3 Meeting future demand and costs
40. Projected changes in the demand for, and
cost of, social care services indicate that the care and support
system in its current form will struggle to meet people's needs.
Those changes relate to:
— demographics;
— availability of support from carers;
— unit costs of care; and
— other factors.
In this chapter we examine each of these and their
potential impact.
Demographics
41. The DH states in the Green Paper Shaping
the Future of Care Together that:
In 20 years' time, we expect there to be 1.7 million
more adults needing care and support than there are now, and proportionately
fewer people of working age to help pay for the funding of that
care and support.[37]
This statement rests on projections showing that
England's population is ageing (i.e. the number of older people
is increasing in absolute terms, and older people form a growing
proportion of the population) but without necessarily becoming
healthier. In the following sections we consider whether the DH's
view of the future is soundly based.
INCREASING NUMBERS OF OLDER PEOPLE
42. The most recent official population projections[38]
show that the numbers of the "oldest old" are projected
to increase in the coming decades. According to these projections,
the number of people aged 85 or over will almost double between
2010 and 2026, rising from 1.2 million (2.3% of the population)
to two million (3.5% of the population).[39]
The increasing absolute number of older people is substantially
down to rising average life expectancy,[40]
i.e. people now are on average living longer than people did in
the past.
43. In the Green Paper the DH says:
In 1948, when the welfare state was founded, society
looked very different. A boy born at that time could expect to
live to 66; a boy born today, in 2009, can expect to live to over
78.[41]
David Behan, the Director General of Social Care
at the Department, similarly told us that:
Life expectancy for a man was 66 in 1948—basically,
you worked until you were 65, you had a year and you died—whereas
now life expectancy for a man is well into the seventies, 77 [the
correct age is actually 78, as stated in the Green Paper] […][42]
While the available data do clearly show that life
expectancy has increased significantly since 1948, both these
statements are, unfortunately, somewhat misleading in their presentation
of the data, as we heard from another witness.[43]
It is not true to say, as the Green Paper effectively suggests,
that the majority of males born in 1948 will be dead by 2014.[44]
Nor is it true, as Mr Behan suggested, that a man who turned 65
in 1948 could expect on average to be dead within a year; in fact,
he could have expected to live to the age of 78.[45]
The data cited by Mr Behan relate to life expectancy at birth
rather than life expectancy at age 65. There was a significant
gain in life expectancy at age 65 between 1948 and 2009 (amounting
to 5.3 years), but it was less dramatic than the gain in life
expectancy at birth over the same period referred to by Mr Behan
(which amounted to 12.0 years).[46]
44. The impact of increasing life expectancy
will inevitably be amplified by the fact that a significant demographic
"bulge" of people born during the post-war "baby
boom"[47] is now
approaching older age. The projected growth in numbers of older
people is thus partly a transient phenomenon (a "cohort effect"),
a point that the DH does not seem to be explicitly acknowledging.
This will not significantly affect the demand for social care
until the early 2030s, when the first "baby boomers"
enter their mid-80s. It thus remains the case that, as our predecessor
committee noted in 1996, there is a "window of opportunity"
in which to prepare the social care system for the onset of significant
demographic challenges in the middle years of the 21st
century.[48]
POPULATION AGEING
45. As well as increasing in absolute numbers,
older people form an increasing proportion of the overall population,
i.e. the average age is increasing, meaning that the balance between
older and younger people is shifting towards the former. This
phenomenon is known as "population ageing" and is a
long-term trend characteristic of all developed countries.[49]
It is evident in the latest population projections for England,
which expect the population aged over 65 to rise from 16% in 2010
to 20% by 2026.[50]
46. The trend to population ageing is being amplified
by the "cohort effect" of the baby-boom generation ageing.
This is compounded by the effect of the "baby bust"
or "birth dearth" that followed the baby boom, in which
fertility rates fell significantly.[51]
Recent increases in fertility and significant inward migration
have slowed the trend towards population ageing, but only slightly.
47. Population ageing is often said to have significant
implications for the future of social care, and other tax-funded
services, since it entails a shifting balance between the working-age
population (aged 18-65) and the population over working age (aged
65 and over). This is generally referred to as the old-age "support
ratio" or "dependency ratio". James Lloyd, Senior
Research Fellow at the Social Market Foundation, told us:
we do have an ageing population, we do have a declining
elderly support ratio, so simply to maintain spending on the NHS
and the state pension at equivalent levels today will mean that
the tax burden will have to increase, so it will mean that income
taxes will have to increase regardless of what we do to social
care. People particularly who are now in their twenties and thirties
will necessarily have to face higher income tax over their lives,
if we are just to maintain spending on the NHS and state pension.[52]
48. However, Mr Wittenberg told us that the dependency
ratio was of limited use:
Clearly when one is looking at long-term care demand
one has to go rather deeper than that and realise several things.
One is that 40% of the gross expenditure on social care actually
relates to people below 65. Secondly, of the 60% that relates
to people above 65, the vast majority actually relates to people
above 75 and in many cases even older than that. I find the dependency
ratio perhaps very useful as a headline starting figure but clearly
in doing detailed work we need more detail. In addition it has
been pointed out that there are plenty of people working beyond
state pension age and there are plenty of people who have retired
before it.[53]
FUTURE LEVELS OF DISABILITY
49. In the current population the likelihood
of needing care and support escalates sharply with age.[54]
Whether extra years of life gained by increasing life expectancy
are lived relatively free from illness or disability is a crucial
determinant of future levels of need for care and support. This
is commonly discussed in terms of "healthy life expectancy"
(expected years of life in good or fairly good health at given
ages) and "disability-free life expectancy" (expected
years of life without a limiting illness or disability at given
ages).
50. Several future scenarios are possible in
the relationship between life expectancy and healthy life expectancy
/ disability-free life expectancy at older ages, including:[55]
— "Compression
of morbidity"[56]
(the optimistic scenario): healthy life expectancy advances at
the same rate as, or faster than, life expectancy, leading to
less dependency overall.
— "Expansion
of morbidity" (the
nightmare scenario): healthy life expectancy advances significantly
more slowly than life expectancy, stays the same, or even recedes,
so there is more dependency overall.
— "Dynamic equilibrium"[57]
(the steady-state scenario): healthy life expectancy advances
marginally more slowly than life expectancy, or light-to-moderate
disability increases while severe disability decreases, so the
overall impact on the level of dependency is marginal.
51. The calculations of future social care need
used by the DH draw on research by Carol Jagger, Professor of
Epidemiology at the University of Leicester.[58]
She told us that she did not subscribe to the "compression
of morbidity" thesis in respect of this country, although
she admitted that the amount known is "Not as much as we
would like"[59]
and "The data we have is rather mixed".[60]
She explained that:
In this country we do not have any really good cohort
data like some other countries such as Denmark and Sweden have.
We are in the process of getting that; there is a study in the
field at the moment which will address that much better than we
have done before. However, there does not seem to be any indication
that the years of disability are reducing very much.[61]
52. The currently available data on healthy life
expectancy at age 65 are published by the Office for National
Statistics (ONS) and indicate mixed conclusions regarding current
trends.[62] These are
period data based on "snapshot" General Household
Survey (GHS)[63] questions
about self-reported illness and disability; cohort data,
by contrast, relate to a particular group of people over time,
giving a much better idea of actual trends. It is noteworthy that
the need to commission better data on healthy life expectancy
was pointed out as long ago as 1996 by one of our predecessor
committees.[64] This
was echoed in 1999 by the Royal Commission on Long-Term Care,
which specifically recommended setting up a longitudinal study,[65]
as did the House of Lords Science and Technology Committee in
2005.[66]
53. The study referred to by Professor Jagger
is part of the Cognitive Function and Ageing Study, funded by
the Medical Research Council.[67]
The English Longitudinal Study of Ageing (ELSA) is also collecting
data on illness and disability (only partially on a self-reported
basis) from a group of people over time and will in due course
generate cohort data.[68]
54. Professor Jagger cited examples of specific
conditions where she thought evidence tended to contradict the
"compression of morbidity" thesis. She told us, for
example, that mortality rates for major conditions such as coronary
heart disease and stroke were improving:
but all that means is that we are keeping more people
alive who have the disease as opposed to actually stopping people
having the disease to begin with. More people are living with
disease now.[69]
She also told us that, while the increasing rate
of obesity might lead to more premature death at younger ages,
"Obesity does not have a huge effect on mortality; it has
a much greater effect on disability".[70]
55. We asked several witnesses about the potential
for future scientific advances to help limit the level of social
care need associated with various conditions. One factor in the
anticipated increase in demand for social care services is the
extension of life expectancy for people with a learning disability.
Whereas a person with Down's syndrome would once not have been
expected to live beyond their mid-20s, now they are often living
well into their 50s and beyond. More people with profound and
multiple learning disabilities are now surviving into adulthood,
often with increasingly complex needs associated with multiple
conditions and the development of early dementia.[71]
In this case, scientific breakthroughs cannot be ruled out, but
they do not seem probable, as we heard from David Congdon, Head
of Campaigns and Policy at Mencap:
it is unlikely—but one can never predict the
future—that there are medical solutions of any shape or
form to learning disability as a generality and, therefore, the
idea that advances in medical science of any shape or form or
genetics will lead to a significant reduction in the demands in
terms of social care for people with a learning disability I do
not think are valid, to be perfectly frank.[72]
56. Regarding degenerative conditions, such as
Multiple Sclerosis (MS), Stuart Nixon, Vice Chair of the Board
of Trustees of the MS Society, told us that at least the management
of such conditions could change:
we have moved in the last 20 years from what was
effectively a diagnosis service, "Go away and live with it,"
to something where hopefully in the next five years or so there
will be a range of disease modifying therapies. None of these
are a stepping back on the line of disability that you have gone
down, but they are hopefully about arresting that progression
[…] There are some positives, but by no means are we looking
at something that within the foreseeable future is going to change.
Q726 Jim Dowd: The impact
on the pressure for social care will be minimal?
Mr Nixon: Yes. We do not see it having an enormous
effect.
57. A large proportion of anticipated future
care need is associated with substantial numbers of people being
affected by dementia. The Alzheimer's Society told us: "There
are 700,000 people with dementia in the UK and this is forecast
to increase to 940,110 by 2021 and 1,735,087 by 2051."[73]
However, here too there seem to be grounds for optimism as regards
managing the condition in future. We heard from the Society's
Head of Policy and Public Affairs, Andrew Chidgey, that :
When you talk to the dementia research community,
what they will say is there is not likely to be a cure on the
horizon in the next 15 years; however, what they do say is that
they are quietly confident that we may see some disease modifying
treatments, so that is to say although people may continue to
develop diseases in the brain that cause dementia, we may be able
to significantly modify the progression of the disease which will
mean we may be able to keep people earlier in the condition with
less significant symptoms than we are at the moment […] If
we can delay the onset of progression of dementia, then I think
that is probably where the most significant opportunity lies.[74]
Future availability of support
from carers
58. As we have already noted, the greater part
of care and support is provided by carers, such as spouses, partners,
family members, friends and neighbours. Consequently, it can be
expected that the extent of future demand for formal care services
will be substantially determined by the availability of this informal
care and support. According to the National Statistician:
The rising numbers of older single people and the
break-up of families through divorce are likely to reduce the
provision of informal caring. In addition, children caring for
their parents will be increasingly old themselves and potentially
caring for their children or grandchildren at the same time as
their ageing parents.[75]
59. We received evidence on this from Linda Pickard,
a Research Fellow at the Personal Social Services Research Unit
(PSSRU), drawing on work undertaken for the Cabinet Office and
the DH, according to which:
The evidence suggests that around 250,000 disabled
older people could be left without family care by 2041, opening
up an unpaid 'care gap' and potentially increasing demand for
social care services.
60. Ms Pickard concludes that, based on the demographic
and other assumptions used in the PSSRU model:
On the demand side, currently around 600,000 disabled
older people receive informal care from adult children and this
is projected to rise by 90% to 1.3 million in 2041 […] On
the supply side, there are currently 400,000 people providing
intense informal care to parents and this is projected to rise
by 27.5% to 500,000 in 2041 […] Therefore, the care-receivers:
care-providers ratio is projected to fall from 0.6 in 2005 to
0.4 in 2041.[76]
61. However, predicting the future availability
of such care is complex and speculative. Mr Wittenberg commented
on some of the variables involved in making such forecasts:
[Ms Pickard's] base case assumption really is that
the propensity to provide informal care is constant, that is to
say that if a given age, gender, educational attainment level
X% provide informal care to their parents, then one way of looking
at it is to say "Let's assume X% remains constant over time".
Of course it may not do. So there are ways of looking at building
up scenarios in some of these issues but of course the future
is uncertain and with informal care not being able to depend on
employment-related issues and geography, where people live, which
in turn may be related to employment, makes it a very difficult
area.[77]
Future unit costs of care
62. In addition to rising demand associated with
demographic pressures, another significant factor in the future
cost of social care could be the unit costs of providing it. In
this case too, the modelling work done for the DH entails making
a projection based on certain assumptions, as Mr Wittenberg explained
to us:
the Treasury have assumed that productivity and average
earnings will both rise by 2% a year in real terms. This is for
very long-term projections over the next 50 years and we have
taken that as our base case. Of course that may not be the case
and there are lots of reasons why it may not be. Particularly
if one uses the 2% assumption and particularly assuming that the
average earnings of care staff will go up in line with the average
earnings of the labour force generally, that may not be the case
[…] There are also issues about expectations. Obviously if
quality of care rises, that may or may not affect the unit costs.[78]
Future expectations
63. The DH recognises that the "baby boomers"
have grown up with much greater expectations of life than their
parents' generation; and that rising expectations will continue
to characterise future cohorts. It is anticipated that older people
will, therefore, be increasingly demanding customers of social
care services, expecting high quality, as well as choice and autonomy.
The Green Paper quotes the Chairman of the Audit Commission as
saying: "Ex-punk rockers and Rolling Stones fans are not
going to be happy with a cup of tea and daytime TV".[79]
The Department links the issue of rising expectations closely
to the need to personalise social care, which we discuss further
in subsequent chapters of our report.
64. Although much is made of changing expectations
of care, there seems to be no solid quantitative evidence in this
regard. Mr Wittenberg told us:
the expectations around the quality and types of
care and the quantity of care is another big issue, that is clearly
a speculative one. There is a view that expectations of future
cohorts may be higher but I am not aware of one particular measurement
of that.[80]
Future availability of funding
65. The ability of the social care system to
meet future levels of demand will be substantially determined
by the future "funding envelope", i.e. the amount of
money, from all sources, that is spent on it, and how sustainable
those sources of funding are. This depends on the future availability
of money from private sources (income and savings) and from the
public purse, and the funding system that is used.
66. In 2008 the Government stated that by 2026
a £6 billion "funding gap" would have opened up
in social care if the system did not change in response to new
pressures (i.e. this would be the additional cost just of standing
still).[81] The recent
Green Paper, however, does not quantify this gap; nor does it
consider the expenditure needed to ensure that in the future there
is less unmet need than under the present system. The Green Paper
does, though, consider the issue of possible funding models. We
discuss these issues further in later chapters of this report.
The funnel of doubt
67. As is apparent from our evidence, there is
a large element of uncertainty involved in projections of future
social care demand and costs. Mr Wittenberg told us:
some of these factors are difficult to look at and
it means there is a range of uncertainty around the estimates.
You remember that the Royal Commission talked about a funnel of
doubt and had a diagram opening up a wedge of different projections;[82]
that was a very good phrase in a sense to have used.[83]
Our predecessor committee in 1996 also heard about
"an 'expanding funnel of doubt' when projecting so far into
the future".[84]
68. As Mr Wittenberg explained, there is no statistically
meaningful margin of error in making such long-term projections;
there is only a "plausible range"[85]
for each component. Even small divergences from the assumptions
made can cause big differences in actual outcomes in the long
run, since the impact of any change is compounded over time. This
means that the uncertainty becomes progressively greater the further
in the future that a projection applies, hence the widening of
the "funnel doubt" around projections.
Conclusions
69. A compelling argument for
thoroughly reforming the social care system is that in its current
form it will struggle to meet people's needs under the pressure
of future growth in demand and costs. However, we recognise that
anticipating these is a far from exact science and there is much
uncertainty. Projections are made from observed trends, based
on a series of plausible assumptions about a number of variables,
but within a considerable "funnel of doubt", which expands
into the future.
70. In order to minimise that
doubt, the best possible evidence base is needed. We are, therefore,
extremely disappointed that, fourteen years after our predecessor
committee called on the then Government to commission better data
on healthy life expectancy, the delay in doing so means the available
data are still inconclusive. The Cognitive Function and Ageing
Study and the English Longitudinal Study of Ageing are expected
in due course to yield cohort data and we recommend that the DH
take full account of these as soon as they become available.
71. Despite the degree of uncertainty
about future demand and cost, it is nonetheless clear that, on
all reasonable assumptions, the social care system will face considerable
increased pressures in the decades to come. It is important, though,
to avoid demographic despair and alarmism. Population ageing is
far from being a new phenomenon, nor is it unique to this country.
Its effects have not yet proved catastrophic and there is no compelling
reason to suppose that they will in the future, provided the right
political decisions are made now.
72. We note that, in its presentation
of the data on life expectancy, the DH has confused period and
cohort measures of life expectancy, as well as life expectancy
at birth and at age 65. In so doing, there is a danger of overstating
the extent of demographic change and potentially discrediting
the projections used. In an area that is characterised by uncertainty,
it is essential that care is taken to interpret existing data
accurately.
73. The Department has also
not made clear that part of the demographic challenge facing the
social care system is the transient "cohort effect"
of the ageing of the population "bulge" born during
the post-war "baby boom". The fact that the first "baby
boomers" will not enter their mid-80s until the early 2030s
means that there is still a 20-year "window of opportunity"
in which to prepare for this. This is not an argument for complacency,
far from it; but there is a chance to address the challenge systematically
so as to ensure comprehensive and lasting reform, rather than
being led by panic into further incremental reform of marginal
and temporary value.
74. We are concerned that an
ageing population is too often seen in public debate as something
negative, a problem to be solved, with older people regarded as
a burden. The fact that many more people can expect to live well
into old age is one of society's greatest achievements and something
to be celebrated rather than lamented.
75. Longer life expectancy does
not inevitably mean more years lived with ill health and disability;
people can live lives that are healthier as well as longer, and
many older people are living proof of this. Future healthy life
expectancy is not fixed; actions taken now could help to make
the "compression of morbidity" more likely. The importance
of research to develop curative or mitigating interventions for
long-term conditions should not be underestimated. Such research
could pay major dividends, in terms of health outcomes and public
spending, as well as in individuals' quality of life, and must
be adequately supported and funded. Similarly, the importance
of public health interventions must be acknowledged. The health
risks posed by smoking, drinking, poor diet and lack of exercise
have important implications for future social care demand. This
reinforces the need for interventions to address these issues,
although their effectiveness must be rigorously evaluated. It
also reinforces the importance of coordinating health and social
care services.
76. We would also counsel against
pessimism regarding the affordability of care and support in the
future. The old-age "support ratio" or "dependency
ratio" is not the most important factor to take account of
in determining the likely future affordability of social care.
Our society must not underestimate its ability to become more
productive and wealthier, nor indeed the contribution that the
growing numbers of older people will continue to make to that.
77. While these challenges to the social care
system lie in the future, there is evidence that at present the
system too often fails to provide adequate support to people in
need, as we explore in the next chapter.
37 Department of Health, Shaping the Future of Care
Together, Cm 7673, July 2009, p 99 Back
38
A population projection is not a forecast or prediction. Rather,
it sets out what the population will be in future, based on observed
trends (in mortality, fertility and migration), if certain assumptions
are made about the likely continuation of those trends. Projections
consist of a principal projection, and a number of variants, showing
the effect of making alternative assumptions about the continuation
of current trends. Back
39
Office for National Statistics, 2008-based National Population
Projections (Principal Projection). Over the same period, the
number of centenarians (people aged at least 100) is expected
almost to quadruple, rising from 10,000 (0.02% of the population)
to 35,000 (0.1 % of the population). Back
40
Life expectancy is the average statistically expected further
years of life at particular ages, calculated using age-specific
mortality rates (rates of death at particular ages). Back
41
Department of Health, Shaping the Future of Care Together,
Cm 7673, 2009, p 32; cf. p 38 Back
42
Q 4 Back
43
Qq 151-152 Back
44
The data cited by the Department relate to period life
expectancy, which is calculated using the age-specific mortality
rates (i.e. rates of death at particular ages) for a given period
in time. It provides a useful way of summarising mortality rates
during a specific time, but it does not reflect how long a particular
person could expect to live, since it makes no allowance for changes
in future actual or projected mortality rates as that person ages.
The appropriate data to have cited would have been those relating
to cohort life expectancy. This is derived from age-specific
mortality rates in an actual cohort of population (a group of
people born in a particular time period) as it ages, rather than
being read off from the mortality rates observed in a particular
"slice of time". It is calculated using known or projected
mortality rates as the cohort ages and, therefore, reflects the
actual length of time a person could expect to live. Back
45
These data apply to England and Wales (Office of Health Economics,
"The Economics of Health Care", www.oheschools.org/ohech6pg4.html). Back
46
Ibid.; Office for National Statistics, Period expectation
of life (years), England, Based on historical mortality rates
from 1981 to 2008 and assumed calendar year mortality rates from
the 2008-based principal projections. These gains relate to period
life expectancy. Over the past century, gains in life expectancy
at birth (driven by steep falls in infant mortality) have been
substantially greater than those at later ages. While gains in
life expectancy have continued at all ages, gains at birth have
slowed since the 1960s; by contrast, gains at age 65 have accelerated,
although they are now beginning to level off. Back
47
The baby boom was a period of increased births (associated with
increased fertility rates) which occurred between the mid-1940s
and the mid-1960s, with significant peaks in 1947 and 1964. Back
48
Health Committee, Third Report of Session 1995-96, Long-term
care: Future provision and funding, HC 59-I, para 120 Back
49
Population ageing has been driven by a persistent long-term combination
of increasing longevity (with life expectancy rising first at
younger ages and then at older ages too) and lower fertility rates
than in pre-industrial societies. The observed process of change
from high birth rates and high mortality at younger ages to low
birth rates and low mortality at younger ages is known as the
"demographic transition". It has included a transitory
phase in which changes in birth rate lagged behind changes in
mortality, leading to a period of high birth rate and low mortality
at younger ages, resulting in population growth. Population ageing
has been less marked in the UK than in much of the rest of Europe. Back
50
Office for National Statistics, 2008-based Principal National
Population Projections, England Back
51
By the 1970s the fertility rate was below the replacement rate
(i.e. that needed to ensure the continuation of the existing level
of population) and it has remained there for over a generation. Back
52
Q 253 Back
53
Q 191 Back
54
As at April 2009, 15.8% of the UK population aged 85 or over (the
"oldest old") were resident in a care home or long-stay
hospital, compared to 4.0% of those aged 75-84, 0.8% of those
aged 65-74, and 0.04% of those aged under 65 (Laing & Buisson,
Care of Elderly People: UK Market Survey 2009, pp 18-19). Back
55
Healthy life expectancy, POSTnote 257, Parliamentary Office
of Science and Technology, February 2006; Raymond Tallis, "The
ultimate aims of medicine and the future of old age", Asian
Journal of Gerontology and Geriatrics, vol 1 (2006), pp 157-162;
Carol Jagger et al., Compression or Expansion of Disability?:
Forecasting Future Disability Levels under Changing Patterns of
Diseases (London, 2006) Back
56
As part of the demographic transition, industrial societies have
already experienced a "compression of mortality", i.e.
the concentration of the majority of deaths into an increasingly
narrow set of older age bands, as a result of age-specific mortality
rates falling more steeply in younger ages than in older ones.
More recently, industrial societies have also experienced falling
age-specific mortality rates at older ages, so over time the majority
of deaths are occurring in increasingly older age bands. The "compression
of morbidity" thesis holds that this will also become the
case in respect of illness and disability, as part of a "health
transition" akin to the "demographic transition". Back
57
A system characterised by "dynamic equilibrium" is one
in which different inputs change in such a way that the changes
cancel each other out, leading to no overall change in outputs. Back
58
Qq 918-920 Back
59
Q 155 Back
60
Q 156 Back
61
Q 155 Back
62
Michael Smith, Grace Edgar and Genevieve Groom, "Health expectancies
in the United Kingdom, 2004-06", Health Statistics Quarterly
40 (2008), pp 77-80 Back
63
The GHS is a multi-purpose continuous survey that collects information
on a range of topics from people living in private households
in Great Britain. It is carried out on annual basis by the Social
Survey Division of the Office for National Statistics, and has
been run every year since 1971 (except in 1997-8 and 1999-2000).
The name of the GHS has recently been changed to the General Lifestyle
Survey, and it now forms part of the Integrated Household Survey. Back
64
Health Committee, Long-term care: Future provision and funding,
para 97 Back
65
Royal Commission on Long-Term Care, With Respect to Old Age:
Long Term Care - Rights and Responsibilities, March
1999, para 2.24 (recommendation 2.2) Back
66
House of Lords, Ageing: Scientific Aspects, First Report
of the Select Committee on Science and Technology, Session 2005-06,
HL Paper 20-I, paras 2.29-30, 36 Back
67
www.ncl.ac.uk/ihs/research/project/2710 Back
68
James Banks, Elizabeth Breeze, Carli Lessof and James Nazroo (eds.),
Living in the 21st century: older people in England the 2006
English Longitudinal Study of Ageing (Wave 3) (London, 2008),
Ch 8 Back
69
Q 159 Back
70
Q 160 Back
71
Ev 6, 42 Back
72
Q 724 Back
73
Ev 57. The source for these figures is the 2007 Dementia UK
report, commissioned by the Alzheimer's Society and prepared by
the London School of Economics and the Institute of Psychiatry
at King's College, London; the study estimated that 574,717 people
in England (84% of the UK total) currently have dementia (as at
2005). The anticipated figures for 2021 and 2051 are arrived at
by applying to population projections the observed rate of prevalence
of dementia (a fifth of people aged between 85 and 89 have dementia;
over the age of 90 the rate approaches a third). They are, thus,
projections rather than forecasts. A recently published study
by the Oxford University Health Economics Research Centre, Dementia
2010 (commissioned by the Alzheimer's Research Trust), estimates
that there are currently 821,884 people with dementia in the UK
(news.bbc.co.uk/1/hi/health/8493248.stm). Back
74
Q 618 Back
75
Karen Dunnell, "Ageing and Mortality in the UK: National
Statistician's Annual Article on the Population", Population
Trends 134 (2008), p 22 Back
76
Ev 44 Back
77
Q 173 Back
78
Q 184; cf. Q 541 Back
79
Department of Health, Shaping the Future of Care Together,
Cm 7673, 2009, p 53 Back
80
Q 172 Back
81
This figure represents the difference between the cost of providing
social care in 2026, allowing for increased demand and increased
unit costs, and current expenditure levels, uprated to allow for
2% annual real terms increases, in line with anticipated GDP growth
(Department of Health, "Technical note: The £6 billion
funding gap for adult social care", 2008). Back
82
Royal Commission on Long-Term Care, With Respect to Old Age,
1999, para 2.14; Research Volume 1, Figure 5.1, p 39 Back
83
Q 173 Back
84
Health Committee, Third Report of Session 1995-96, Long-term
care: Future provision and funding, HC 59-1, para 98 Back
85
Q 182 Back
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