By John Thornton | 1 October 2011
We are living longer but there’s no need to panic about a demographic time bomb. We need to look at the positives and improve prevention, data and IT
Do you want to live to 100? The chances are that there could be a million centenarians in the world by 2030. Today’s 20-year-olds are three times more likely to reach 100 than their grandparents, and twice as likely as their parents. Plus, if some predictions are right, the first person who will live to celebrate their 150th birthday has already been born.
We currently see this as a huge problem, with hair-raising projections from the Office for Budget Responsibility on the costs of supporting an ageing population. How might we respond to this demographic and financial time bomb?
There are three parallel strategies available. The first is to reduce demand for services. As Professor Steve Field points out in the recent NHS Future Forum report, the health service of today is mostly about the provision of episodic treatment of illnesses such as cancer and cardiovascular disease.
Priority has been given to acute hospitals and to providing effective interventions and treatments for people affected by life-threatening conditions. The NHS needs to shift its focus from treating people when they are acutely ill to prevention and supporting self-care. You don’t wait until your car breaks down to get it serviced.
The ageing process is fast becoming seen as the lifelong accumulation of various types of molecular and cellular damage throughout the body. This holds out a future for health care as a series of preventive processes that periodically repair the body before the damage becomes terminal.
People do need to take greater responsibility for their own health but to do this they need to be better informed about lifestyle choices, diet and preventive strategies.
This in turn requires much better information to be provided and shared with the wider population, coupled with the availability of more ‘trusted advisers’, real or virtual, to guide us through a maze of perhaps conflicting and sometimes partial advice.
The second strategy is to improve the efficiency of the supply side. The NHS Future Forum also concludes that there has been too much focus on different parts of the system – GPs, hospitals, public health, social care – and insufficient attention to how they all join up to provide the integrated care that patients need.
The forum recognises that better and more integrated electronic information systems will be a major enabling factor in improving efficiency, integrating services and improving patient care.
Health Secretary Andrew Lansley is also clear that high-quality health and care services depend on good information. He has called for an ‘information revolution’ in the NHS.
The third strategy requires an even bigger change of mind-set. It does not seem unreasonable to assume that an ageing population might present opportunities as well as challenges and that people won’t automatically turn into dribbling burdens for 30 years just because they are living longer.
We know that usually the biggest health care costs for people over 60 are, by a significant margin, in the final year of life, regardless of the age at death. Perhaps we are just moving costs to later in life and need to think more radically than Andrew Dilnot’s commission on the funding of
long-term care for elderly people.
Many people are claiming that 60 is the new 40, and that 80 is the new 60. Currently, less than 1% of those aged 60–79 live in communal establishments and only two out of five of those aged 95+ are in care homes.
As people remain active longer, we need to engage in a wider debate about how older people can continue to enjoy a rewarding life and contribute productively in their communities. This might mean that you will actually want to live to be 100.
John Thornton is a director of e-ssential Resources, and an independent adviser and writer on business transformation, financial management and innovation
