What are the big changes in our society and what do they mean for us over the next 10, 20, or 30 years? In a world that often seems consumed by the immediate considerations of 24-hour media coverage and the short-term attentions of social media, this is something that often gets overlooked in public discourse.
Foresight is a government-funded research programme that takes for each of its projects a big, complex question facing society and public policy, uses robust scientific approaches to collate all the known relevant evidence, and provides strategic options to address it. Work in the past has looked at the challenges to society of obesity and of mental wellbeing.
Scope of the report
The most recent Foresight report concerns the future of an ageing population and was put together by drawing on a wide spectrum of expertise including demography, economics, design and technology, social and health policy, geography and gerontology.
The changing ageing profile of the population has been known about for some time; we have most likely all heard about ‘baby boomers’, increases in the state pension age, or about the challenges of dementia. This report brings all the knowledge on this subject together in one digestible portion. (Well, OK, the full report is over 100 pages, but if you don’t want the full meal a manageable snack comes in the form of the executive summary and key findings, a mere 8 pages and 2 diagrams.)
So, what is meant by an ageing population? The key trend is that, happily, more people are living for longer. Alongside a decline in the fertility rates as people have had fewer children, it means that the age profile of the population is shifting more to the older end of the gradient.
Some population projections in the report are:
- Whilst the number of people in the age group 0-29 is expected to rise from 24 million to 25.9 million between 2014 and 2039, those aged 60 and over is predicted to increase from 14.9 million to 21.9 million
- By 2040 nearly one in seven people will be aged over 75
- By 2037 there are projected to be 1.42 million more households headed by someone aged 85 or over; an increase of 161% over 25 years
- The proportion of the working age population aged between 50 and the state pension age will increase from 26% in 2012 to 35% in 2050; an increase of approximately 8 million people.
These changes have implications for public sector budgets, how government departments plan and respond to social demands, how public services are organised, for work life, retirement and pensions, for housing, and for our general experiences of what society is like and what people can expect for them and their families. This comprehensive Foresight report discusses all this, but in this blog I will focus on some implications for social care.
What does it mean for social care?
The report summarises projections that from 2015 to 2035, the number of people requiring state-funded home care services will rise by 86%, and demand for state-funded care homes places will rise by 49%. The number of care home residents who pay privately is forecast to rise by 110% over the same period. This from a position where there are question marks over the current viability of significant parts of the care home sector.
Social isolation is becoming more prevalent amongst older people, and it has poor implications for people’s physical and mental health, plus lonely people are more likely to use emergency health services and experience earlier entry in to care homes. In short, we are in danger of creating a society in which there are more older people, who are becoming more unwell as a result of social isolation and, hence, increasingly likely to need care services. We are at the foothills of understanding the processes linking social isolation and health and wellbeing, and how to intervene to improve outcomes.
Another key question in this is who will be the staff to care for people needing these services. With increased demand but a smaller proportion of the population being of what we currently think of as working age, this is no small challenge.
We need, of course, to also consider the impact of these demographic changes on the sibling of social care, namely health care. The expectation is that there will be a move away from demands on health services of acute illness towards those arising from chronic conditions, multi-morbidities, cognitive impairments and long-term frailty. What are the best forms of health services to meet these challenges and how should they dovetail with social care to ensure high quality care, good quality of life for people and the most efficient use of resources?
The Foresight report suggests a need to move to more interventions to prevent chronic illnesses, yet we seem some way from being able to do this (it is a recommendation in many reports on health care over the years, for example see the Wanless reports from 2002 through to 2006 on health and social care spending). Can we carry on the public debate about funding for the NHS and publicly avoiding any debate about the financial future for social care as well?
The role of informal carers
Of course, an important part of the current care system is the care provided by family and friends as unpaid or informal carers. The implications for families and caring for relatives and friends are also covered in the Foresight report, which predicts that families and communities will play an increasing role in providing care.
Between 2007 and 2032, the number of people aged 65 and over requiring unpaid care is projected to grow by more than one million. The number of hours provided by family carers has already increased, by 25% between 2005 and 2014. Whilst across a population caring for others has mixed effects on carers, the increasing demands on families and carers will mean more carers needing support to minimise the negative effects of the role.
Strengths and limitations
It should be remembered that the Foresight reports do not present a deterministic view of what society will definitely be like. They are a forecast based on the current situation and the best available evidence and models. As a society we are able to choose public policy responses to whatever happens.
As John Appleby commented in his review of spending on health and social care over the next 50 years:
There are important political and social choices to be made about how much to spend, what it should be spent on and how this spending should be funded. These choices are not easy and will inevitably involve trade-offs.
However, to make these choices for such complex issues requires careful consideration and discussion and a longer-term perspective, something we all have a responsibility for as citizens. If we make these choices well, we can enjoy the rewards of more people having longer lives with good quality of life. The Foresight report gives us a sound knowledge base to help us to do this, but will we be able to rise to the challenges of deliberation and public engagement?
Government Office for Science (2016). Future of an Ageing Population. Foresight Report, London: Government Office for Science.
Appleby J (2013). Spending on Health and Social Care over the Next 50 Years: Why think long term? London: King’s Fund.