Facing up to the facts of life

We’re getting older – the sooner politicians recognise that and set about changing attitudes the better, says Hilary Burrage

Perhaps it’s superfluous to say this, but ageing is an issue which affects us all quite fundamentally; but you wouldn’t always know this, to judge from the general invisibility of the topic. And that invisibility is a big element of the difficult challenges which policymakers in this field face.

Unless we’re very unlucky we shall all experience it, but how many of us want to think about old age? We don’t want to consider the often lonely lives, reduced mobility and other unrelenting afflictions which many older people encounter at some point in their senior years. Nor do most of us see during our everyday business the more distressing aspects of very old age, when once perfectly fit and competent adults may become totally dependent on helpers for their every need.

These vexed realities are hidden behind the closed doors of private homes, care establishments and hospitals, undisclosed to all except stressed family carers and health and social care workers. In other words, there’s not much political capital as things stand to be had in policies for old age. We don’t want to admit it will very probably one day be us, and we don’t want to pay.

Ignoring the problem is not, however, an option for serious politicians, however much they might like to shift the whole thing on to policymakers. Perhaps they would prefer to join the rest of us in denial, but ultimately there are economic and human costs and consequences to ignoring the issues, as much as to addressing them. So, for politicians, what to do?

The first thing may be to acknowledge we’re all in this together, but the second is to understand old age hits different people differently. Folk are no more uniform in their old age than they were in their middle years.

Likewise, while some things (such as state pensions) must be dealt with at a national strategic level, the specifics of others (such as local support, care and transport logistics) are best resolved much closer to home. And there are also matters which, although different approaches may be appropriate in different places, there is surely a requirement on all local authorities to address.

Most obvious is the planning function. Demographies of areas can vary dramatically, but in almost every instance this variation can be captured well in advance of its impact. Just as local authorities calculate how many school places are likely to be required, so can be estimated the level of need which older people in a community will have in a few years’ time.

But this assumes several things: that there is a shared determination to plan properly and long-term between different aspects of local wellbeing, health and social care provision; that the influencing factors are understood; and that the political will is there. So while the determination of likely levels of provision for old age needs to be done locally, the parameters of this exercise require a wider view, shared expertise and a degree of uniformity.

‘The idea that everyone over the age of 65 (even 55!?) is economically burdensome is straightforwardly wrong; and the value in other ways of older people, who often know their localities so much better than the policymakers, must start to be formally appreciated.’ These requirements lead inescapably to the conclusion that there is a fundamental duty on national government, at the very least to facilitate and insist upon adequate and transparent data collection and projections at every level from national right down to locality. This is essential, as are equally transparent and data referenced plans at every level for how to ‘cope’ with the challenges for us all behind the good fortune that people now live longer.

Only national government can effectively shape public understanding; only national government can ensure that dialogue between all stakeholders about the precise nature of strategically required information actually comes up with the goods; and only national government can ensure that the data, planning and provision are there across the land at each tier of delivery.

Likewise, however, only local providers have the capacity to coordinate provision on the ground. But to do this effectively there must be much more flexibility, and much more insight, than arrangements suggest elderly people sometimes currently experience.

Let’s be clear: not all older people live near able-bodied and willing family helpers. And while some can, not all older people are able to speak for themselves. The bland assumption by health authorities that ‘the family’ will take care of laundry for hospitalised seniors is crass (otherwise, these patients may end up perpetually in hospital gowns).

The lack of supported housing provision, and restrictions on transfer between local authorities of elders requiring nursing home care are cruel (a significant percentage of older people are sometimes or even always lonely). The casual, unthinking acceptance by agencies of often treatable conditions – hearing loss, depression, mobility, nutritional deficiencies – because a person is ‘old’ must be challenged vigorously, especially in the absence of family members to keep the issues to the fore.

The idea that everyone over the age of 65 (even 55!?) is economically burdensome is straightforwardly wrong; and the value in other ways of older people, who often know their localities so much better than the policymakers, must start to be formally appreciated.

The list could go on, but the underlying theme is painfully obvious. Synergy between local and national policy development for properly designed, strategically managed support and care in old age is massively overdue. To a degree it matters not whether the support and care is delivered by the state or another agency, formal or informal.

But it matters desperately that coordination is achieved. Grey panthers – who see ageing as a positive development – and other age-positive protagonists there may now be, but they remain in the minority. Perhaps most much older people still require, and will always require, people who can speak with and for them and promote their wellbeing when that needs to be done. This advocacy and care is ultimately a responsibility, in our complex contemporary society, of the state.

Remember: it’s not just ‘Them’. One day, with good fortune, it will be ‘You’.

• Read our If Focus on the economic and social challenges of ageing here.