Ageing: Public Services and Demographic Change Committee Report
(11 years ago)
Lords ChamberRead Hansard Text Read Debate Ministerial Extracts
Lord Filkin
That this House takes note of the Report of the Public Service and Demographic Change Committee Ready for Ageing? (Session 2012–13, HL Paper 140).
Lord Popat (Con)
My Lords, there are 21 speakers for the debate this evening. If the Back-Benchers stick to five minutes for each speaker, that should enable the House to adjourn by 7.15 pm.
Lord Filkin (Lab)
My Lords, our ageing society is by far our biggest social change, bringing great benefits. Many people will live longer, much longer than might have been expected, and in doing so will contribute much to our society and economy, and will benefit personally from this longer life. This change is happening now. There will be 24% more people aged 65-plus in our present decade, and the change will persist for decades to come. By 2030, there will be over 100% more people aged 85-plus compared to 2010. Our report explored what we all need to do to maximise the benefits of this great social change. The House will be relieved to hear that I will be assuming that all Members have read it, given that it was only 10 pages long; I will pick out a few of the highlights.
First, I offer warm thanks to a talented and challenging committee. You could not get a better committee of Members to work with than we had. They were superb and their commitment and contribution was very great indeed. I also thank our two special advisers, Howard Glennerster and Jonathan Portes; it is particularly good to see Professor Glennerster with us today. I also thank our excellent staff, Bina Sudra, Tristan Stubbs, Tansy Hutchinson and our quite remarkable clerk, Susannah Street. I thank Philippa Tudor for the quiet support she gave in the background to this process. We had a remarkably pressured timetable, trying to deal with 70 witnesses in about three months, and she was very helpful indeed. Lastly, I thank the House itself for agreeing to the suggestion for this ad hoc Select Committee.
How, then, do all of us need to change to be ready for this ageing society? Clearly, first, as individuals, our prime responsibility is always to try to manage our own lives ourselves rather than to expect others to do it for us. Clearly, people need to understand the probabilities and risks consequent on ageing—that they may need to save more, to work for longer, to at least make provision for their social care and to think about how they care for others. Individuals also need to engage with the choices and behaviours that are likely to make for a healthier and happier longer life. We have control over quite a lot of things—at least, some of us do.
It may well be that many people need trusted, accessible, person-centred information and evidence to make these informed choices and, hopefully, the behaviour shifts that might go with them. Clearly, civil society itself will have to make changes in how it will need to engage with ageing and how it can better work to support the many more older people in our society. It would be naive to think that the state, either central or local government, was able to support all the increased numbers of people in our society. Yet there is enormous potential if civil society itself engages positively in this and the question, of course, is how we stimulate such a growth of civil action.
Clearly, civil society also needs to understand the choices that we all have to make collectively as a nation to address the changes and some of the pressures and choices consequent on them. Finally, we need to use the assets of many more older people as a resource that is able to contribute to meeting the needs of other older people. That is obvious to many of us and axiomatic. Again, we need to think about how we make it happen in practice.
There needs to be much greater engagement with ageing from businesses generally, large and small. Ageing affects our economic growth, our fiscal position and the supply of labour to businesses, which others may speak on later. Business needs to become much more positive about flexible working for older people, otherwise we will have labour supply problems, less economic growth and less fiscal contribution than we otherwise would. In other countries, particularly Germany, business is actively engaged in these debates. I look forward to hearing invitations to discuss these issues from some of our business leadership figures, not least the CBI.
Local government will clearly be at the fulcrum of ageing at local level. In some local authorities, the scale of the changes in their older population is quite remarkably greater even than the dramatic figures I have given already. Clearly, local government’s role has to go way beyond just the management of social care, although that is already an enormously taxing role for it. It has to address the failures of planning and housing supply for older people at a local level, which clearly cause greater problems for many people and clog up family housing that could be released. Local authorities will need to work with, and generate greater engagement from, the voluntary sector and civil society to increase volunteering, to support attempts to reduce loneliness and isolation, and to contribute towards informal social care. We will need a quite remarkable scale of increase in informal social care. Again, it would be naive to think that the state will deal with all those things by itself. There is, therefore, a very large range of roles for local authorities over and above their new public health role. One would expect to see thoughtful local authorities making estimates of the scale of demand that they will face, and starting to have dialogues with their communities about how they will plan for and address those great opportunities and pressures.
The voluntary sector—which I recognise does enormously good work—will itself want to consider, individually and collectively, how it will need to change to make a greater contribution to meeting the needs of an ageing society. I doubt that doing what it has done in the past, or even doing more of what it has done in the past, would be adequate or sufficient. Therefore, we have already started discussions with some of the key voluntary sector organisations about how they need to assess the scale of future need and how they will raise their game to meet the future needs that will be required of our society.
Public health at national and local level is, I think it is obvious to all of us, a central issue in how we address ageing. I will give one simple illustration. If, over the next 15 years, we were able to shift the behaviours of many people in our society so that they made healthier lifestyle choices about diet, weight, exercise, smoking and drugs—and we all know ourselves how difficult some of those resistances are—the personal, fiscal and economic benefits would be remarkable. I argue, both to government and to civil society: think of what we have done on smoking, but also think of how we make these changes. They start to make coping for an ageing society more bearable in public policy terms, but they also make individuals’ lives that much happier and more fulfilled if they are able to enjoy them in that way.
On the NHS, I think we would all acknowledge that the fact that we are living longer is due in part to the great success of medical science and of the NHS itself, combined with many people making better lifestyle choices. That, therefore, is to be celebrated. Nevertheless, an ageing society is by far the biggest challenge that the NHS has faced since its foundation. I will give three reasons why that is the case. First, there will be an enormous increase in the number of long-term conditions in our society, consequent on many more older people, many more much older, older people, and the propensity that that causes to generate long-term conditions. In the past you died of certain conditions; now you live many years longer with those long-term conditions. That is a wonder, but it has challenges.
Secondly, there will obviously be very great increases in cost for the NHS and for social care, consequent on that increase in long-term conditions and social care needs itself, so we will see remarkable increases in cost hitting the system as well. Thirdly, every bit of evidence we received, and all the expert opinion—including the briefing noble Lords have received from the NHS Confederation—is of one mind that the system needs to go through quite a remarkable change so that it moves to the better management of long-term conditions in the community and away from what is essentially an acute and hospital-centric focus. Everybody broadly agrees with that diagnosis; the challenge is how it is going to be made to happen.
The problem—without wishing to be party-political for a second—is that politicians do not always give the impression that they are facing up to the scale of those three issues: the scale of increased demand, increased cost and how to bring about that system change. We all hope that NHS England, when it produces its strategy in the autumn, will set out a clear vision as to how that should be addressed, both assessing the demand and setting out how it thinks the system should change to do so. However, even if it does that well, it will not be able to do it without clear, strong, consistent political leadership, preferably supported by all political parties.
How has central government responded to our call for action? First, we all recognise that central government is not responsible for all these challenges. They are issues for all of us. However, many of us consider that central government is responsible for leading the debate and setting out the issues so that we as a society can face them rather than hide from them. It is also remarkable that there was no rebuttal in the Government’s response of the fundamental evidence and analysis that the committee set out in its paper. They did not say that we got it wrong; they were almost totally silent on that. Therefore, it is reasonable to assume that the diagnosis we presented was reasonably accurate. That has been the view of many experts, as well.
We were disappointed not to see from the Government a vision statement, or a commitment to produce some sort of vision, about what they think we should do for our older society in future, and some sort of outline of how, as a society collectively—central government and civil society—we should go about making that vision a reality. They have also resisted our request to set out an honest debate with the public about the opportunities, challenges and changes. We argued for a White Paper and a Green Paper to set out the issues so that we could all engage with them seriously. They did not respond to that. In part I know why, but it is a great shame, because that is what we all need.
In my final few minutes, I will say a little about what we have done to maximise engagement with the Government on this report. Our committee ceased to exist in March, but we chose to ignore that and to continue having very vigorous discussions among ourselves, and excellent meetings with Ministers and senior civil servants. We tended to go in twos, as is our way, whenever we could. I met five or six Ministers, virtually all the top civil servants relevant to this, and special advisers, and I thank them all. Without exception, the conversations were thoughtful, and with many officials we could discuss both policy and politics—realities—at the same time, because those things are real.
Next we should acknowledge that the Government have done some very good things in a difficult environment. They have made remarkable progress on pensions reform and on putting into practice the fundamentals of Turner. Steve Webb is to be commended on that, in an incredibly difficult fiscal context. That is good progress, but, as we said, it is the start, not the end of the story.
The situation is similar with Norman Lamb and social care. It is not the thing to mention this week, but we should recognise that Dilnot, even if you did not think that it was the perfect answer, was a brave and difficult thing to do, and was not always welcomed by the Treasury. Again, that is to be commended; it gives us a basis to move forward. We will have to get the details right as we work on it.
We have had discussions with Mark Prisk, the Housing Minister, as well as with Norman Lamb. We had excellent discussions in closed seminars about what the report said, and there was a recognition in the Government’s response that there were significant failures in current policy and practice. The market in specialist housing for older people does not appear to be working, and there is a need to do something about that. Again, I commend the honesty and engagement that we have had there.
I wish I could be as positive everywhere, but, as noble Lords will sense, I am not going to be. What still amazes us as a committee is that we have not seen from the Department of Health any published data of its estimation of the increasing demand consequent on the absolutely certain increase in the number of older people. Perhaps we will get that from NHS England; let us hope so. It is fundamental to the situation. When you know that you will face massive increases in demand, you make some assessment of what that will look like and you then think about what it implies.
Secondly, there is still a doubt over the Government’s narrative that the massive systems changes that we all recognise need to happen will just come about organically in a bottom-up process. Clearly, the leadership of the NHS and the health service generally looks for clear, solid, consistent ministerial support for these changes. That is difficult, but they will not happen without it. Lastly, we need an honest conversation between politicians—hopefully of all parties—and the public about the changes that our NHS will face.
I am coming towards the end. I will now deal with the fiscal implications of this. As noble Lords will know, the dependency ratio is obviously worsening as a consequence of these demographics, and I will not go into detail on that. Many more older people, and older old people, will mean much more spending on pensions, health and social care. It is axiomatic that that will happen. The debate is about how much of that extra expenditure should be paid for by the state out of taxation and how much of it should be paid for by individuals themselves. However, it will have to be paid for one way or the other because our society will demand a level of care and healthcare befitting a civilised society. Therefore, we must face up to a discussion on that.
Apart from what the Nuffield Foundation and the IFS have produced, to date we have not seen much indication of the scale of that future cost. However, the material that has been produced is frightening enough. It signals a gap of at least £35 billion, and probably £54 billion, by 2021-22. The IFS told me that those figures had been reached just by looking at the 4% per annum historical trends; not by assessing the elemental increase in demand consequent on having more older people with long-term conditions, so I think the figures, are, if anything, likely to be an underestimate. We have to discuss as a society the implications of how we fund these increased public service costs. There are no right or simple answers to that, but thoughtful discussion, preferably across the party divide, would be helpful. Ideally, I think that some Turner-style process that commanded cross-party support would be a healthy approach.
We have not seen what we hoped for from the Government in terms of a Green Paper or even a ministerial subgroup to look at these issues. However, I hope that all is not lost. We are 18 months away from an election. Although I have been putting these questions to the Government, it seems to me they are equally questions for all three political parties. We hope that all three political parties engage seriously with these questions over the next 18 months, and, we hope, do so in a more transparent way so that there is a proper engagement by experts in their thinking about how we as a society address these challenges.
I am pleased to say that one of the consequences of our work is that eight major charities came together into the Ready for Ageing Alliance. They will work with our committee and maintain a constant dialogue with experts and politicians about these issues over the next 18 months. No doubt they will inspect the election manifestos, and the work behind them, of all the major parties.
As noble Lords sense, my committee members and I think that these are important issues. We will not let them go. We look forward to further discussions in the House and with wider and civil society about them. The benefits of getting this right are enormous, but if we are in denial on these issues we will massively underestimate those benefits.
Lord Mawhinney (Con)
My Lords, I presume to speak on behalf of all the committee colleagues of the noble Lord, Lord Filkin, by thanking him for the leadership which he gave the Select Committee and for his own knowledge and enthusiasm which drove that leadership. The five-minute advisory length of speeches will constrain committee members from dealing in any depth with the multitude of issues that we raised. No doubt that was part of the Government’s thinking when they scheduled this debate at this time.
I will restrict myself to one issue only, which came through regularly and strongly in the evidence that we were given. The report states:
“To meet the needs of our ageing population … the health and social care system needs to work well 24 hours a day, seven days a week”.
The Secretary of State told us that,
“we have to have a 24/7 NHS”.
That is good. Actually, it is vital that we have such a service, but when will we have it? We called on the Secretary of State in our report to,
“within 12 months … set out how this will be made real”.
To date, we have heard nothing. The clock is ticking in an otherwise silent room and we look to my noble friend the Minister to inject a degree of urgency in his colleagues—for I suspect that my noble friend senses that urgency even if at times he, too, is constrained from being as explicit about the issue as some of the rest of us wish to be.
Because there was no indication of timing, I put down a Parliamentary Question in July asking the Government what was the percentage of GPs providing a full weekend service. My noble friend will remember his Answer. He told me that it is all being looked at by NHS England. My heart sank because, first, I was a Minister long enough to know that when Ministers are trying to distance themselves from something difficult, they pass it on to someone else. Secondly, as my noble friend knows, I am not a great admirer of NHS England, particularly of its chief executive Sir David Nicholson—he with the wildly chequered career. He is the one who the previous Secretary of State, Mr Lansley, wanted to be wholly in charge of the NHS, rather than the Secretary of State. I know what the department thinks of Sir David. I know what the health professions and the public think of him. I maintain hope that my noble friend will be persuaded to join me and the majority, and put Sir David on a bicycle as quickly as possible.
On the other hand, the Prime Minister announced just recently that he was going to initiate a pilot study in nine areas about GP surgeries running through the weekend and providing a full service. This is very good. Well done, Prime Minister. I am not sure why there are nine areas. To be honest, as a former health Minister, I am not sure whether this policy needs to be piloted at all, but it is a step in the right direction. On the other hand, after 11 and a half years as a Minister, I have developed a marginally healthy scepticism. I was immediately reminded of that old Chinese proverb that states:
“A journey of a thousand miles starts with a single step”.
I have to say to my noble friend that I think we still have 999 miles and 1,750 yards to go. We need a full-week service.
I tabled another Parliamentary Question to my noble friend. I asked him to tell me what percentage of full social care was available at weekends. My noble friend—perhaps above all of his colleagues on the Front Bench—is too courteous and sophisticated to have given me the Answer that the words yelled out: “Nothing to do with me, guv”. We all know who has the primary responsibility for delivering social care. However, we all also know that it is to do with the Government. It is to do with providing what the Government believe people need. If it is not a matter for the Government, who is it for? While we dicker, duck and dive, there are more elderly people with frailties in mind and body, needs, deprivation, suffering and pain. All are made worse by the absence of a full seven-day-a-week service. Only government can ensure that care, support and treatment are administered effectively—I repeat, effectively—24 hours a day, seven days a week.
I have no vested interest but I have hard-won, emotionally draining experience about the importance of that to which I make reference. Near the end of her life, my mother had to spend two weekends in a local hospital because she had contracted pneumonia. Her care and treatment adversely affected her condition, even though the infection was cured. The hospital wrote a self-satisfied letter telling me how good the standard of care that it provided had been. We, the family, could not wait to get her out of the hospital and back to the residential home. In this day and age, that may sound strange because residential and nursing homes have not always had a very good reputation or appreciation—and some of them should not have, because some of the things that have happened have been horrendous. However, I want to say how grateful I am to Abbott House in Oundle for its professional, sympathetic and focused care for my mother and her well-being, despite the pressures that people are facing and the inadequacies of what the NHS made available at weekends.
Our report’s conclusion was that a radical change and an improvement in health and social care were badly needed to provide a full service. I share the view of the noble Lord, Lord Filkin: radical change will take time, and time in politics means cross-party support or radical change will never happen. Without it, the present scandal of the treatment of our elderly will grow to a point where it is not handleable by politicians who wish to act humanely. That is the size of the challenge and the size of the problem that this Government face.
Lord Hutton of Furness (Lab)
My Lords, it is always a great pleasure to follow a speech from the noble Lord, Lord Mawhinney, as indeed it was for me to serve under the leadership of my noble friend Lord Filkin on the Select Committee. I am grateful to the House for giving me the opportunity to serve in that capacity.
I should start my remarks by drawing the attention of the House to the interests that I have declared in the Register of Lords’ Interests.
It will probably not be a surprise to any of your Lordships that a Select Committee of this House took the unanimous view very early on in its deliberations that the fact that Britain was becoming an ageing society did not mean the end of the world as we know it. Far from it—it is going to be a blessing, not a curse. However, one thing was very clear to all of us: that if we are to respond to the quite significant challenges that the ageing nature of our society is going to present, then we expect—and we are right to demand—vision, leadership and a coherent strategy from government. So, too, are we right to expect that from all those parties that aspire to government. Nowhere is that more obvious and clear than in the area of pensions, and that is where I want to concentrate my remarks this evening.
We tried to draw attention to two very significant problems that we face. We all know that not enough people in Britain are saving for their retirement and that those who are generally tend not to be saving enough. That led us to conclude that nearly 11 million people of working age are, on current trends, likely to be heading towards inadequate retirement incomes. That will be a significant social and economic problem for our country and we need to address it with urgency.
As my noble friend said, there are plenty of positive signs that the Government are now beginning to address this problem. The previous Government set in train the implementation of the important recommendations of the noble Lord, Lord Turner, and the present Government have taken those forward. That is to be welcomed. However, we also took the view that, in their present guise and format, defined contribution pension schemes are unlikely to be able to discharge the very heavy responsibility that we are about to place on them. In the future, millions more people will be saving not in final salary or career average defined benefit schemes but in defined contribution schemes. Of course, the one characteristic of those schemes is that there is no guaranteed level of retirement income.
We all know the history of the demise of defined benefit. We will not be able to recreate new defined benefit schemes in the UK or, for that matter, in any other developed nation. That is part of the pensions past. I hope that we can sustain defined benefit pensions in the public sector for as long as possible. We know that the millions of people who will be enrolled automatically into new workplace pension schemes will be saving in defined contribution schemes. It was the committee’s view that they are not fit for purpose; they are not going to be adequate in their current form to address the expectations that millions of people have for the level of income that they can aspire to in retirement. How we respond to that is the crucial challenge in the pensions world today. We have obsessed in this House and elsewhere about how we can prolong defined benefit schemes. That debate is concluded—we will not be able to do that in the private sector. But there has been insufficient attention until recently about the inadequacies of defined contribution schemes. I, and I am sure all members of the committee, would welcome the Government’s new focus on addressing the shortcomings in defined contribution schemes. That is the big challenge that we face.
The Government’s response to date in its defined ambition pension plans and proposals have some promise and potential, but there is a warning to the Government that I would like to give tonight—to avoid the gimmicks and expensive flummery, as well as the false promises of guarantees and other devices that have been floated. In the world of defined contributions, it is unlikely to be possible to construct anything that looks like a defined benefit-style guarantee of retirement income. That is simply not a possibility, and we should not mislead people somehow into thinking that it is possible.
What we felt was possible was that the Government could convene on a much more urgent basis the attention of the industry and employers on how the current structure of defined contribution pensions could be improved—and I think that they can. From my experience, I believe that we have to focus in future on outcomes from defined contribution schemes and work to ensure that there is greater confidence in those outcomes. That is a challenge primarily to the pensions and investment industry as to how those improvements could be brought about. I personally do not believe that there is a case for some legislative solution or some magic wand to be waved over this problem by government. That is simply not a possibility; it is not the world that we live in. But there is an urgent case for more focused action and intention, led by government, as to how the current failing platform of defined contribution could be improved for millions of people going forward. We have a special responsibility now that we have decided, as successive Parliaments, to automatically enrol people into defined contributions, as to how we can improve the way in which those schemes work for future generations. This is a pressing problem, and it is incumbent on government and others to address it as a matter of urgency. I welcome what the committee had to say about that matter.
I want to finish with a quote, not a quote from your Lordships’ Select Committee but a comment from the National Audit Office, in a report that it made in July 2013, when it said:
“Measures to encourage people to save for retirement are not being managed by Departments with enough coherence or accountability”.
Sadly, I think that that is true, but the Government have time to put that right. I hope that they pay attention to our report as well as the work of others, and begin to address with more urgency this chronic problem of how to improve the performance of defined contribution schemes. If they can do that, I hope that a beginning of a stronger coherence and consensus around pensions policy will emerge as a result.
Baroness Tyler of Enfield (LD)
My Lords, in the short time available, I should like to do two things—to give my reactions to the government response to the report and to focus on one key issue raised in the report.
I was at least pleased that the government response said that the Government shared the ambitions of the Select Committee report of making the country,
“one of the best places to grow old”.
The response is certainly detailed and offers a good overview of current policy on issues related to ageing. I very much applaud the very important measures that the coalition Government have taken in very difficult financial times. I mention in particular the Pensions Bill and the Care Bill, which is currently before this House, which I consider to be a landmark piece of legislation. But—and, of course, there has to be a but—while the government response is long on past achievements and current policy commitments up to 2015, it is short on the long term and the need for a long-term strategic joined-up understanding of the big choices facing the country over the next 10 to 20 years, particularly the need to stimulate a national debate so that people understand the implications, the choices ahead and difficult decisions that will have to be taken about the balance of responsibilities between the individual and the state. Asking the chief scientist to lead an analysis of the challenges of an ageing society is a welcome step forward, but it would have been so much more effective if the chief scientist had been asked to report to Parliament every year on both progress made and the challenges ahead and, indeed, if the Government had produced an action plan with specific goals and milestones that this House could monitor.
Will the Minister consider those suggestions and respond in due course? I recognise that that will require consideration across government. There was no response on the call for a White Paper setting out a long-term vision from Government, their role in stimulating a national conversation, the two cross-party commissions after the next election, or indeed that party political manifestos should address those issues. In retrospect, perhaps it was a little unrealistic to expect the Government to respond to something about party political manifestos. From these Benches, I am pleased to report that the Deputy Prime Minister has now established a new Liberal Democrat policy working group, to be chaired by my right honourable friend Paul Burstow, to consider how public policy can address the broad issues of an ageing society. I am pleased to be able to serve as a member of that group.
In the rest of my contribution I want to focus briefly on attitudes to ageing and the issue of loneliness and social isolation. Ready for Ageing? addressed these issues but, perhaps inevitably it did not attract the headlines in the same way as issues around retirement pensions, health and social care, and so on did. I would argue that not enough focus has been given to the importance of social isolation and loneliness, which are so often both the root cause and consequence of issues that were discussed at length in the report and which no doubt will be discussed in the debate.
A big barrier to making the UK ready for ageing is the denial of most younger people of the likelihood of becoming older themselves, with all its perceived negative connotations. It is human nature to put off thinking about becoming old, until the day it happens, but the problem is that by then it is usually too late to do the financial and other planning necessary to ensure a happy and comfortable retirement. If we could take away some of the fear, perhaps more younger people would be more willing to face up to the fact that, barring ill fortune, such as accidents and grave illness earlier in life, the chances are that they will live longer than they currently expect—certainly longer than most previous generations thought likely or even possible. That is a fact.
I do not have time to go into all the life expectancy details here, but it is so important to understand the issues of why younger people, or those in middle age, do not do the thinking and preparation that they need to do. We also need to address a key social trend that has not had enough attention. A lot of people who will be moving into old age over the next 20 or 30 years will be childless and will not have adult children to provide some of the care and support that so many do today. The issue of loneliness and isolation is significant. We need to be realistic. It would not be true to say that the majority of older people are lonely; the majority live happy and non-lonely lives. However, some of the statistics are very stark. Do noble Lords know that some 5% of people aged 65 plus in the UK said that they spent Christmas Day 2010 alone? How should we feel about that? It has also been said that loneliness is very bad for our health. Something that brings that home starkly is the estimate that loneliness is as harmful to health as smoking 15 cigarettes a day. There is much that can be done about this.
I am very pleased to be involved with a project that is being taken forward by the think tank, CentreForum, which is looking specifically at what can be done for old people to help them to avoid loneliness and isolation. I am pleased that the charity Age UK is involved because I believe that the answer to many of these issues lies with voluntary organisations, charities and faith groups, but it is for the Government to create the climate in which these things happen.
I shall finish by saying something that may sound a little trite. In later life, he or she who is rich is he or she who has a strong network of family and friends around them. We must do all we can to encourage that.
Lord Livingston of Parkhead (Con)
My Lords, I speak here today with some amount of nervousness and a large dollop of disbelief. First, I thank the House for the warmth of its welcome, and particularly my two supporters, the noble Lord, Lord Reid, and my noble friend Lord Green, whom I will be honoured to succeed as Minister of State for Trade and Investment in December. I also thank my mentors and the people who are huddled on the Second Floor West, somewhere near the fire escape, for all their guidance; my roommates have been very helpful. Most of all, I thank the staff of the House. They have been unfailingly pleasant and smiling and I thank them for all their help, particularly for their directions. This is not a House for those who are geographically challenged like me. I think it was designed along the line of Hogwarts: there are some staircases that do not lead to the same place today as they did yesterday.
I used the word “disbelief” about speaking in this august Chamber. That, in part, reflects my background. My family came to this country over a century ago. They were penniless when they arrived. When my great-grandfather became prosperous he moved into a two-bedroom flat, with just 12 of the family. My father was the first person in our family to go to university. He became a doctor, a GP in the east end of Glasgow near Parkhead. His 30 years of service to one of the most deprived communities in the whole of Britain is one of the reasons I took the title “of Parkhead”. The other reason is because I am a lifelong supporter of Glasgow Celtic. Its home is at Parkhead and I thought a recognition of the first British team to win the European Cup was appropriate.
I chose to make my maiden speech today for the simple reason that this debate is about one of the most important issues facing society today. In tackling this subject the committee chaired by the noble Lord, Lord Filkin, has shown many of the great attributes of this House: it is considered, long-term, bipartisan and constructive
I should like to expand on a few of the points raised in this excellent report. First, too many people are still facing a cliff edge on retirement. They need help going into retirement but do not want to completely give up doing things because they still have a contribution to make to society. That contribution may take place through voluntary work and it is highly appropriate to have an organisation to help with that.
However, as an ex-businessman, I want to raise the issue of what business can do. Businesses already have to meet an increasing demand 24/7. There are peaks in demand, with customers wanting things very quickly seven days a week. These workers present a real opportunity. They are well trained, reliable and want to work part-time. They can help to meet some of the peaks in demand and be great mentors for newer workers. They provide a real opportunity for business. However, business needs to change its attitude to grab it but it will need help. Flexibility of pensions would assist it.
Businesses can benefit from this demographic shift in other ways and it can contribute to its solution. Most products today are designed for youth—it is the hot thing to do. However, there are more and more affluent older people—it is a growing market—and businesses need to put more effort into designing inclusive products that can not only assist people as they get older but can also provide real solutions, particularly for those who are housebound, to give them an outlook on society and to help them stay independent for longer.
Indeed, the emotional and financial case for independence is absolutely overwhelming. It costs something around £3,000 a month to keep someone in a care home; to keep them in a hospital bed is a multiple of that. To help them live on their own usually is a fraction of it. We need to look at what kind of levers we can introduce to allow people to live for longer independently. I will refer to two of them—carers and housing.
I turn first to carers. Carers already play a vital role, but it is a very tough one. Too often the stress and physical demands are too much, so that they themselves also become ill, and society ends up looking after two people rather than none. A little bit of help, such a small amount of respite care, can make a world of difference. Also, there should be grants to assist in the provision of a washing machine, given the amount of laundry that a caring situation can often create. A little money and effort can yield multiple returns.
We also have to recognise the need for the right type of housing. It should be designed to be more inclusive from the start. This will help people to stay in their homes for longer, but as their needs become greater, it is vital to provide them with the right sort of housing with the right sort of monitoring and care. That will help not only the ageing population, it will free up family homes for younger people and make the whole housing ladder more flexible. This area has to be looked at with the same urgency with which the issue of starter homes and social housing is being considered.
The UK is not unique. We face the same demographic challenges as many other countries. In fact, there are other countries in Europe with far worse challenges, while the position in Japan is more urgent still. We should look to them to learn about some of the things that they are doing, both on the micro and the macro basis. We do not have a monopoly on this problem, and I am absolutely sure that we do not have a monopoly on the solutions. If we take the right measures, we can make a big difference. As was said earlier, longevity and longer good health are a blessing. If we do not take these measures, we will have a crisis. We owe it not only to those who are now ageing but even more to our grandchildren and our great-grandchildren to take action sooner rather than later.
Lord Wei (Con)
My Lords, it is a great honour and pleasure to follow my noble friend Lord Livingston of Parkhead’s insightful, witty and passionate maiden speech. We all welcome his contribution to the House, and indeed to the whole country and beyond. As a businessman, he distinguished himself when running BT, not merely by driving it forward to growth commercially inside and especially outside the UK, but also in helping to spearhead many corporate social initiatives, including those that have helped to create suitable employment for those in later life, initiatives which I know are dear to his heart.
From an early age he has shown tremendous commercial acumen and has had a stellar rise from his start as an accountant to becoming a chief accountant, then a banker and venture capitalist, before becoming the youngest ever FTSE CEO in 1991, of the Dixons Group, at the age of 32. Subsequently, he became the BT Group finance director, head of retail and group CEO. It has been an amazing rise. As a Scot from humble beginnings and originally from overseas, I am sure that he will bring additional experience to your Lordships’ House, not least from his being a non-executive director at Celtic. What better representative could we have as our soon to be installed Trade Minister, promoting the country, bringing commercial expertise to our trade promotion bodies, and insight and common sense to our deliberations in this House? I know that fellow Peers will join me in congratulating him on his appointment and once again on his wonderful maiden speech.
Turning to today’s debate, I declare an interest as co-chair of the All-Party Parliamentary Group on Life Transitions. I want to thank the Select Committee, chaired by the noble Lord, Lord Filkin, for its tremendous work and the Government for their response. It is just over a year since I had the privilege of co-authoring a report on life transitions that touches on many of the areas highlighted in the Select Committee’s report. It is encouraging to see how the report I wrote, supported by the Gulbenkian Foundation and entitled, Next Steps: Life Transitions and Retirement in the 21st Century, finds echoes in much of the tone and language of the work of the Select Committee, and indeed that we are able to think about life transitions, in this case those of ageing and retirement, in terms of presenting significant challenges and opportunities for public policy and public services. It is no longer enough to stick to our silos and care about the services on either side of a particular life transition; we now need to integrate and consider the impact of transitions both on service provision and on the individuals, families and communities who are affected by them.
I agree with many of the recommendations made in the Select Committee report. They are generally balanced, thoughtful and sensible, but I want to highlight one area where I feel that more research could be carried out, which is how the efforts of public and social entrepreneurs can contribute to enabling a smoother transition in later life, particularly when it comes to planning for retirement and ageing, and in building the support networks to cope better with and combat isolation. We tend to see retirement in the public policy arena in terms of hard fiscal, and non-fiscal, measures: pensions, saving, housing, social and healthcare implications and so on. However, in Life Transitions and Retirement in the 21st Century, we found that a major challenge for people was also the softer side and that better consideration is needed to enable people to feel positively about ageing and to see it as a journey, rather than as a disparate set of choices which can be confusing, easy to ignore when you are busy and sometimes daunting given the prospect of ill health and the end of life itself.
Specifically, we argued for a framework to provide a national retirement service that could mobilise charities, private organisations and government bodies to better signpost and draw in the ageing population. It would start when people are healthy and still in work and be designed to connect people locally and across generations, while giving them the information and training needed to make the right choices for them as they enter later life. A pilot to explore this has been initiated, which starts this weekend in Stoke with sponsorship, again, from Gulbenkian under the banner of the Retirement Transitions Initiative, using the incubation capabilities of the Shaftesbury Partnership—in which I declare a former interest as a founder. The scheme will work with employers, community organisations such as football clubs, charities, government agencies and faith groups, and local champions to encourage people to attend pre-retirement courses in a relaxed, down-to-earth and friendly local environment. By knitting people together and giving them the right information, the aim is to empower them and help them build resilience and networks of support from a cross-section of society. The aim is both to help prevent costs to the NHS and other statutory bodies further down the line and for us to learn what works and explore what blockages exist that might affect policy.
I would have liked to see a bit more in the Select Committee report about these aspects of ageing and how we can provide a cross-party consensus around significantly expanding holistic retirement planning courses under a national campaign, before it is too late. I would also have liked to see a bit more on how older people themselves can be a source of wisdom and ideas about how to improve the relationship between social care and health services and on how best to release equity and financial assets to pay for retirement or to incentivise continuing to work and a shift into portfolio part-time work. Those going through the process of retiring from the corporate world, as well as those who are unemployed or dealing with chronic illness, can often see more clearly than even some experts what the challenges are and what can be done. The APPG on Life Transitions aims to provide a forum to hear from the public and actors in the community such as social entrepreneurs about these challenges and the possible innovations in this area. I would like, in this regard, to ask the Minister whether the Chief Scientific Adviser’s research will be able to go further and gather or even crowdsource innovation and ideas from a wider audience than purely professionals and experts alone.
Clearly, the challenges and opportunities of an ageing society are mammoth and will require contributions from all quarters. How will we facilitate new kinds of start-up businesses, for example, that explicitly incorporate the wisdom and experience of part-time or non-executive semi-retirees along with young unemployed graduates and apprentices? How do we enable even more brokering of non-monetary means of bartering and support between those in later life and the wider population so that even those with limited means can still have a decent life? What role might housing design and building play in enabling young and old to live near each other and to support each other in their respective challenges, along Shared Lives and Homeshare lines, or is policy to lead inadvertently to a dangerous ghettoisation of different generations? These and many more questions and ideas need exploring if we are to have a step change in our understanding of later life and what is possible from both a wider public and public policy perspective.
Lord Bichard (CB)
My Lords, I congratulate the noble Lord, Lord Filkin, on the way in which he has led the work of this committee, which has been quite exceptional. I also want to congratulate the noble Lord, Lord Livingston, on a quite outstanding maiden speech. I cannot share the noble Lord’s passion for Glasgow Celtic but I agreed with every other word. The greatest compliment that I can pay is that the noble Lord would have made a quite exceptional member of this Select Committee. I look forward to hearing more from him in the future.
The Select Committee inquiry was not just about ageing but about our public services and how well equipped they are to cope with the major social challenges that we face. I am afraid that I came to the conclusion that they are not well equipped: not because they do not have the resources—although clearly there are problems at the moment—but because somehow we have still not been able to design, build and shape our public services around citizens and clients. Whatever the rhetoric and whatever the good intentions, our focus has continued to be on the providers and their convenience rather than on the needs of clients and citizens.
The evidence for that is very clear. For many years, we have encouraged different agencies to develop plans and objectives in isolation. We have set separate targets for each of them, which have sometimes been in conflict. We have developed different and sometimes contradictory regimes. We have failed to provide support for users seeking to find a way through this increasingly complex system. We have failed to encourage and incentivise collaboration between different agencies.
That has been the case especially in Whitehall, where departments have fought, mostly successfully, to maintain their independence, sometimes reinforcing their empires by building their own inspection and regulation regimes which have made it very difficult, sometimes impossible, for local agencies to work together for the benefit of clients. In addition, we have designed measures of success which have had more to do with bureaucracy and budgets than the needs of clients. We have responded to problems by reorganising structures, not redesigning services. Perhaps most of all, we have consistently failed to involve clients in the design of our public services.
The work of the Select Committee exposed four consequences of these fault lines. First, the failure of departments to work together means that there is still no coherent strategy for ageing in this country, because to have one would need housing through the DCLG and finance through the Treasury, and for health, social care, planning, education and DWP to get together meaningfully to produce a coherent strategy. They have not done it.
Secondly, the fragmentation of the system means that it copes particularly badly with people who have complex problems. Most older people now have what is known as comorbidity—they have complex problems. I am afraid to say that they often find themselves having to go to different providers or agencies to deal with each of their conditions.
The third consequence is that when those on the front line trying to provide joined-up care have succeeded it has been in spite of the system that we have designed and not because of it—they told us that very clearly. Fourthly and worst of all, vulnerable old people, often with long-standing and debilitating conditions, find their final days consumed with stress and bureaucracy. I was hearing yesterday of an old lady—let us call her Mrs Jones—who was in hospital when she was given the news that she was reaching the end of her life. Mrs Jones wanted to end her life, like most people do, at home. The hospital staff, to their credit, wanted to support her in that ambition. In order to realise that single, simple wish required the involvement of 23 different teams, the completion of 25 assessment forms and the convening of two separate funding panels. It took three agonising months and she finally got home two weeks before she died.
I have been speaking about the need for designing around clients and collaboration in our public services for many years. Many people think that you are talking about something dry: the reorganisation of Whitehall or whatever. But you are not. You are talking about the implications for Mrs Jones and the countless people like her for whom this system does not work.
The Minister, who I know shares many of these thoughts, will point to many very good initiatives which are under way. The integration pioneer programme is fantastic and, similarly, much in the care plan. I applaud that; I wish him well with it. But we need even more. We need a crusade to ensure that in future we never design public services for the benefit of providers; we design them for the benefit of clients.
The Lord Bishop of Derby
My Lords, I, too, thank the noble Lord, Lord Filkin, and his colleagues on the Select Committee for introducing such a comprehensive and expert report. I shall pursue the theme mentioned of the contribution of civil society.
My first point is about the language that we use and the signals that we give out. The noble Baroness, Lady Tyler, talked about the importance of a public debate. It is easy to use language such as “retirement”, which indicates something negative, about stopping and ceasing to contribute. In the diocese where I work, we have 200 clergy who are retired; 80% of them make an enormous contribution, not just filling in but front-line, active contribution to the life of the church. Some cultures use the word senior rather than the word ageing. We must be very careful how we frame the debate. I invite the Minister to comment on the language that we use and the signals that we give out, so that it is not about a problem of decline and desperation but celebrating life at different stages and in different ways.
My second point is about the breadth of health issues that need to be considered. In the city of Derby last year, I organised something that was called the Redfern Commission. A number of us as commissioners invited people to come into a space and talk about the challenges facing citizens in the present context: the lack of investment, declining local authority resources and such things.
People from Age Concern raised two things that had not occurred to any of us on the commission. One was the lack of sexual health advice for older people; it is all targeted at younger people; but with changing lifestyles and changing relationships, there is an urgent need for people to have access to information about sexually transmitted diseases and sexual health. The second area that was brought to our attention was the importance of recognising depression as people face loss at various stages and the need to set targets, as in other areas of health, for depression as people get older. Those were two things that came out from the commission that surprised me. I invite the Minister to comment on the breadth of how we look at health issues. Some big things, such as dementia, take all the space, but we may need to be more refined in talking about what health involves.
My third point is to talk about care with a small ‘c’ in the Government's response, the civil society contribution. In the Church of England, more than 8,000 of our parishes are actively engaged with work with people who are growing older—seniors. The great thing is that you have more than 8,000 intergenerational resource centres, where people of all ages are engaged in home visiting, meeting loneliness and prolonging a quality of life and conversation that gives health and vitality to people. The committee proposes a commission about the care system. I endorse that proposal, because I think that there is an urgent need to look at how all that informal, civil society caring, which is intergenerational, with a lot of energy put into it and which is making an enormous difference. How can we more systematically embrace what is a highly organised effort in all those 8,000-plus parishes across the country into a system that is also trying to best target the use of financial resources and professional expertise?
I have two final points. I remind your Lordships of the fragility of values. When I am in London, I stay in Putney. As I was walking in Putney this morning, I passed a huge office block. Over the door a sign says, “Volunteers overcoming poverty”. I looked closely; the block is empty, virtually derelict. We have these aspirations but then they drift away. We must recognise something that the church is passionate about: in an age where people approach things from the point of view of, “I want to safeguard my rights”, we must be bold enough to talk about the discourse of duty to neighbour. That is vital to turn around the social atmosphere and sense of commitment in an age that, for understandable reasons, is obsessed with the rights of the individual as a person.
Finally, a great friend, colleague and scholar who was a professor at King’s College London, Christopher Evans, lived to be well over 100 and died fairly recently. People kept asking him, as he went through the journey and had various health issues, what it was like getting older. He said that the key is perspective: “You have to understand that whatever happens to you as you get older, you’re simply waiting in the departure lounge”. There is a much richer and more exciting journey for all of us, whatever age we live to, and that needs to frame the debate too.
Lord Borwick (Con)
My Lords,
“Old age ain’t no place for sissies”,
as the late, great Bette Davis once said. This excellent report underscores the importance of that statement, and in markedly better English too. I am grateful for the opportunity to deliver my maiden speech on a subject so vitally important.
I took my oath on 29 July, after the whole House so generously elected me as a hereditary Peer to the Conservative Benches. I noticed that your Lordships considered my arrival and immediately went on Recess. This allowed me, though, to wander the temporarily lonely corridors of this fine building and to consume the time so unselfishly given by so many of the senior staff to bemused new Members such as me—and what an extraordinarily talented group of directors and senior staff I have met. My thanks are due to all of them, and particularly to my whip and mentor, my noble friend Lady Perry of Southwark.
My previous career has been in the automotive, housing and finance industries, but with a constant thread of disability. The reason may be that our two eldest sons had very bad heart defects when they were born. Our eldest son had to spend his entire first year of life in the intensive care ward at the great Royal Brompton Hospital, leaving him with some permanent disabilities. However, my wife Victoria and I are great believers in the American maxim, “When life gives you lemons, make lemonade”. Perhaps this is why I worked to make the London taxi wheelchair accessible. The secret was to make the accessibility ordinary rather than extraordinary; to make it normal and not mark it with wheelchair signs.
Disability will be ordinary in the future of our ageing society, as ordinary as hearing aids and glasses are today. The truth is that every one of us spends time in a wheelchair. That wheelchair is called a pram, or maybe I should say a baby buggy now, and we are very lucky if it is only at the beginning of our lives that we need such a wheelchair. If our physical environment must change to become even more accessible, our younger citizens had better start demanding it now so that it is ready when they need it for themselves. And yet our young people ignore their longevity—a point made in this remarkable report.
As the report says, arbitrary age triggers are out of date now, such as getting a free BBC TV licence at the age of 75 or being compelled to retire at any particular age whatever. Age-based benefits become increasingly absurd as the population grows older. Nobody knows better than the individual how well he or she is ageing. Many people will be able to start whole new careers when they are retired. In America, the Prudential advertises pension savings plans with the strap-line, “If you could pay yourself to do what you love in retirement, what would you do? Would you be a teacher? Would you be a musician or a painter?”. That is the optimist’s point of view. For many people who have saved wisely, the freedom to take risks and learn new skills will be very attractive. Many of us here in the House certainly are lucky to have started whole new careers as parliamentarians. The point is that arbitrary regulation by age is flawed.
Two differences stand out about the current cohort of young people who will eventually become Britain’s ageing population. The first is that they are definitely more computer literate than today’s average pensioner. They will expect information to arrive via the internet, not through newspapers or TV. Monitoring their health, happiness and well-being will be so much easier and cheaper in the future. We also need new ways to reduce their loneliness.
The second difference is that the level of debt they will bear will become heavier than anyone imagines, both as their share of our national debt but also through their own personal debts. I do not know what brouhaha will erupt when it finally dawns on people how much their predecessors have spent, leaving the bills to be financed later. The cost of servicing debt will inevitably claw into the cash available to look after our older citizens.
Next month Britons will remember fondly the veterans who gave their lives to protect our nation from destruction in two world wars. I hope that in decades to come Britons as yet unborn will look back in gratitude at what today’s leaders did to bequeath them a financially sound economy with debts at lower and more manageable levels.
There is nobody more aware of the value of experience than a brand new Member of your Lordships’ House, surrounded by the experienced people who constitute his new colleagues. I look forward to learning from all of you.
Viscount Ridley (Con)
My Lords, it is a great privilege to speak after my noble friend Lord Borwick and to congratulate him on an eloquent and perceptive speech. I have known him for a little over a year but in that time we have become firm friends, despite the fact that we were briefly rivals on the hustings. He is, I venture to suggest, exactly the sort of successful and independent mind that the House of Lords most values. Indeed, I hope I do not cause offence if I say that there are probably not enough of us here who have such direct experience of manufacturing industry. He has developed batteries, reinvented electric vehicles, traded with China, run a foundry and metal powder group, employed thousands of people and, of course, was for over 20 years the man behind the famous London black cab.
I am sorry to trump my noble friend Lord Wei but, although my noble friend Lord Livingston became chief executive of a plc at the age of 32, my noble friend Lord Borwick did so at 31, albeit that the company was a slightly smaller one. It is curious that we should be trumping each other on youth in a debate about ageing. It was in that role, as he has said, that my noble friend Lord Borwick championed the idea of making the London taxi the first wheelchair-accessible public transport in the UK. This precedent enabled him to make the door ramps that transformed the London buses to become wheelchair-accessible too.
Successful as my noble friend has been, though, he has had his share of worries and challenges. He has mentioned today his two sons who needed complex heart surgery, and I know that he and his wife Victoria have thrown themselves into various medical and disability charities to enable others to cope with what life throws at them. I congratulate him on a fine maiden speech, and we look forward to many more contributions from him.
Turning to the topic of the debate today, and not wishing to take up too much of your Lordships’ time, I begin by saying that it is hard to remain an optimist after reading some of the things at the beginning of this report. We read phrases like “woefully underprepared”, see references to an inappropriate health model for England and are told that the current system is in trouble now. So, before making a more serious point, I would like to offer a tiny crumb of demographic good news—at least, I think it is good.
Although the number of 85 year-olds is going to double by 2030, as the report says, and although the number of people over 100 is increasing at the rate of about 7% a year globally so that there are now 500,000 people in the world over the age of 100, none the less there are just 60 people in the world over 110 and that number, if anything, seems to be going down. When the party opposite came to power in 1997 there were four people in the world over 115; today there is one. I am not sure who that reflects badly on.
The last time the global longevity record was beaten was in 1997 when Jeanne Calment died at the age of 122, and it will be at least 23 years until it is beaten again. The last time Britain’s longevity record was broken was in 1993—20 years ago—when Charlotte Hughes died at the age of 115. So something slightly odd is happening. Average lifespan is going up dramatically all the time, but maximum lifespan seems not to be changing much at all. As I said, it is a very small crumb of comfort as far as the issues discussed in this report are concerned.
I turn briefly to three of the report’s conclusions that I found most interesting and vital. The emphasis on a new model of healthcare to cope with this problem is crucial. We had a debate in this House a few months ago, which was initiated by the noble Lord, Lord Patel, on models of healthcare. I was very struck by how bipartisan the support was for fresh thinking on how we tackle healthcare. We have to be able to get beyond the sterile debate about whether it should be public or private and realise that it is bound to be a mixture of both.
The second, which the noble Lord, Lord Filkin, mentioned in his speech, is the importance of drawing on the assets of the elderly to support their care. This is not an easy subject, and it is one that many people have struggled with. I do not pretend to have the answer, but it is vital to have raised this matter and to be able to discuss it again, I hope in a bipartisan way.
The final thing is the vital importance of economic growth, because if we redoubled our efforts to increase the growth rate of this country, some of these problems would suddenly look a lot less insoluble. Nothing does more to make debts affordable than economic growth. If this country were suddenly to find a way of growing at 5% a year, it would double its economy in 14 years. On that note, I draw the attention of the House to the possibility that what we need to be doing is looking at the wider economy as a whole as a way to solve this problem.
Lord Warner (Lab)
My Lords, I, too, compliment the two maiden speakers on excellent, thoughtful and entertaining speeches. I say to the noble Viscount, Lord Ridley, that a Labour Cabinet Minister, Emanuel Shinwell, lived to 109, and I challenge him to find a Conservative better in that area.
I congratulate my noble friend Lord Filkin and his committee on securing this debate and on their excellent report. This document is theoretically a wake-up call, but like so many alarm clocks, it runs the risk that people may turn over and hide themselves under the duvet rather than respond to it, so I propose to talk in more apocalyptic terms today about a national icon: the NHS, the star of Danny Boyle’s Olympic nostalgia-fest last year.
Let us forget the schmaltz for a moment and remember that the NHS is a £100 billion-plus a year business and its budget will account for nearly one-third of public service spending in 2015-16, up from just over one-quarter in 2010. By 2015, the NHS will still be spending every pound that it had in real terms in 2010, but most other public services, such as local government, will have only 70p of their 2010 pound. Those are not my figures; they are from the Institute for Fiscal Studies. The NHS is a 65 year-old pensioner that has adopted a lifestyle that is well beyond its current and future means. It now faces—and I do not think this is too apocalyptic—bankruptcy. If noble Lords do not believe me, they should read the chief executive—of whom the noble Lord, Lord Mawhinney, is so fond—of the NHS in this week’s Health Service Journal. The NHS is in very difficult financial trouble. It faces not only the demographic time bomb well described in the committee’s report, but rising public expectations and the costs of scientific advances, many of which may produce cost savings, but usually involve extra cost at the point of introduction. However, it is doing this not at a time of economic growth but at a time of fiscal constraint, probably low economic growth and serious limits on the tax ability of the electorate or the capacity to transfer resources from other public services.
Forget 2030—a huge back hole in the NHS’s finances is opening up by the end of this decade if it carries on as it is. The outgoing NHS chief executive thinks that it is £30 billion. The respected Nuffield Trust puts it at upwards of £40 billion and possibly more than £50 billion. These are serious financial problems to be tackled. As my noble friend Lord Filkin has indicated, the NHS’s core business has changed to coping with and treating long-term conditions, and often multiple long-term conditions in a single individual. However, we have simply not changed the service delivery model accordingly.
It is increasingly apparent that we are spending our highly valued NHS pounds on the wrong business model. The customer base has changed and needs something radically different. The NHS is seriously on the way to becoming like British Leyland in the 1970s. I do not have time today to describe how we need to reshape these services but—and this is my final point—if we do not change them and increase the efficiency of staff on NHS plant, we face a real problem. Even if we make all those changes, that will remain a problem. If the NHS is to remain largely a tax-funded healthcare system universally available in this country, it has to find new sources of revenue streams and new ways of adding money to that provided by the taxpayer. We need to look at the possibility of changing the boundary of what the NHS covers. We need to look at co-payments. We need to look at the NHS undertaking more commercial activities. There are many more possibilities.
I recognise that I am trespassing on holy ground here, but we have to start facing up to these issues if we are going to make the kind of responses that my noble friend’s committee’s report suggests that we should be making.
Baroness Thomas of Winchester (LD)
My Lords, I cannot remember when I last enjoyed two maiden speeches so much as those which we have heard today.
I, too, congratulate the committee on what must be one of the most important reports ever produced by a Select Committee of this House. Why has this whole question of our ageing population not been at the top of the agenda for successive Governments in the recent past? After all, we have known about the figures for many years. I am glad that at last we are having a proper debate about the whole subject of our ageing society. This report gives us a most welcome route map, and must be seen in conjunction with some of the health reforms and, of course, the Care Bill which simply would not have happened without the former Minister, Paul Burstow, whom I salute today.
Paragraphs 37 and 54 of the report both state:
“Central and local government, housing associations and house builders need urgently to plan how to ensure that the housing needs of the older population are better addressed”,
because the housing market is delivering much less specialist housing for older people than is needed. The Government’s response is encouraging. They acknowledge that more designated specialised housing for older people and disabled adults is needed, and highlight the capital grant of up to £300 million for the care and support specialised housing fund. Perhaps my noble friend could tell us more about how that money is being allocated.
However, many older people want to keep their independence by staying in their own home. Although I acknowledge that the Government have increased their funding of the disabled facilities grant over the past two years, I worry about the bureaucracy involved. In his oral evidence, the managing director of Care and Repair Cymru in Wales says that the first thing they try to do is to make sure that people do not have to use that system for smaller things such as handrails, grab rails or even a stairlift. That plea is echoed by occupational therapists because, they say, the DFG process is long and bureaucratic. That sounds ridiculous. Is my noble friend convinced that the DFG process is working as well as it should? Surely it should be simplified because a long bureaucratic process must cost a lot of money to administer—if for no other reason.
This brings me to the role of the social services departments of local authorities. The spotlight is often thrown on to social workers when tragedies occur involving the death of young children, but the other vital professional group we hardly ever hear about are the occupational therapists, who are the first port of call when an elderly person rings their local authority to say that they can no longer get out of their bath safely or climb the stairs. What may not be so well known is that local authority OTs advise people in all forms of housing on how to stay independent as they age. They manage the long waiting lists of assessments and are the key workers in providing early interventions, preventive approaches and reablement. That assesses what people can do for themselves with their existing support, helping them to set weekly goals, and reablement workers support the person in meeting those goals.
However, the occupational therapists’ workload grows ever heavier, while local authority budgets are shrinking. OTs deal with between 35% and 45% of local authority referrals yet make up only 2% of the workforce. The importance of their intervention is illustrated if one looks at what happens when an elderly person has a fall which leads to a hip fracture. That costs the public purse around £28,665, which is more than four and a half times the average cost of a major housing adaptation and more than 100 times the cost of fitting hand and grab rails to prevent falls. There are many other savings to be made when OTs become involved at an early stage, and I urge the Government to do all they can to make sure that guidance is given to the relevant authorities to involve occupational therapists in designing and commissioning services.
The two other functions these invaluable people undertake are also getting busier. These are advice for people with dementia on strategies and techniques for managing problems, and in the public health field, advising people with long-term conditions on how to manage their health and well-being. The more OTs are employed in the public service, the more money will be saved.
Lord Crisp (CB)
My Lords, this is an excellent report. I very much agree with the recommendations and with the disappointment of the noble Lord, Lord Filkin, at the Government’s response. I add that I am not a member of the committee that produced the report. I also agree with many noble Lords who said that this issue cannot be avoided or just left to muddle through. I congratulate the committee on not letting it go, and on continuing life after its committee proceedings.
I speak as a former permanent secretary of the Department of Health and chief executive of the NHS, and declare that I work in health, although globally, not in the UK. This is, of course, a global issue, as the noble Lord, Lord Livingston, said in his excellent maiden speech. I agree with the analysis that the committee has made of the problem. Very simply, we are using a 20th century model of health and social care to deal with 21st century problems of health and social care. It does not work, and we see that every day in the newspapers and will continue to see it in the newspapers, in our A&E departments, in the number of elderly people who are stuck in hospital—and in everything that we all know.
As noble Lords have said, and as the report says, we still do not have a clear strategic vision for the future of health and social care, and that is fundamental. I will mention two areas where the report could go even further—and I hope that the Government will. There is a lot of agreement, as has been said already in the House, about the nature of the problem. People are all aware that we need a much more community-based system that is much more focused on prevention. We also seem to accept a lot of the implications of that, which will involve bringing together health and social care much more closely, closing some acute hospitals, and investing in technology and in the community. However, agreement falls apart when we get to some of the detail, and the issues of winners and losers. Because we do not have a strategic vision that spells out all the implications, we have too many initiatives that are piecemeal and that often tackle symptoms rather than causes. Camilla Cavendish’s review of healthcare assistants, which was mentioned in the government response, is a good case in point. It was a good review, but it would have been even better if it had been in the context of a genuine, strategic vision for the workforce. Healthcare assistants do not operate in a vacuum.
This is the biggest failure at the moment. The biggest factor to take into account is the workforce. I do not think that it is mentioned in the report or in the Government’s response. I may have got that wrong, but clearly it is not in any of the headlines. Of course, the workforce never is. If you are going to have radical change in the service that is provided, you will have to have radical change in the workforce, as well. I will give some radical examples, although I am not necessarily advocating them. Are we going to be talking about having far fewer specialist doctors and more generalists? Are we talking about nurses doing many more of the things that doctors do now, and other people doing things that nurses have done in the past? We need graduate nurses, but do all nurses need to be graduates? What about the links between health and social care and the workforce? How radical are we going to be in taking this on? I am a member of the Lancet commission on the future of professional education. That has produced some radical notions about the role of senior professionals and team leaders as agents of change who are constantly searching for quality and cost improvements. Are we going to be that radical?
Of course, this is the biggest cost in the NHS; around two-thirds of the cost is in the workforce. In Africa, where I work, we have long recognised that the scarcest commodity is not money but skilled health-worker time. Do we in the UK use skilled health-worker time to best effect? Do we always make sure that people are working, as the Americans say, at the top of their licence, as opposed to doing things that other people in the system can do? This is not just about getting rid of paperwork for professionals; it is about making much more radical changes.
While Africa leads the way in changing health roles globally, the UK leads the way in developed countries—for example, with the expanded role of nurse prescribers and of nurses more generally. As I said, this is the highest cost, which is one reason why it is the most difficult area to tackle, and why people never tackle it. I understand the political traps of taking on the doctors or nurses to make some of these changes, and I understand that it would create winners and losers. However, it is not good enough to leave this to the local level. First, they cannot do it; you cannot make the changes necessary at local level. The headquarters has the responsibility of ensuring the capacity and capability of an organisation, and it is not doing so at all at the moment. Of course, this need not be top-down; it should be developed with practitioners and people at local level. However, as many people have said, the Government have a responsibility to ensure that there is an appropriate framework here for the future. Of course, if it is not sorted out, we will not see change.
My point is that this is not just about economic costs. The other question that needs to be looked at alongside it is: who will give the care? I will take 30 seconds more to refer to the fact that this is not just about professionals. We must not slip into the lazy assumption that the NHS is like a commercial insurance system, and that patients are simply customers. Care is not given just by professionals but by many carers. It is given by neighbours and voluntary organisations; it is given in a wide range of different ways. The NHS and social care form a social system rather than an insurance system. There are roles for carers, patients and families, and we need to redefine those as well. People can do more for themselves. We see examples in other countries of people doing much more in the way of monitoring. We see them delivering dialysis for themselves. Of course, these examples also produce improvements in quality and in cost.
In conclusion, I would be very interested to hear what both the Government and the Opposition say about the challenges that the report sets them in setting out the position for the future and a long-term vision. I will also ask the Minister a specific point, as a first step towards that. Does he accept that a changed, new NHS of the type described here will require a new, radically different workforce strategy, with changed roles for doctors and nurses, and changes in professional education? If he says that that is the responsibility of NHS England, as I suspect he will, will he then ensure from the Government that NHS England, in developing its strategy, will take proper account of the 60% of the NHS budget and of the changes that need to be made there as well as elsewhere?
Lord Griffiths of Fforestfach (Con)
My Lords, it was a great pleasure to be a member of the committee. I congratulate the noble Lord, Lord Filkin, on his chairmanship of it as this subject is potentially politically divisive. He chaired the committee brilliantly. He listened carefully to everyone’s arguments and was very balanced in his judgment. We have heard two outstanding maiden speeches this afternoon. I am delighted to see two more noble Lords with a business background on the Benches of our House and look forward to hearing many more outstanding contributions from them.
I wish to make four points. First, I draw noble Lords’ attention to the strong language in the report and to the strong language of the chairman. The noble Viscount, Lord Ridley, pointed out that the report says that the Government are woefully underprepared to tackle this problem. It also refers to “a collective failure” to address the problem. Indeed, the noble Lord, Lord Filkin, has said that the Government’s response to the committee’s report was weak and failed to give leadership. He also said:
“Government and all political parties prefer to keep the public in the dark”.
In opening this debate, he said that there was no rebuttal by the Government of the committee’s evidence and that the Government lacked vision, which was a great shame. As I say, the noble Lord is a man of balanced judgment and moderate temperament. However, I suggest that the strength of his language and the stringency of his argument fairly reflect the views of the committee regarding the sheer scale of this problem—it is enormous—and the fact that we are simply not grappling with it.
Secondly, one thing which came out very clearly is that many people in our society are not financially prepared for retirement. People are living longer. Many surveys have been done—for example, by HSBC, Scottish Widows and the department itself—which have tried to figure out what people’s position really is. I shall not bore noble Lords with the details, but, frankly, they are horrendous. A section of our society, the members of which unfortunately fall in the lower income groups, is not at all prepared for retirement. If we as a society do nothing, we face the spectre of a much more unequal and less inclusive society. In the future, no Government will be able to stand by and be indifferent to pensioner poverty, which will create a serious problem for the public finances. We need to grasp this problem now; it cannot be deferred.
Thirdly, something in our report that struck me forcefully was that many people will have no option but to work longer if they want to have a decent standard of living in retirement. We made it very clear that no one will be forced to work against their will. The decision of when to retire must be made freely by the individuals concerned and not be imposed by society as a whole, least of all by government. On the other hand, if people have to work longer through necessity, the committee’s view was that we should make a virtue of this.
In any case, as I know myself, work brings positive benefits. Apart from providing some extra income, it keeps your mind active and means that you are involved in a community of much younger people. I find it extremely stimulating. The good news from surveys that have been carried out is that many people would like to work into retirement, whether part-time, part-year, job-sharing, working reduced hours, doing term-only work or home working, and perhaps taking unpaid leave. Business is already rising to the challenge of this extra work. The department has published a list of companies and local authorities which have been very innovative. We also know from maternity leave and from the arrangements made for pregnant women while at work that business can be very flexible. Therefore, there is evidence of this.
Finally, I very much chimed with the closing remarks of the noble Lord, Lord Filkin, when he said that the Government need to set a framework encompassing retirement age, state pension, housing equity release and developing a savings culture and so on. On the other hand, could not the political parties make a commitment in the manifestos that they will be preparing for the next election regarding the immediate challenge that we face? I should like to ask the Minister what he would suggest in this regard. Could they not make a commitment saying, “We will address this problem in our manifesto.”? Such is the scale and seriousness of the problem, as I think our report shows.
Baroness Wilkins (Lab)
My Lords, I, too, congratulate my noble friend Lord Filkin on securing this debate and on his committee’s excellent report warning us that the Government and society are woefully unprepared for the ageing of the UK population.
Like many fellow noble Lords, I am one of that cohort known as the baby boomers. However, we have not just arrived; we have been around a long time—long enough for successive Governments to prepare for. By 2031, I shall be 85, when there will be twice the number of people of that age than in 2010. Yet, as the report says,
“no government so far has had a vision and coherent strategy”,
to ensure that our society is ready for ageing. Government, central and local, can no longer keep their heads buried in the sand.
It is the report’s reflections on loneliness and isolation on which I want to concentrate today. Citing the deleterious impact of loneliness on the quality of life and the health and well-being of the old, the report sees this as,
“one of the biggest risk factors for people needing care and support”,
and the group most affected is older women who mostly live alone.
In their response to Ready for Ageing?, the Government acknowledge the huge impact of social isolation and persistent loneliness on people’s health and well-being in later life. However, they then go on to suggest technology, touch-screen tablets, e-mails and video conferencing as a remedy. This surely was dreamed up by a 25 year-old, totally unaware of the realities of being an 85 year-old woman living on her own in frail health in 2030. Loneliness requires human contact, touch and empathy, and the everyday stimulus of news and gossip. It requires people whose presence does not depend on the state of a local authority’s budget.
I have spoken a number of times in this Chamber about cohousing—a way of living that combines today’s aspiration for the autonomy of our own home with being within a supportive community. It is a model well established in continental Europe, where senior cohousing communities are encouraged by various Governments also faced with rapidly ageing societies. They are based on a range of ages over 50 and are a self-help model—fundamentally a means of prevention, harnessing the energies of younger cohorts of older people to address their own futures and help others.
I declare an interest in that I am a member of Cohousing Woodside, a group working with Hanover Housing Association to develop a senior cohousing community in Muswell Hill. I am also partner to one of senior cohousing’s main advocates in the UK.
I first spoke of the struggle to establish senior cohousing in the UK in the debate on the Queen’s Speech in 2003, mentioning OWCH, the Older Women’s Cohousing project, a low-income group of women Londoners aged between 50 and 80, all living alone. For five years they had been meeting regularly, building the social capital which is the essence of cohousing. They aimed to be, and are, a living demonstration of how older people can band together to address the challenges of ageing. My noble friend Lord Warner, then the Minister, was very encouraging in his reply to the debate. But that was 10 years ago, and those people are still waiting for their homes to be built. One of the founder members is now 84, and living up a flight of 27 steps. Thankfully, Hanover Housing Association has seen the benefits of cohousing and taken action. It is now about to build the OWCH community in Barnet, the first senior cohousing community in the country, due for completion in 2015. In what will be an age-proofed, low-energy, lifetime homes standard environment, which they will manage themselves, they will operate as friendly, supportive neighbours. This insightful initiative by Hanover sets an example that others should follow.
This model of cohousing deserves much greater official support and encouragement in a housing and planning system where the cards are totally stacked against it. Hanover’s enterprise in promoting it is to be applauded and lessons need to be learnt from the 14 groups around the country struggling to develop senior cohousing. The authorities must be shaken out of their torpor by the report of the noble Lord, Lord Filkin, and start to take radical action. So much could and should be done. The Government could do much to offer incentives to developers and local authorities. For instance, they could provide public land from public housing sites.
Cohousing is obviously not the answer to societal ageing, but it is one answer, and one that makes full use of the assets of our older population.
Baroness Finlay of Llandaff (CB)
My Lords, it was an enormous privilege to serve on this Select Committee, which was led so elegantly and chaired so well by the noble Lord, Lord Filkin. The report should be a wake-up call to everyone, but we must be careful that the language does not disguise what we are facing. Talk of a demographic time bomb makes it sound as if everybody growing old is a problem, when actually we must harness this fantastic cohort in our population, who are well and living well, but who are not encouraged to contribute adequately back into society, as many want to. We know that 30% of those over 60 volunteer through formal organisations but, sadly, their real skills are often not adequately harnessed. I have just met a group of people, many of whom are retired, who provide accompanying people—doulas—for people at the end of their life, to sit with them and stay with them. They are provided with training and many of them work as volunteers, giving of their own experience, their ability to be calm and the wisdom that comes with age to those who are frightened and to support families. That is just one example.
At a personal level, I also experienced over the summer how well some of the services can work to enable and re-enable the elderly. My 95 year-old uncle, adamant that he was not going into hospital, looked as if he was dying. The sensitivity and compassion with which Westminster social services dealt with him when he was in need has re-enabled him. He is now back using his iPad, working, in a voluntary capacity of course, and lending a listening ear to other people who are lonely and want someone to talk to. He has a great network that he is supporting, and he is contributing back into that society. Sometimes it can be done, but the elderly population themselves need to be encouraged and harnessed, and our policies need to recognise that.
In healthcare we view the elderly potentially as a problem. I had the privilege of being asked by Mark Drakeford, the Minister for Health and Social Services, following my time on this committee, to lead a national conversation in Wales about the unscheduled care of the elderly. There the problems are exactly the same, with emergency departments that seem to be full of elderly people. Indeed, there has been a 26% rise in the past four years of elderly people attending emergency departments but they do that by default. They go to hospital because it is the only part of the system that is open 24/7. Like other noble Lords, I fully support the need for a seven-day service. We cannot have a service that admits on seven days and discharges people on four and a half days. That does not add up.
We need to change attitudes, too, across the whole piece to stop being risk-averse, so that the kind of delays we heard about of people getting home will go, and that people will be respected for their own ideas and for what they want to do. Care homes are a place that many people fear going into. In our inquiry, we found that things are not always as good as they should be. It is a tragedy that one in 20 people report that they do not always get adequate or timely food and drink. Even though 71% are very or extremely satisfied with their care, that drops to only 55% for home care. So the attitude within all aspects of the services has to change to say that the older person is of worth. Cicely Saunders said that dignity was having a sense of personal worth. We need to value that wisdom and that cohort and harness them.
I hope that the Government and all future Governments will proofread every policy that they produce against the needs of the elderly to make sure that they are maximising the ability of the elderly—the older population—to live well and to contribute their resources back into the society in which they have lived and to which they have contributed previously.
Baroness Greengross (CB)
My Lords, I begin by thanking and congratulating the noble Lord, Lord Filkin, and the Committee for their excellent report.
I want to point out a few things that I have been thinking while listening to the excellent contributions today. First, we are living in an unprecedented situation—unprecedented in the history of mankind’s existence on this planet, which in the history of the planet is perhaps not very long, but which in our minds is a long time. It is a long time since people died before the age of 25 because they were starving, were attacked by wild animals or caught an infection that they had no possible means of correcting.
We know now that most of us are not as certain as we used to be about what happens when we depart this world, so we want to hang around for as long as possible. For that to happen, we want to be in good enough health to enjoy living and be recognised by other people as part of society—not an add-on to be cared for or looked after, but a real part of the total society in which we live. We have to plan, which is what the committee’s report emphasised, across the board to cope positively and to enable us to celebrate in the appropriate way this incredible change in the longevity that each of us can expect to enjoy—real planning for today’s society, and not, as the noble Lord, Lord Crisp, pointed out, planning the future on the basis of what we did in the past. That would be a bit like planning for a war on the basis of yesterday’s war technology and weapons. If we do not, as the report points out, needs will remain unmet, cost pressures will rise inexorably and the balance of responsibilities between individuals and the Government will not change in the way that is absolutely essential. Again, the report points this out.
We need radical reforms across the board but this will be very difficult to achieve because there are many pressures not to change. The report points to the essential fact that, as the noble Lord, Lord Warner, said, we have to look at everything in the light of what we need to keep as it is and what we must change.
In the world of work, we need employers and government to work together because people cannot save in the way that they need to unless they work for longer. We know people have to save more, so they have to work more. In order to do that, employers need help in creating the kind of workplace in which older people can work. There are some brilliant examples in other countries and there are a few in this country. We have to change.
We have to look at how we pay for the kind of care and pensions that we will need in the future if we are to live decently. The move to support old age must take place. If not, age-related spending is projected to rise from an annual cost of 21.3% of GDP in 2016 to 26.3% of GDP in 2061, which is a rise of £79 billion in today’s money. We must therefore consider at all options. We must look at pensions and benefits, and look again at property values, and consider how we will pay for our needs in old age with an open mind.
The support ratio is projected to fall. The Pensions Bill was a laudable attempt by the Government to begin to get this right, on which I congratulate them, but the support ratio—which, by 2051, will be only 2.9 workers to every person of pensionable age—means that this is even more necessary that we thought previously. To make employment realistically possible for our ageing population, flexible work must improve. However, many other changes are needed in work patterns and employers need to be supported in that.
Our built environment must be designed for the real society of tomorrow—not only in terms of housing, critical as that is, but our parks, our open spaces, our roads, our pavements, our transport. The design for the ageing of our population will benefit all of us but it must be taken into consideration. On education, we must look more closely at mixed-age learning centres and open up to the new technology and what it can do.
This is not a party issue or an issue only for the Government, employers, unions and the voluntary sector; this is a whole-society challenge. Major works are going on, in which I am grateful I can play a part, and I wish to mention two or three. The King’s Fund has set up a commission looking at the future of health and social care, of which I am delighted to be a part; the Institute of Chartered Accountants in England and Wales is looking at a strategy for the ageing society; Business in the Community is looking at responsible business practice going forward; and the current and future work of the ILC is part of the Commission on Ageing and the Voluntary Sector. These organisations are trying to address these issues so that we can truly celebrate the ageing of our society in the future. It is a triumph. We must therefore ensure that both our older and our younger future populations together create a society where age does not mean stigmatising labels, but rather that we are all valued for what we are, what we do and what we contribute, so that we can forget about the number of birthdays we have celebrated.
Lord Hunt of Kings Heath (Lab)
My Lords, it is a great pleasure to wind up for the Opposition and to congratulate the noble Lords, Lord Livingston and Lord Borwick, on their excellent maiden speeches. I also congratulate my noble friend Lord Filkin and the members of his committee on producing such a good report. We have had a good debate and many issues have been raised, but for me one of the most important was mentioned by my noble friend Lord Hutton. He was surely right to point to the impact of defined contribution schemes on pensions and whether the well known shortcomings of those schemes really are going to be dealt with. The noble Lord, Lord Griffiths, talked about literacy in terms of the financial issues facing pensioners. We have been discussing in the Care Bill the whole issue of whether vulnerable older people are able to make the big decisions that often have to be taken on their finances without access to proper information and advice. The recent ABI report on annuities makes for sobering reading in relation to the differences between the best and the worst annuity schemes, and the seeming inability of very many people to understand that they can shop around when the time comes to make a decision.
We also heard about the cliff edge of retirement and the need for businesses to be flexible. The positive point which has come through that I would stress to the Minister is that it can be a key advantage to businesses if they are flexible with their workforce in terms of the contribution that older people can make to the working environment. My noble friend Lady Wilkins talked about housing and the need for a much more cohesive approach to meeting the housing needs of older people. I refer also, of course, to the pressures on our health and social care system.
Above all, the message has come through to the Government and indeed to the Opposition that there is the need for a vision. We are facing a tremendous challenge, and at this point none of us is confident that we know how to meet it. I hope to hear from the noble Earl, Lord Howe, that there will be a greater recognition on the part of the Government of the kind of challenge we face and the vision that is needed. Certainly the initial Government response to the report is what I would call a worthy one, where each department has put forward a number of points, but at the moment it does not read like a cohesive whole. That, I think, is what the clear message of this debate is all about. Certainly from the point of view of the Opposition, the Leader of my party is very well aware of these issues and we will be assessing how we can take the lessons of this report forward into the next election.
The noble Lord, Lord Bichard, raised a very important point when he talked about the failure of different government departments to work together. That leads to different performance and management processes at the local level and different regulatory systems. The result is that when people at the local level are planning and delivering services, there are often perverse incentives in the way of them working together. I would be grateful if the noble Earl could say a little about how the Government can encourage local organisations to work more together effectively by blowing away some of the bureaucracy that often gets in the way.
We have to talk about health and social care, as did my noble friend Lord Filkin. There are huge pressures in these areas. Now, in mid October, many hospitals are facing an A&E crisis. If we are facing a crisis in October, the winter is going to be bloody. It is very simple: primary care is inaccessible and therefore 24/7 A&E is often the only place where people can go. Discharge has become much more difficult, and so hospitals are getting fuller and fuller. At the same time, the pressures that have come, quite rightly, from the Francis report, the Berwick report and the Keogh report, have been particularly around the need for hospitals to increase their staff. But money has got much tighter and something is going to have to give. That is a serious issue which underpins what my noble friend Lord Warner said. We are marching towards a real crisis in health and social care, and at the moment, I do not think that any of us are confident that we really know the way through. Clearly, we have to integrate services and find answers to the funding issues. We must not only meet the demographic challenge but engage the huge technological advances, which can do much for older people but will cost more money, particularly in the short term.
The noble Lord, Lord Crisp, talked about the workforce in health and social care. How right he was. I would just say to him that the recent Royal College of Physicians’ report on the future hospital did not just look at new ways of running hospitals, reflecting that most people in hospital will be older, but said that we should move away from specialisation and that the way forward was for general physicians to treat the patient as a whole, with many comorbidities. It is really exciting that a royal college is leading that kind of movement. We need to work on that.
My noble friend Lord Filkin said that the committee was continuing, albeit unofficially. That is very welcome. The report has given us a huge wake-up call and the responsibility falls on all of us to respond as effectively as we can.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I begin by congratulating the noble Lord, Lord Filkin, not only on raising this important debate but on chairing the committee that produced Ready for Ageing?. I thank the other members of the committee for their work on this valuable report. I am sorry that we were unable to discuss the report earlier in the year. However, had we done so, we would not have had the advantage or the pleasure of listening to my noble friends Lord Livingston and Lord Borwick deliver their superb and wise maiden speeches.
The committee’s report covers a number of very important and fundamental issues. As a result, it has provoked discussion and debate across government about how we can continue to work together most effectively to meet the needs of an older population. This country faces major demographic and economic challenges as a result of an increasingly ageing population. We welcome the committee’s report, which shares the Government’s ambition of making this country a great place in which to grow old. If we think about what such a country should look like, it is a place where older people get excellent care and support when they need it, where people are supported to live independently, where people plan and save to ensure a good retirement income in later life and where we make the most of the skills and talents everyone has to offer.
We know the challenge is significant. The quality of our later life is an issue which affects us all. The noble Lord, Lord Bichard, was right that cross-government co-ordination and focus are crucial to achieving success. We all have responsibility for ensuring we make the most of the extraordinary opportunity of increasing life expectancy, as the noble Baroness, Lady Finlay, rightly pointed out. These challenges are for individuals and communities, for local and national government and for the private and third sectors.
The Government’s response to Ready for Ageing?, published in July, describes the far-reaching programme of reforms we have put in place, as well as the plans we have for further work, which we believe will begin to address the challenges that the noble Lord and his committee have set out. The noble Lord, Lord Warner, was correct to highlight the pressures on the NHS. For example, the NHS handles more than 2 million unplanned admissions to hospital a year for people aged over 65. These account for 68% of hospital emergency beds and the use of more than 51,000 acute beds at any one time. It would simply not be sustainable for those admissions to go on increasing in line with demographic changes. We know that, to adapt and respond to future need, the health and care system needs to change. The challenges set out in the report create an opportunity for the NHS and local authorities to innovate and explore new ways of working, better to meet the needs of the local populations and optimise the use of available resources.
I listened with a very considerable measure of agreement to the noble Lord, Lord Bichard. Our vulnerable older people plan will strengthen primary care to make sure vulnerable and elderly people, including those with long-term conditions, have the support they need to keep them in better health and out of hospital. These are urgent and absolutely necessary changes to help ensure that our health service is person-centred, efficient and sustainable for the future. It is our ambition that people should receive high-quality, integrated and person-centred services that deliver the best outcome to the service user and make the system as a whole more efficient.
The noble Lord, Lord Filkin, questioned whether bottom-up change would be sufficient to transform health services. On 26 June, we announced the establishment of a £3.8 billion integration transformation fund, a pooled fund between local government and health to drive forward better integration between health and care services. It is perhaps more of a top-down initiative than the Government have been used to, but we felt that it was necessary.
The noble Baroness, Lady Finlay, and my noble friend Lord Mawhinney referred to the need for a 24/7 NHS, and my noble friend questioned how we would create that. Professor Sir Bruce Keogh, medical director of NHS England, is undertaking a review, consulting patients, the public and NHS staff to help shape the future of urgent and emergency care services. The review is investigating the provision of urgent and emergency care as part of a drive to promote more extensive seven-day services in the NHS and developing a national framework to build a safe, more efficient system. I can tell my noble friend that we are holding Sir Bruce to account for delivery of that framework. We urgently need to improve the way we offer care between our hospitals, primary and community care, and social services. Better integration and communication between these services is the key to success.
I can tell the noble Lord, Lord Crisp, that the NHS is planning for the longer term. In July, NHS England published NHS: A Call to Action. This is a first step in a sustained programme of engagement between NHS users, staff and the public around how the NHS will meet future challenges, including an ageing population and a significant increase in the number of people with long-term conditions. We are also consulting on major changes to the way in which people plan and pay for their care. The reforms will give everyone the peace of mind that they will get the care they need, and that they and their home will be protected from huge costs if they develop very complex care needs.
My noble friends Lord Borwick and Lord Griffiths and the noble Baroness, Lady Greengross, were absolutely right: enabling older people who can work to stay in work is critical to the economy and pension sustainability, and to the financial health and social well-being of individuals. The noble Lord, Lord Hunt, made that point as well. We have abolished the default retirement age, meaning that most people can now retire when the time is right for them. However, employment rates for older people remain lower than for some of their younger counterparts, and we must ensure that older people who wish to contribute in the workforce have the opportunity to do so. To that end, we have announced our commitment to publish an extending working life framework for action early next year.
The state pension reforms, which are currently in the House of Commons, will replace the two-tier pension system with a simpler, single-tier state pension for future pensioners. The full rate of the new state pension will be set above the basic means test, helping to provide a clear foundation for retirement saving. The reforms will underpin the rollout of automatic enrolment, which will see 6 million to 9 million people saving more, or saving for the first time, into a workplace pension. I can tell my noble friend Lord Griffiths that increasing the basic state pension by the triple lock is part of the secret here—a minimum of inflation, earnings or 2.5%. From April this year, the basic state pension has represented a higher share of average earnings than at any time since 1992.
The noble Lord, Lord Hutton, with his insight into these areas, spoke with great authority about defined contribution pension schemes. Automatic enrolment and the single-tier pension will provide a firm foundation for saving for retirement, but if the current forms of defined contribution pension saving become the default alternative to defined benefit schemes, the pension income of future generations from workplace pensions will be more uncertain than for past generations. Over the past 12 months, the defined ambition project, a joint project between DWP and the pensions industry, has been exploring options in a middle ground that do not leave either individuals or employers shouldering the entire risk of pension saving. The Government will shortly publish a consultation paper outlining the conclusions from this work and proposals for defined ambition pensions. Following the response, the Government will consult on draft legislation.
The noble Lord, Lord Filkin, and my noble friend Lady Thomas referred to the imperative of housing, as did the noble Baroness, Lady Wilkins. The Government are providing £315 million to help to develop specialist housing for older people and adults with a disability. That tailored accommodation will help people to retain their independence for as long as possible and provide a better quality of life at the same time as maintaining links to family and friends and retaining ties to their local communities.
I can tell my noble friend Lady Thomas that the care and support specialist housing fund will be paid out in two tranches. The first tranche will provide 3,000 extra specialist houses for older and adult disabled people; the second will support development of private sector housing for that group. All that is in addition to £4.5 billion being invested over the spending review period to deliver 170,000 affordable homes by 2015 for rent and affordable home ownership. That investment will lever in £15 billion of private sector investment, a total of £19.5 billion invested in new affordable housing. The National Planning Policy Framework, published last year, should deliver a wide choice of homes and plans for a mix of housing based on demographic trends and the needs of different groups in the community, such as older people.
Those are just a few examples of the wide-ranging reforms that are detailed in the Government's response to Ready for Ageing?. To follow up a point made by my noble friend Lord Livingston, work that we are doing today will mean that future generations will not be burdened with huge debts. As Albert Camus said:
“Real generosity towards the future lies in giving all to the present”.
Public provision must continue to adapt and respond as the needs and expectations of the population change. At the same time, individuals must take personal responsibility for planning for their later life, making choices and exercising control.
However, we are conscious that that is not the whole answer. I can reassure the noble Lord, Lord Filkin, and my noble friend Lord Ridley that work is ongoing across government to identify the scale of the challenges ahead. At a ministerial level, we will then consider how we should meet those challenges. I say to my noble friend Lord Mawhinney that this is definitely a matter for government. We will use this work to look for opportunities to innovate and explore new ways better to meet the needs of our local communities and optimise the use of available resources.
The Department of Health does not make its own projections of demographic changes, but is informed by work undertaken by academic experts in the field. Their models were developed under a programme of research funded by the Department of Health and other funding agencies. Inevitably, although they are plausible assumptions, there is significant uncertainty about the direction of future trends, and there is no consensus among academics. However, the department is confident that it is informed by the best modelling and evidence available.
My noble friend Lady Thomas rightly observed that social care funding is dropping. She made the point that it was not keeping pace with demand. I would not want to belittle the pressures on local government budgets. However, interestingly, the Health and Social Care Information Centre has recorded a drop in demand for social care. Local authorities report that preventive services, such as reablement of people leaving hospital, are successfully reducing demand on social care. We need to build on that.
The noble Lord, Lord Hunt, called for greater literacy in decisions about paying for care, and I completely agree. I am sure that he will therefore welcome the new advocacy powers that we have inserted into the Care Bill, which local authorities will be able to exercise.
My noble friend Lord Wei asked about the use of crowdsourcing as part of the chief scientist’s analysis. I can tell him that the chief scientist’s work is still being scoped, but I shall pass on my noble friend’s suggestion.
My noble friend Lady Tyler spoke powerfully about loneliness among the elderly, which is a serious issue blighting the lives of many people. We know that the quality of people's relationships has a massive impact on their physical and mental well-being. If we improve social and local connections, we can keep people healthier, active and more resilient for longer. If we do not, as she rightly said, people will continue to have their lives cut short. We are raising awareness of the issue and helping local health and well-being boards and commissioners to get better at measuring the issue in their local communities. This will help them to come up with the right targeted solutions and to drive local improvements that really make a difference. Loneliness and social isolation are problems that government alone cannot solve. For older people, as the right reverend Prelate was right to say, extending working life may be part of the answer, along with encouraging neighbourhood action, volunteering and participation.
The noble Lord, Lord Filkin, raised volunteering, as did the noble Lord, Lord Hunt of Kings Heath. It is vital that the voluntary sector, business and individuals work together to find the right solutions. The Government, alongside Age UK and the Age Action Alliance, are supporting a whole strand of work: a growing network of more than 465 organisations from all sectors of society, including businesses and the voluntary sector, working alongside older people to find practical solutions to the issues that the noble Lord, Lord Filkin, highlighted in his report. ILC-UK, the organisation with which the noble Baroness, Lady Greengross, is involved, is a member of the alliance along with several government departments and businesses such as Microsoft and all the major energy companies.
My noble friend Lord Livingston spoke about carers, and rightly said that they needed support. A summit last year, co-hosted by the Government and Employers for Carers, agreed that a task and finish group would be set up to consider national and international evidence on good practice to support carers who wish to remain in the labour market and to support employers to grow their businesses. He spoke, too, about the use of technology; it is a key priority for government to bring the technology revolution to health and care. We believe that at least 3 million people with long-term conditions could benefit from the use of telehealth and telecare services. Their use can also, incidentally, help social inclusion.
My noble friend Lady Tyler called for the Government to report back on progress. The Government’s response to this report is a first step in an important dialogue between the Government and the public, which must and will continue into the next Parliament. As part of this dialogue, the Government have committed to writing to the House of Lords Liaison Committee in a year’s time to update on the progress of their reforms, as well as providing any new evidence on challenges that might have arisen since the original report was published. This debate has contributed further to that dialogue and I thank the noble Lord, Lord Filkin, for bringing us together today and for his tireless work in raising the profile of these important issues.
Lord Filkin
My Lords, I thank the Minister for his thoughtful response, as ever. I thank all who have spoken so powerfully, whether from humanity, policy or politics in different dimensions. I particularly enjoyed, as did we all in the Chamber, the superb maiden speeches of the noble Lords, Lord Livingston and Lord Borwick. We could not have been better served. Above all, I was pleased as one of the committee’s goals was to get all political parties to commit to working on these issues in their manifestos. That was explicit in our report and we heard, I think for the first time in public, two political parties saying that they would do so. That is good news and I am sure that we will get the third before long.
I should have mentioned one member of staff who I forgot: Owen Williams. He was our press officer and was genuinely superb. He got almost everything right, except for the final day. At about 10 pm on the night before our launch, we know that we had the lead spot on the “Today” programme the following day. Then the College of Cardinals elected the Pope. Owen had failed to control the College of Cardinals and we were bumped off the top slot. You cannot get the perfect staff, can you?
In conclusion, the noble Lord, Lord Mawhinney, was good at giving me strong advice—the committee will recollect this. He did not mince his words and at the end of the process I asked him, “What do you think I should do now?”. He said, basically, “Keep going”, and he made me think that that was the right thing to do. I thank him for that because we have kept going, which is sensible even if we are not really a Select Committee anymore. We will keep going and I will wish to discuss some of the excellent ideas that I have heard in this debate to see how we can pick up on them. I thank all who have spoken.