We are all living longer – but at 65 years old we can expect to spend around a decade of our later years in poor health, and the current gap in life expectancy between the richest and poorest in our society is shameful.
As the ‘baby boomers’ enter later life, we face the prospect of a significant increase in the number of people in need of health and social care. In 15 years, we will have 1.2 million more people aged 85 than today – an increase of nearly 80% between 2018 and 2033. Pressure on the NHS and the social care system will only get worse unless urgent action is taken to support people to stay healthier for longer.
If we are to meet the Government’s stated ambition of increasing people’s healthy life expectancy by five years by 2035, the NHS must take a more strategic and forward-thinking approach to healthy ageing. This means a focus on prevention and maintaining independence – not seeing people as a collection of diseases or viewing old age as an inevitable time of frailty and decline.
To turn the NHS from a ‘national illness service’ that simply reacts to diseases into one that actively improves population health, we need a focus on four key areas:
Zero in on prevention: The NHS should be bold in using its independent voice to hold the Government and industry to account for its role in creating the conditions that lead to poor health. This means helping the public understand how much of their health is dependent on factors outside of the NHS – like junk food marketing and sugar and fat content in our food and drink. It means helping people to stop smoking, be more active and reduce alcohol consumption. The transfer of the commissioning of preventive services, including NHS Health Checks, means they are poorly integrated with the NHS, and the end of the ring fence in local authorities means critical services, such as smoking cessation and drug and alcohol services, are underfunded.
Support people managing long-term conditions and living with disabilities: Co-ordinated and personalised health services are needed to help people manage their health holistically, particularly as they reach older age, instead of reacting to specific diseases individually. There’s a drastic shortage in intermediate care that needs urgent investment and there’s not enough focus on and investment in rehabilitation and reablement. We must also tackle ageist attitudes among health professionals – some still believe that older people’s health can’t improve and so don’t put energy into rehabilitation.
Help people stay in work: Health is one of the main reasons people leave the labour market before reaching State Pension age – a quarter of workers aged 55 and over with a health condition are considering stopping work because of their poor health. The NHS could give occupational health training to primary care professionals and extend coverage of occupational health and wellbeing support to smaller employers and self-employed people. And the NHS itself should adopt age-friendly employer practices and support staff as they approach retirement.
Play a role in ensuring safe and warm housing: Unsuitable housing not only impacts individual wellbeing, it also costs the NHS around £624 million for first-year treatment costs, mainly due to excess cold hazards and falls. Working more closely with social care on rehabilitation and making small changes to older people’s homes, such as installing handrails, ramps and level-access showers, could play a significant role in relieving pressure on both the NHS and social care. The NHS should launch a national programme of ‘home health checks’ for the safety and quality of a home environment for those at risk, building on the lessons from the Safe and Well checks carried out by the Fire Service. The partnership between health, social care and housing needs to move beyond warm words and into hard action and national commitments.
Successive governments have increased funding for the NHS – though not always to a sufficient degree. If we are to create a health service that is truly fit for the future, we need to think differently now.
A focus on improving the health of the nation as we age must be central to this vision – and is crucial for the NHS’ long-term sustainability.