, however, unwilling or unable to spend more on care, insufficient numbers of British citizens wish to perform care roles, and immigration is not practical or politically acceptable, we will have to reduce the need for care by improving the population’s health.
- Reduce demand for care
Multiple factors influence human health, so a silver bullet is unlikely. Where could we focus attention?
Social determinants of health
The UK’s spend on healthcare is around 11% of GDP, which is comparable to peer countries. Relative to peers, though, the UK’s spending on acute hospital care is among the highest and on community-based and preventative care among the lowest in the OECD. We also spend less and have fewer beds and physicians per capita than the European average.
Evidence shows that social factors such as relationships and community connections, poverty, education, housing, diet and physical activity have a far greater impact on health outcomes than healthcare per se.
We need to shift from crisis management of hospitals to supporting people to live well at home and in their communities. Comprehensive analysis of options is beyond the scope of this brief article, but we could:
- Prioritise preventative care and early intervention to promote healthy ageing.
- Promote healthy lifestyles, social connections including intergenerational interactions, volunteering and meaningful activities to support physical and mental wellbeing.
- Provide family carers with financial relief, workplace flexibility, respite care and training.
- Build more age-friendly homes and communities with accessible features.
- Improve mobile phone and IT infrastructure so more people have access to fast Wi-Fi and mobile networks.
- Improve transportation options for older adults, ensuring mobility and connectivity.
- Support financial security by encouraging longer working lives and pension reforms to ensure adequate retirement income, as well as phased retirement and flexible working arrangements.
- Retrain and upskill older workers to enhance their employability.
- Promote positive attitudes towards ageing and tackle age-based discrimination.
Alongside social policy change, advances in science and technology could support healthy longevity.
Science and technology
Medical advances, such as drugs to prevent or treat dementia may emerge. There are around 900,000 people with dementia in the UK. This could rise to 1.6 million by 2040. Reducing this number could substantially reduce the need for care.
Assistive technologies, including Internet of Things (IoT), Ambient/Active Assisted Living (AAL) robots, and other artificial intelligence tools, can support independent living. Robots to help us in and out of bed independently, for example, could be life changing. Redesigning ordinary products to make daily activities, such as opening cans easier, could also be transformational. End users must be involved in the design process to avoid mismatches between technologies and needs.
Robotics could also help to address labour shortages in the wider economy caused by an ageing population China is investing heavily in automation to reduce reliance on people. Indirectly, automation could assist the availability of labour for the care sector.
Older adults are using telehealth, smartphone apps, and wearable devices to reduce barriers to care, maintain patient-provider communication, and promote disease self-management. These technologies can shift traditional medical routines to remote medicine, transforming our ability to manage health and wellness. Technology solutions can also enrich lives by connecting people and reducing loneliness. Most of us need face-to-face contact with others for wellbeing, so technology has limitations. Some older people struggle to use telehealth independently, which will change in future generations.
For the first time in history, projections show older adults will outnumber children. Without urgent action, our society faces dire consequences. We have a moral obligation to act now.