Social Care - Health Committee Contents

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.


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.


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]


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]


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.


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", 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 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 ( 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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