On Wednesday 9th November 2016, ILC-UK held it's second annual future of Ageing conference.
We welcomed over 180 delegates made up of business leaders; charity sector experts; public sector decision makers; local authority staff; academics; and senior journalists.
The one day conference was chaired by Baroness Slly Greengross OBE and Lawrence Churchill CBE, and we heard from the following speakers:
- Dr Islene Araujo de Carvalho, Senior Policy and Strategy Adviser, Department of Ageing and Life Course, WHO
- John Cridland CBE, Head of the Independent State Pension Age Review
- The Rt Rev. and the Rt Hon. the Lord Carey of Clifton, Archbishop of Canterbury 1991-2002
- Ben Franklin, Head of Economics of an Ageing Society, ILC-UK
- Professor Sarah Harper, Director, Oxford Institute of Population Ageing
- Dwayne Johnson, Director of Social Care and Health at Sefton Metropolitan Borough Council
- Dr Margaret McCartney, Author and Broadcaster
- John Pullinger CB, National Statistician, UK Statistics Authority
- David Sinclair, Director, ILC-UK
- Jonathan Stevens, Senior Vice President, Thought Leadership, AARP
- Linda Woodall, Director of Life Insurance and Financial Advice, and sponsor of the Ageing Population project, Financial Conduct Authority
15. “A thought leader is someone who looks at
the future and sets a course for it that
others will follow.
They foment change, often causing great
disruption.
Thought leaders are people, not
companies. Smart enterprises employ,
encourage, and embrace individual
thought leaders, and thus earn recognition
as a thought leadership company.”
Shel Israel, Forbes.com
22. Dr Islene Araujo de Carvalho
Senior Policy and Strategy Adviser
Department of Ageing and Life Course
WHO
#futureofageing
23. Presenter’s name if needed
Islene Araujo de Carvalho
Senior Policy and Strategy Adviser
Department of Ageing and Life
Course
World Health Organization
@islene123
24. World report on ageing
and health
• Summarizes the best available
evidence
• Outlines a framework for action around
a new concept of functional ability
31. Barriers to Healthy Ageing
• Outdated and ageist stereotypes
• Inadequate policies
• Lack of accessibility
• Inadequate or absent services
• Lack of consultation and involvement
36. Align health systems
• Place older people at the centre of health
care
• Shift the care focus from managing
diseases to optimizing what people can do
• Develop the health workforce
37. Develop long-term care systems
• Establish the foundation for a functioning
system
• Develop the long-term care workforce
• Ensure the quality of long-term care
39. Improve measurement,
monitoring, and understanding
• Agree on metrics, measures and analytical
approaches
• Improve understanding of the health status
and needs of older populations
• Increase understanding of ageing
trajectories and what can be done to
improve them
40. Investing in Healthy Ageing
means creating a future that
gives older people the
freedom to live lives that
previous generations could
never have imagined.
48. Extended family life in the East End
• Growing up in the East End of London.. Remarkable
symbiosis between the different age groups.
• BUT IN 2015
The UK is one of the happiest countries in terms of family
relationships but is among the least friendly to neighbours,
according to an international study.
• We are, however, one of the least friendly nations in terms
of knowing our neighbours. Only Germany ranked as less
sociable in the study.
More than 90 per cent of Britons said they were either very
happy or fairly happy with their family life, ranking the
country fourth highest of developed nations.
49. Thousands are dying alone and unloved.
• Britain is failing to meet its obligation to the elderly
because some people lead such "busy, atomised lives"
that they don't even know whether their relatives are
dying.
• Jeremy Hunt, the Health Secretary, said that it is
"shocking" that thousands of people are dying alone in
Britain.
• Telegraph, July 2015
50. An Important Book
• THE POLITICS OF VIRTUE: POST-LIBERALISM AND
THE HUMAN FUTURE,
• By John Milbank and Adrian Pabst.
• “Reduction of democracy to market terms”
51. The Spiritual Question
• How does our society today find language for those
things that are to be sought for what they are – and
mean- and not for their exchange value?
• “What kind of world have we allowed to develop in
which our most important values are now physical
and material?”
52. The Dangers of Utilitarianism
• Jeremy Bentham and John Mills contention that life must
be conducted on the consequences of the greatest
happiness for the greater number.
• J. J. C. Smart (49) explains this difference by imagining
the action of a person who, in 1938,saves someone from
drowning. While we generally regard saving a drowning
person as the right thing to do and praise people for such
actions, in Smart’s imagined example, the person saved
from drowning turns out to be Adolph Hitler. Had Hitler
drowned, millions of other people might have been saved
from suffering and death between 1938 and 1945. If
utilitarianism evaluates the rescuer’s action based on its
actual consequences, then the rescuer did the wrong
thing.
53. The Consequences of Utilitarianism
• Think of a medical missionary in, say, India, with
a drug that is only sufficient to cure five people
but she has twenty very ill people who would also
benefit from the drug. She is clearly going to have
to make a choice but upon what basis?
• Will her choice depend upon the severity of
illness? Those likely to get most benefit from the
drug? A policy decision in favour of the young?
54. What some Older People Fear
• Old people 'viewed as second-class citizens'
• Older people in Britain are viewed as second-class citizens and face
"blatant discrimination" in health, social care and other areas of
everyday life, a new report claimed today.
• The study, called Age Discrimination in Public Policy, said age is used
to ration resources in the NHS and older people are being excluded
from the job market.
• A parallel Help the Aged/NOP poll of more than 2,000 people across
the country also revealed that more than half believe the UK treats
older people as if they are on the scrapheap.
• Nearly 50% said that older people are viewed as a burden on society.
• Help the Aged, which published the report with British Gas, said the
findings showed that age discrimination was "endemic" in public
institutions.
MAIL ON SUNDAY. OCT 29th 2016
57. The Churches and Older People
• I want to draw attention to the Leveson Centre in the
diocese of Birmingham which exists to focus attention on
the study of ageing, spirituality and care for the elderly.
The centre is based upon the philosophy that life should
be lived to the full and that age is merely a number, not a
confession of decline.
• The challenge for the churches at our present time where
society is ageing, is to provide resources for the elderly
where they feel welcomed and cared for.
58. CHALLENGES FACING US
• Given the resources that voluntary groups like the
churches are able to offer, is it not time for some
joined-up thinking to include such groups in a
national strategy for care for the elderly? Is it not
time to draw upon the good will that exists in our
society and put that compassion to work? But
there is also a challenge to the churches and
other voluntary groups and that is to reach out in
their communities to those living alone, with
health problems and other needs.
60. WHAT MAKES A COUNTRY GREAT
• Is measured more simply by how we care for the most
vulnerable in our society. This transcends our religious
affinities because it touches what it is to be human. If we
do not value the elderly it suggests that we do not value
the young either.
• “What will become of us?” older people often ask. We
should respond: ‘You matter because though vulnerable,
you are valued and are of worth that transcends your
economic status’.
61. Think Positively
• ‘Grow old along with me!
• The best is yet to be,
• The last of life, for which the first was made.
• Our times are in his hand who saith:
• ‘A whole I planned, youth shows but half:
• Trust God; see all,
• Nor be afraid’.
• Robert Browning, Rabbi Ben Ezra.
66. State Pension Age
Independent Review
The Future of Ageing, ILC-UK Conference
9th November 2016
John Cridland CBE
State Pension Age Independent Reviewer
66
67. 67
State Pension age review: Three
Pillars
• Affordability
• Fairness
• Fuller Working Lives
74. Socio-economic variations in healthy life expectancy
74
Source: ONS
2016 Health
state Life
Expectancies
(general
health) and
Life
Expectancy,
2010 to 2012
92. dementia screening
• 100 people, prevalence of 6%
• correctly identify 4/6
• incorrectly identify 23/100
• UKNSC have never recommended screening
• functional impairment is necessary for a
diagnosis of dementia
96. Rosa
• aged 72
• lung cancer
• medication for blood pressure, cholesterol,
osteoporosis, COPD (multimorbidity)
• breathless and in pain, frail
• lives with husband in first floor flat
97. chemotherapy
• non small cell lung cancer
• not fit for surgery
• relapse after 1st cycle
• trials of chemo: 27% reduction death
98. which is also
• a change in 1 year survival from 15% to 25%
• median survival increase of 1.5 months
• (from 4 months average to 5.5 months
average survival)
• “hope of progress, and suggest that
chemotherapy has role....”
Cochrane systematic reviews of treatment for lung cancer. Fong et al. Respiratory Medicine Vol 99 Issue 9 Sept 05 1071-1078
99. unintended harms
• about 40% people dying from cancer have
palliative chemo within 4m of death
• die in ITU: 11% vs 2%
• late hospice referral 54% vs 37%
• die in preferred place: 65% vs 80%
Associations between palliative chemotherapy and adult cancer patients’ end of life care and place of death: prospective cohort study. Wright et al, BMJ 2014; 348
doi http//doi.org/10.1136/bmj.g1219
100. Early Palliative Care for Patients with metastatic non-small-cell lung cancer. NEJM, 19/8/10, DOI 1056/NEJoa1000678
101. An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomised controlled trial
Higginson, Irene J et al.
The Lancet Respiratory Medicine , Volume 2 , Issue 12 , 979 - 987
102. • Rosa might be better off with palliative care
• chemotherapy may not give her what she
wants
• how does she want to live, where does she
want to die?
• treatment burden
• ‘I really don’t want to be in pain’
• ‘shouldn’t I be fighting this more?’
103. fighting cancer
• no evidence that specific psychological coping
styles are helpful
• “for patients these responses meant resisting
the expression of emotional distress”
Influence of psychological coping on survival and recurrence in people with cancer: systematic review BMJ 2002; 325 9/11/02
Patients’ experience of cancer; evidence of the role of ‘fighting’ in collusive clinical communication. Patient Educ Couns. 2002
Sept; 48(1) 15-21
107. CPR
• ER/Chicago Hope: 75% survive
• Holby City/Casualty: 46% survive
• older people in US rate chances of survival as
80%
• 63% people with COPD rate chances survival
> 40%
CPR on television - Miracles and misinformation. 334:1578-1582 13/6/96, NEJM
Resuscitation on TV: realistic or ridiculous. A quantatitive observational analysis of the portrayal of
cardiopulmonary resucitation in television medical drama. Resuscitation 21/8/09
Journal of American Osteopathic Association 2006;106 (7) 402-404
Int J Chron Obstruc Pulmon Dis. June 08 3(2) 295-300
108. CPR in real life
• CPR outside hospital: 9.6% survive to
discharge home
• CPR inside hospital: 17% survive to discharge
home
109. CPR in people who
have cancer
• 243 patients with cancer had CPR
• no people with metastatic cancer survived to
discharge
• 7 with localised cancer survived
JAMA Internal Medicine 1991 Vol 151 No 2
110. CPR
• CPR is potentially life saving in the otherwise
reasonably well
• unlikely to work in people who are frail
• no evidence that it will work in people with
metastatic cancer
111. death is inevitable
it is often hard to
predict
it is not a failure of
medicine
but bad death might
be
115. Context
• 1 in 3 people in England rely on or have a close family member
that relies on social care
• £5bn was taken out of the social care system between 2011-
2015/16 (ADASS)
• Care and support Alliance estimated that 500,000 people who
had social care in 2009 no longer do so because of rationing
• “were extra funding available, frankly we should be arguing that
it should be going to social care” – CExec NHS England
• 2016 CQC State of Care report…”pressures in social care “is
approaching a tipping point”
• No solutions to long term care funding…”deeper existential crisis
of care” - Kings Fund 2016
• However……
116. Care Act 2014
Care Act 2014 heralded a new era for social care and was
the most significant change in social care law for 60 years,
its key aims:
• people to have more control over their lives;
• support should be less about firefighting and
more about prevention;
• goal of independence
• By 2016 the final arrangements for the funding of care –
including the £72,000 cap on care costs
• However…..
117. Budget…. The true story
• By the end of the decade Adult social care will have a
funding gap of £1.259bn (ADASS) why…:
• Demands…..inflation…..national living wage …unfunded
Deprivation of Liberty safeguards…Council overspends
• £200M in year cut to public health in 2015/16 and a
further £330M reduction by 2020/21
• Some good news….:
• Council tax precept for adult social care 2016/17 -
£393M
• Better care Fund - £105M 2016/17
118. Adult Social Care Funding
Year
All figures in £m 2016/17
baseline
spend
2017/18 2018/19 2019/20
Adult social care –
forward cost
projection
14,380 15,444 16,629 17,833
Council tax: adult
social care precept
393 821 1,290 1,804
Improved Better
Care Fund
105 825 1,500
119. Care Market fragility
In the 6 months to July 2016:
• 48 Councils experienced at least 1 provider
ceasing trading in the home care market and;
• 77 Councils experiencing at least 1 provider in
the residential/nursing care market
• Continuing Health Care pressures and
associated impact on the care system
• Sustainability and Transformation plans STPs
120. Opportunities
• Devolution ?
• Working with the provider market to quantify the pressures
• Work with the voluntary sector – they are the very heart beat
of our communities
• Prevention – obesity, diabetes….people looking after
themselves
• Digital and ICT solutions
• Bring forward the £700M of the ‘up to £1.5bn’ additional
funding to 2019/20
• Business rates?
122. Conclusions
• Local Government should be seen as a key
part of the system and solution
• The social care sector is a major employment
area and providing good quality care should
be the key part of the system
• This is not a new agenda…..rather it is an
agenda in new times and we should be
promoting Inclusivity, cohesive communities
and promoting life chances for all
126. Linda Woodall
Director of Life Insurance and Financial Advice
and Sponsor of the Ageing Population project
Financial Conduct Authority
#futureofageing
128. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
So near and yet so far:
Striving for economic bliss
Ben Franklin, ILC-UK
follow us on twitter: @ilcuk @bjafranklin
129. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
“But it will be those peoples, who can keep alive, and
cultivate into a fuller perfection, the art of life itself…who
will be able to enjoy the abundance when it comes.”
John Maynard Keynes,
The economic possibilities for our grandchildren (1930)
130. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
What am I going to cover?
- Revisiting Keynes’ vision of economic bliss.
- In what ways have we reached this ideal world?
- In what ways have we failed?
- Is the vision slipping away?
131. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Revisiting economic bliss
• The end of the struggle for subsistence.
• Shorter working weeks – 3 hour days.
• Learning to enjoy leisure and abundance.
The economic possibilities for our grandchildren, Essays in Persuasion
(1930)
132. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
The end of the struggle for subsistence?
133. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Great successes have been made in reducing pensioner poverty in particular
134. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
And the number of working hours has fallen
135. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
As has the proportion of time spent in the labour force
136. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
In fact…we are not far from the 15 hour working week if we include the whole of
our adult lives
• The number of hours worked has fallen.
• The date of labour market exit has fallen.
• But life expectancy has continued to rise.
• As a result….
137. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Source: ILC-UK calculations based on OECD data
Big health warning: “work” in our calculations does not include caring for others or looking
after the family home since comparable data was not available. Neither do our calculations
account for changes in participation rate over time.
138. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Are longer retirements the real world manifestation of
Keynes’ vision?
Yes
• Current pension incomes are strong for many.
• Significant time for leisure activities.
• Proportion volunteering in retirement is initially high.
No
• People don’t spend their abundance but continue to save.
• Health prevents people doing what they want.
• Most leisure time is taken up watching TV and later on living
at home alone.
139. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Yes…Current pension income is strong
Source: Eurostat
140. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
No…People don’t spend the abundance in
retirement
% and amount saved rises during retirement
141. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Maybe these are the leisure activities Keynes had in mind or maybe not
Percentage spending time on different activities in week
142. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
No…Health prevents people doing what they want
To what extent does health stop you from doing the things you want to do
Source: ELSA Wave 6 (2012/13)
143. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
What about the prospects for current and future
generations?
Signs of a return to subsistence?
• Wage growth has slowed.
• Hours worked have been rising.
• Productivity growth has stagnated.
Reasons to be optimistic
• Technological change hard to predict.
• A record number of educated and technically proficient people.
144. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Wage growth has slowed
Source: ILC-UK calculations and BoE
145. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Much of which may be underpinned by lower productivity growth
146. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
And a slowdown in productive invention
Source: ILC-UK calculations and BoE
147. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Which means hours worked have been increasing
Sources: ONS LFS BoE and ILC-UK calculations
148. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
The product of labour has allowed us to live way above
subsistence for many years.
Increased the amount of time for leisure primarily by
longer periods in retirement.
But maybe people have not done the sorts of things with
this leisure time that Keynes would have dreamt about.
And…our post-crisis economic fundamentals suggest a
return to our longer run trend. Might this mean
economic bliss will slip further from our fingers?
Key conclusions
149. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Many thanks
Ben Franklin
International Longevity Centre - UK
02073400440
Twitter: @ilcuk @bjafranklin
153. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
David Sinclair, ILC-UK
“Necessity is the
mother of invention”
(and perhaps there is a
silver bullet)
154. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
We are supported by.. thank you
155. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Thank you
156. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
The future of ageing – A new golden age?
A new life-course: Grow up, have
fun, spend, work, save, care,
spend, learn, work, save, have
fun, work, save, care, learn, work,
be cared for..
Healthier, happier, more engaged
older population
Keynes, Marx, Bertrand Russell -
the shortening of work time as an
important ingredient of a better life
157. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Ageing is slow, change is sometimes slow
iwaited96years.com
A new social revolution: "social
revolution means the reorganization
of the industrial, economic life of the
country and consequently also of
the entire structure of society.”
Alexander Berkman
158. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
We are at a tipping point
Staff and skills shortages
http://www.birmingha
mmail.co.uk/whats-
on/food-drink-
news/brum-chef-
opens-indian-
restaurant-7190927
A "new normal" of low
investment returns
combined with low real
wage growth is
repressing savings
levels and presenting a
significant risk of long
term pensioner poverty.
“The financial cost of Britain’s ageing population
will require a fresh £20bn wave of spending cuts or tax
increases from 2020 to bring the national debt back to
pre-recession levels in 50 years time” [OBR 2015]
Eastern Europe
labour shortage is
so acute
McDonald’s is
offering free
housing
159. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
There are some “known unknowns”
Antibiotic Resistance
could lead to the deaths
of ten million people a
year globally by 2050”
“Pill to help us live to 120:
10p-a-day MIRACLE drug
could slow the ageing
process”
“Alzheimer's cure at last:
First drug to stop disease in
its tracks”
160. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
But – we are miles from where we need to be
We know the direction of ageing and we
have made progress.
We are miles from where we need to be
Ensuring our economy is ready for
ageing
Ensuring Health and Care is ready
for ageing
Ensuring our communities are ready
for ageing
161. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Ensuring our economy is ready for ageing
ONS annual survey of hours and earnings, pension tables
162. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Today’s older population are wealthier than
previous generations
The remarkable catch-up in pensioner incomes
Chart shows median after
housing costs incomes of
pensioner households
as % of median for
non-pensioners
(HBAI income definitions)
But still
1.6 million
ish in
poverty
163. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Ensuring our economy is ready for ageing
Savings levels remain far too low
Real wage growth is low
Returns on investments are at historic lows
House prices continue to be high
Our economy still loses billions due to the
underemployment of older people
The private sector is not maximising the economic
spending power of older people
164. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Ensuring our communities are ready for
ageing
165. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Ensuring our communities are ready for
ageing
Isolation and loneliness remain blights on our
society
Spending cuts have hit services for older and
younger people
We have a huge undersupply of retirement
housing. New mainstream housing is not
adaptable enough.
166. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Ensuring Health and Care is ready for ageing
Prevalence of serious illness among those
aged 50+ has been slightly decreasing over
time, from 15.8% in 2002 to 13.6% in 2012.
– the overall % of older people reporting
a cardiovascular event fell
– lower % of people in each age group
from 50-79 experiencing heart attacks
in 2012 compared to 2002
167. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Excess winter deaths have been falling
168. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Ensuring Health and Care is ready for ageing
Urgent action is needed to
ensure our health service
keeps up with the demands of
demographic change.
Social Care funding reform
seems to have been put in
the “too difficult” box.
Health and care face major
staffing shortages
“A disaster for older people today and tomorrow”. Ready for Ageing Alliance
169. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
“NHS spending will drop
per head despite ageing
population and growing
demand, says chief
executive”
“The NHS last year recorded
the biggest deficit in its
history, at £2.45bn”
170. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
1.86 million people over the age of 50 in
England (1 in 10) have unmet care needs –
an increase of 120,000 people (or 7%) since
2008/9.
There are 4.3 million people aged 50+ in
England who are living alone (1 in 5).
The numbers accessing care services have
fallen by half a million since 2008/9 (30%).
The number of over 80s have risen by
800,000 in the last decade.
There are already around 1.5 million people
providing over 50 hours per week of unpaid
care.
171. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Ensuring Health and Care is ready for ageing
Prevalence of five serious illnesses among people aged 50+ in England,
2002-2012
172. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Is there a magic bullet
(or perhaps 6)?
173. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
The 6 magic bullets
Maximising the economic contribution of older
people
Getting us healthy
Maximising the potential of technology and big
data
Stop patronising old age. Treat adults as adults
Start talking about end of life
Let’s make ageing fun
174. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Maximising the economic contribution –
Ensuring older people spend more..
We calculate total per annum savings made by those
in retirement in the UK today of around £48.7bn. This
equates to 2.8% of GDP. The majority of savings
made by older people are sitting in low interest
current accounts. (UK)
175. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Maximising the economic contribution – more
of us working longer
Unless a higher proportion of older people
remain in the workforce, we estimate that
total Eurozone employment could fall by up to
17% over the next 35 years. (ILC-UK)
176. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Maximising the economic contribution – More
of us working longer
177. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
But employment rates are lower than 1960s
Source: Family Expenditure Survey (1968–
1982), Labour Force Survey (1983–2013).
Figure 2.1 in Retirement in the 21st Century
Employment rates of older men, 1968–2013
178. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
How do we get people to work a little more and
spend a little more? (we just need the political
will)
Can we use the tax system to discourage hoarding?
Can we have products which give people certainty of
income so they know how much they have to spend?
(oops)
Can we give people certainty of future care costs?
Can we ensure the tax system supports working longer?
Can employers better recruit/retain/retrain older
workers?
Universal income?
Can we make workplaces healthier?
Can we help industry better understand the older
consumer?
179. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Getting us healthy
BHF Physical
Activity Stats
2015
180. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
How might we get people to exercise more?..
(we just need the political will)
We need to move the “social norm”. Active
workplaces and active travel are key.
Educate and inform (e.g. leaflets, information,
posters)
Nudge (e.g. make healthy choices easier or the
default, move the social norm, small financial
incentives for “goods”)
Compel (e.g. taxation/fines of “bads”, parking
bans)
181. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Maximising the potential of new technology -
automation
BBC News - RBS, NatWest
and SEB banks employ
virtual staff
182. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Technology can help us with our daily
activities
183. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
But innovations have often made the world more
difficult rather than simpler
Most of the need comes at 75+ (i.e. the market
isn’t big enough to deliver innovations)
184. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Do we really want robots?
“Sexbots, though not yet exactly
flying off shelves, have stoked
enough cultural interest to inflame
a widely covered campaign to ban
them. Meanwhile, care robots for
the elderly remain stuck in
sociocultural purgatory.”
…The Guardian: being left with
a carebot is just “another way of
dying even more miserably”.
185. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
1997: ..harness the enormous potential benefits of IT to
support the drive for quality and efficiency in the NHS..
Electronic patient records
2005: Technology has the capacity to transform the way we
offer services and the support that is available to help
people with dementia stay in their own homes. (DH)
2005: We need to seize the full potential of the advanced
application of science and technology to help deliver better
later lives. (DWP)
2006: New service models and technology have an
important role in enabling older people to remain in their
own homes” (The Wanless social care review, 2006)
186. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
2009: Using technology to enable delivery of high-quality
support will be a vital element of the future care and support
system. DH
2009: New technology opens up new horizons for care. From
community alarms to sophisticated communication systems.
DH
2013: Technologies, including telecare and telehealth, also
have the potential to save money and improve the quality of
care that older people experience. (House of Lords)
2014: Technology can improve connectivity, address health,
work and care challenges, and help people unlock the
potential benefits of living longer. DH
187. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
So how can we maximise the potential of
technology? (we just need the political will)
Ensure social care is adequately funded
Design products better (inclusive design)
Tackle digital exclusion
Better engage with older people about what they want
and need
Have a proper public debate on data sharing, protection
and ownership
Have regulation which protects consumers but does not
stop innovation
Build a culture of private purchase for health products
188. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Is the sharing economy part of the solution?
189. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
It might work for some but…
It’s not a new economy
Flexible working will
work for some (but how
can the gig economy
deliver retirement
savings?)
Most of us don’t work in
the gig economy
190. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Stop patronising old age. Treat adults as
adults
Let’s embrace, not ignore
ageing
Let’s all stop denying ageing
Don’t treat us like infants as
we age
Give people rights &
responsibilities for their whole
adult life
191. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Start talking about the end of life
Focus on living better rather than longer
We have to die of something
Stop competing disease against disease
Let people be involved in their death
Let’s help people die well
We cant say we believe in self determination for
older people but not on end of life issues
192. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Let’s make ageing fun
193. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Swings at bus stops… listening to One
Direction (or Metallica)
194. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
(although ageing is hitting condom sales!)
http://www.bloomberg.com/news/articles/2016-01-24/china-s-foreign-condom-frenzy-gives-low-
libido-japan-a-boost
195. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
But we are at least getting our swings..
196. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
We can have a new golden age. Delivering the
utopian lifecourse vision?
Grow up, have fun,
spend, work, save,
care, spend, learn,
work, save, have fun,
work, save, care, learn,
work, be cared for..
197. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Public policy and financial services should better
help us smooth our income (and expenditure)
across our lives?
Universal income?
Access to learning across our lives?
Access to care and support for young and old?
A more equal society?
What do you think?
198. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Ageing is a social revolution
whose time has come
We have made some
progress
There are a few uncertainties
But we know that we are miles
from where we need to be
There are no silver bullets –
Or perhaps there are?
Getting to a new golden age is
possible
We just need the political will
http://www.flickr.com/pho
tos/48039948@N02/607
0071650/sizes/m/in/pool-
92307085@N00/
199. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
See you in 2017
@sinclairda
@ilcuk
davidsinclair@ilcuk.org.uk
International Longevity Centre-UK
201. ‘Future of an Ageing Population’ -
Making the UK more resilient to age-structural
change and longevity: translating academic
evidence into policy
Professor Sarah Harper
University of Oxford
ILC
9th November 2016
202. GO-Science
UK demographics are changing.
Approximately 75% of UK projected
population growth between 2012-2040 is in
the 60+ group.
Meeting the challenges of the ageing
population will have policy implications for
housing, work, education, families, health
and care, and technology.
Population size in millions to 2040, broken down by
age groups1
Projected percentage of the population
aged 65+, 2037
202
Context and background
203. GO-Science
Demographic trends
Right:
Population size
in millions to
2040, broken
down by age
groups
Populationsize(millions)
Sources: [to add] 203
Left: historic
& projected
period life
expectancy
at birth
(years)
Life expectancy increasing
Population age structure changing
Left: the
population
distribution
of UK
according to
age, males,
1925, 1950
and 2015
Livebirthsperwoman
Fertility below replace level of 2.1 live births/woman
Right: total
fertility in the
United
Kingdom,
1960-2011
75% growth in 60+ age group whilst
other age groups remain fairly
constant
Lifeexpectancyatbirth(years)
204. As a result not only are individuals living longer, they are doing so within a UK
population which is in itself growing older.
To grow old in a society where most people are young is fundamentally
different from doing so in a society where most people are old.
In demographically young populations, there are high proportions of
economically active individuals who may produce the wealth needed to support
dependents, old and young. However, these societies may not place much
emphasis on the wellbeing of older people as they comprise a small minority of
the overall population.
Conversely, demographically old populations have a lower proportion of
economically active individuals and thus the responsibility of providing for old
age dependency may be increasingly fall to the older person themselves.
204
205. Societal Risks for Ageing Societies
The shift from predominantly young to predominantly older populations raises
concerns over
1. The ability of nations to finance the social security and long term health and
social care which are required to support a growing number and percentage of
older dependents, at a time when the number and percentage of those who are
economically active is declining.
2. The ability to reconfigure health and long term care provision.
3. The reconfiguration of social institutions to address issues of intergenerational
and intergenerational fairness, that is fairness and equity within and between
different generations as population age and the support of individual well-being
across the life course
Inequalities in access to resources, health, economic and social, is likely to remain
a pressing concern over the coming decades.
205
206. GO-Science
Implications of demographic trends
Right: Projected
Population
change 2012-37
(million people)4
Populationsize(millions)
Sources: 1. ONS (2014) 2. OBR Fiscal Sustainability Report 2015 ;3. DCLG 2012-based household projections; 4. Champion, T (2015) 206
Left: working &
pensionable age
population & old
age dependency
ratio (‘working
age’ person per
‘pension age’
person)1
Work: fewer people of working age per older person
Housing: demand growing in older age groups
Livebirthsperwoman
Health: long term pressure on cost of care
Connectivity: potential challenge from large growth
of older populations in towns and rural areas
People(thousands)
Left: Head of
household in
England by age,
2012 and 2037
(thousand
people)3
People(millions)
Right:
Projected
public
expenditure
on health
and long-
term care
from 2014/15
to 2064/65 as
a % of GDP2
207. Work: fewer people of working age
per older person
Working & pensionable age population & old age dependency
ratio (‘working age’ person per ‘pension age’ person)
208. Health: long term pressure on cost of care
Projected public expenditure on health and long-term care from
2014/15 to 2064/65 as a % of GDP
209. Connectivity: potential challenge from large
growth of older populations in towns and rural
areas
Projected Population change 2012-37
(million people)
210. Head of household in England by age,
estimations for 2012 and projections for 2037
212. Lead Expert Group
• Professor Sarah Harper (Chair) - University of Oxford
• Professor James Banks - University of Manchester and Institute for Fiscal Studies
• Professor Paul Boyle CBE - University of Leicester
• Professor Tom Kirkwood - Newcastle University and University of Copenhagen
• Professor Martin Knapp - London School of Economics and Political Science
• Professor Jeremy Myerson – Royal College of Art
• Mrs Mary Sinfield OBE - Former Chairman of the New Dynamics of Ageing
Programme’s Older People’s Reference Group
• Professor Alan Walker CBE - University of Sheffield
• Mr Oliver Wells - Devices for Dignity Healthcare Technology Co-operative
212
213. The challenge in all regions is how
to sustain and enhance well-being
across an individual’s life, while at
the same time reducing the
inequalities within each generation,
and ensuring an equitable
reallocation of resources between
the generations
213
215. GO-Science
Internet use by educational qualifications
215
Areas of the UK with the slowest internet
speeds have disproportionately higher
populations of older people.
There is a “digital differentiation” in uptake in
the population associated with age, income,
gender and disability.
Overall broadband performance by administrative
authority
Technology can provide the solutions to
challenges of an ageing population
216. GO-Science
How can technology address demographic challenges?
Frequency of loneliness by marital status, older adults4
%ofeachagegroup
Sources: 1. ONS (2014) 2015 ; 2. Monitor/HMG (2015) 3. Torrington (2015) / BRE; 4. ILCUK / ONS (2015)
* Fixed costs include larger structures such as wards; semi-fixed include bed bays; variable costs are based on basic ward staffing requirements
216
Left: % of each age
group of workers
who work from
home (with total
numbers above
each bar)1
Work: Extending working lives through smart &
connected homes, workplace adaptations
Housing: Improving homes through low-fi
solutions (stairs, footing, lighting)
Health: Remote/home-based care can provide cost
efficiencies & services tailored to individual circumstances
Right: Cost
of a patient spell
on a community-
based scheme in
its fifth year
compared to
a spell for an
equivalent patient
in the acute
hospital
Connectivity: ICT can help social connectivity,
alleviating loneliness
Cost(£billions)
Left: Head of
household in
England by age,
2012 and 2037
(thousand
people)3
People(millions)
Percentage
Left: cost of
common health
hazards to NHS)3
*
217. GO-ScienceSources: 1. Dutton and Blank 2013; 2. Ofcom 2015 217
Barriers (1): sub-optimal technology uptake in the older
population Internet use by lifestage1
• The older population has lower
technology uptake levels.
• ‘Catch-up’ of existing technology
is likely to occur over time as
cohorts who learnt technologies
earlier in life grow older.
• However, this phenomenon is
balanced by the pace of
technological change. The older
population is always likely to be
‘left behind’ to some extent
(without intervention).
* Technology readiness is a concept developed by Professor A. Parasuraman in 2000 and refers to the propensity to embrace and
use new technologies for accomplishing goals in home life and at work. Full reference: Parasuraman, A. (2000) Technology
Readiness Index (Tri) A Multiple-Item Scale to Measure Readiness to Embrace New Technologies Journal of Service Research 2(4)
207-320
Proportion of adults who own a smartphone, by age2
%ofUKadults
218. GO-ScienceSources: 1. Dutton and Blank 2013; 2. ONS 2014 218
Barriers (2): Differences in uptake within cohorts (e.g. between
different socio-economic groups) will widen as cohorts age
• Digital ‘divide’ or differentiation
in uptake in the population
associated with income, gender
and disability, as well as age.
• Technology readiness also
depends on wealth, social
context and culture.
• In summary: wealthier, socially
active individuals possess &
maintain a higher level of
‘technology readiness’ longer
than poorer, socially excluded
individuals. This is exaggerated
into older age.
Internet use by educational
qualifications (2013)1
Internet non-
users % of
population
(2014)2
219. GO-ScienceSources: 1. Dutton and Blank 2013; 2. ONS 2014; 4. Resolution Foundation 2012 219
Implications of low technology uptake in ageing population
Wellbeing: individuals will not
gain full benefits of technologies
in terms of wellbeing or
independence.
Society does not get full
benefits in terms of reduced
dependency and cost effective
public services.
Survey for +50 group: what 2 or 3 things are you most worried about as
you age?2
Employment status of people living in low to middle income households for
carers and non-carers4
220. GO-Science
• Skills: 79% of 65-74 year olds
had ‘low’ or ‘no’ internet skills in
2013.
• Perceived benefits/utility of
ICT: Older adults are currently
deeply ambivalent towards ICT,
use it for limited purposes and
only when it does not interfere in
their daily lives2.
• Affordability and perceptions
of affordability are often rooted
in long- established spending
patterns and consumer
behaviour.
Specific internet skills by lifestage6
What are the barriers to technology adoption?
Sources: [to add] 220
% of participants in one study who agreed that “technologies
are very useful”7
221. GO-Science
• Choice, control, issues of privacy,
and fear of reduced social
interaction in certain technologies
(e.g. assisted living technologies3
and telecare4).
• Technology can be hard to access
of perceived as hard to access,
including:
• Fonts, layouts of web-based
applications including some
telemedicine systems
• Insufficient ‘reach’ of monitoring &
community alarm systems
• Bulky, cumbersome, awkward
wearables
• Poor sound quality of audio
equipment
Specific internet skills by lifestage6
What are the barriers to technology adoption?
Sources: [to add] 221
% of participants in one study who agreed that “technologies
are very useful”7
222. A Coherent Response to Ageing
The report combined evidence about today’s older people with future trends
and projections to identify the most critical implications of the ageing
population for government policy and the socio-economic resilience of the UK.
The following principles were followed to ensure a coherent response to ageing:
• The future success and resilience of the UK will be determined in a
large part by its ageing population.
• Issues cannot be addressed in silos. A co-ordinated response is
likely to be more successful than addressing issues in isolation.
• Most domestic policy areas will be affected by the ageing
population. Beyond the expected (Health and social care/pensions)
are housing, education, family, transport, infrastructure and
technology. 222
223. A Coherent Response to Ageing
The report combined evidence about today’s older people with future trends
and projections to identify the most critical implications of the ageing
population for government policy and the socio-economic resilience of the UK.
The following principles were followed to ensure a coherent response to ageing:
• Factors throughout an individual’s lifetime affect how they age. To
improve outcomes for people as they age – whether in skills,
health, employability, housing or financial assets - requires
interventions from an early age, and an understanding of the
impact of policies through the life course.
• Regional and local variation must be understood. There are also
important differences between how the devolved administrations
will experience ageing.
223
224. Oxford Institute of Population Ageing
Picture: Nasir Hamid/Oxford University
We also know that population ageing is happening much more quickly than in the past.
For example, while France had almost 150 years to adapt to a change from 10% to 20% in the proportion of the population that was older than 60 years, places such as Brazil, China and India will have slightly more than 20 years to make the same adaptation.
There are two key drivers of population ageing. The first is is falling fertility rates, and the second is people living longer overall.
Investing in both of these areas - maximizing capacity and ability– will enable older people to continue to do the things that are important to them. Maximizing functional ability is the primary goal of policies to promote healthy ageing.
Thank you for your attention. For more information about the report, or to access related information, please visit the web site listed in this slide.
UK demographics are changing. Approximately 75% of UK projected population growth between 2012-2040 is in the 60+ group.
Meeting the challenges of the ageing population will have significant policy implications for housing, work, education, families, health and care, and technology.
Between 2012 and 2040 numbers of 60+ are projected to grow from approximately 14 million to 22 million. Of the additional 10.6m people in the ONS central projection to 2040, 7.7m of them are over 60.
The ONS also estimated population growth in a ‘low migration variant’ scenario. In this projection, population growth is less – 6.8m by 2037 – but the growth in people aged 60+ remains the same as the central projection at 7.7m. In that scenario, the growth in people 60+ exceeds total population growth, implying population decline in other age groups.
These six themes came out as those central to an ageing population:
Productivity and employment
Lifelong learning
Housing
Families
Health and social care
Connectivity
Interconnectedness of themes became apparent – factors are not isolated from one another
There is a “digital differentiation” in uptake in the population associated with age, income, gender and disability. In 2013, 91% of people of all ages in social classes ABC1 were online, vs. 74% of people in classes C2DE.
Areas of the UK with the slowest internet speeds have disproportionately higher populations of older people: of the nine areas in the UK with poorest levels of internet speed, eight have a higher proportion of people aged 65+ than the English national average.
There is evidence that the use of telemedicine and telecare interventions, e.g. in monitoring patients’ physiological data in their homes, can bring a range of benefits to patients and providers. However, studies question current cost-effectiveness compared to conventional healthcare.
In 2014, 6.4 million people in the UK (13% of the population) had not used the internet, of which 5.6 million were aged 55+. Older and disabled people are likelier to stop using the internet than other users
Choice, control, issues of privacy, and fear of reduced social interaction are key concerns for older people in relation to assistive living technologies.
Key questions:
How can we ensure new technologies are accessible across the population with the aim of maximising uptake?
How can we support older people to take up and sustain use of new technologies?
How can we support innovative business models aimed at deploying technologies for older populations?
Changing dependencies
Consumption and environment
Conclusion
