House of Lords - Ready for Ageing? - Select Committee on Public Service and Demographic Change

Ready for Ageing? - Select Committee on Public Service and Demographic Change Contents

Annex 9: Increasing demand for health and social care (see paragraphs 2, 19 and 20 of the report)

181. Extended life expectancy is one of the greatest triumphs of the twentieth century. The NHS has had great successes in extending life: so much so that it is a victim of its own success.[246] People are now living for more years with multiple long-term conditions and need for long-term care.[247] This results in increases in the demand for, and the costs of, health and social care.

182. Eventually almost all of us will need healthcare, and two thirds of men and 84% of women currently aged 65 will need some social care before they die.[248] The box below gives some illustrations of the impact that the ageing society will have on demands for health and social care and informal care.

BOX 1

Increasing pressures on health and social care

Care for older people is more expensive than care for younger adults, and the number of older people is rising:

· The number of people aged over 75 is expected to grow from 5.4 million in 2015 to 8.8 million in 2035.

· The demand for hospital and community service spending by those aged 75 and over is in general more than three times the demand from those aged between 30 and 40, although this varies with other supply and needs factors. The primary care GP workload incurred by those aged 75 and over is roughly three times that of the 45-64 age group.[249]

The number of long-term conditions increases with age, and they account for much of health and social care spending:

· As of January 2010, there were 15.4 million people in England with at least one long-term condition (around 30% of the population); and it is estimated that by 2025 this number will rise to 18 million.[250]

· In 2010 it was estimated that the treatment and care of people with long-term conditions accounted for 70% of the total health and social care spend in England.[251]

· In 2010 people with long-term conditions accounted for more than 50% of all GP appointments, 65% of all outpatient appointments and over 70% of all inpatient bed days in England.[252]

· By 2018 the number of people in England with three or more long-term conditions is predicted to grow from 1.9 million in 2008 to 2.9 million.[253]

· It is forecast that in England and Wales, the number of people aged 65 and over with diabetes will increase by over 45% from 2010 to 2030, and the numbers with arthritis, coronary heart disease and stroke all by over 50%

· It is also forecast that the number of people in England and Wales aged 65 and over with dementia (moderate or severe cognitive impairment) will increase by over 80% between 2010 and 2030, to 1.96 million.[254]

Rates of limiting long-standing illness give an indication of the number of people with a long-term health problem which limits their daily activities or work:

· If rates hold constant at 2010 levels, by 2030 the number of UK people aged over 65 with a limiting long-standing illness could rise by 44% from 4.2 million to 6 million.[255]

· If trends in limiting long-standing illness rates over 2000 to 2010 are projected to 2030 then the number may be limited to 5.7 million (a 36% rise).[256]

Rates of disabled people requiring care:

· It is estimated that by 2022, the number of people in England aged 65 and over with some disability will increase by 40% to 3.3 million.[257]

· The number of people in England and Wales aged 65 and over who have a level of disability meaning that they cannot put on shoes and socks, have a bath or all-over wash, or transfer to and from bed—or in other words, who need at least daily assistance from another person—is projected to rise from 1.0 million in 2010 (11.1% of the population) to 1.9 million in 2030 (14% of the population), an increase of 90%.[258]

· It is estimated that under current funding arrangements total spending (public and private) on long-term care for older people would need to more than

double in real terms by 2030 to sustain standards. Public spending would need to double, and private spending to rise by nearly 150%.[259]

· For England between 2010 and 2022, the number of older people with moderate or severe disability is forecast to rise by a third if prevalence rates remain the same, and rise by over a half if they rise as they have in the recent past.[260]

Demand for unpaid care provided by families and friends:

· There are already twice as many unpaid carers—nearly 6.4 million—as there are paid staff in the health and social care systems combined.[261]

· The numbers of older people with disabilities receiving informal care would need to nearly double over the next 20 years if the probability of receiving care is to remain constant—but it is not clear that the supply of informal care will rise to keep pace with demand. Demand for informal care provided by adults to their parents is projected to rise by over 50% between 2007 and 2032, whereas the supply of this care is projected to rise by only 20%.[262]

· By 2017 we will reach a "tipping point" for care when the numbers of older people needing care will outstrip the numbers of working age family members currently available to meet that demand.[263]

183. These are very large increases in a short time. If new treatments cause a welcome reduction in the impact of some long-term conditions, it is likely that there will still be large demand increases coming onto the system from others.

184. It is possible that medical advances will reduce the numbers needing long-term care over the coming decades. However, as we cannot predict the future, policy must be designed using the trends that we can calculate, which show major increases in the level of demand falling on the healthcare and social care system.[264] It is important to note that the number of people requiring care is not the only factor driving increasing health and social care costs: pressure for better quality care is another important factor.[265]

246 Q 217 Back

247 QQ 216-217; Q 562 Back

248 Impact of changes in length of stay on the demand for residential care services in England: Estimates from a dynamic microsimulation model, Personal Social Services Research Unit (PSSRU) Discussion Paper 2771, 2011, J-L Fernandez and J Forder. The gender breakdown was supplied by the authors. Back

249 ONS, National Population Projections 2010 Based Statistical Bulletin, Oct 2011, Table 4; The King's Fund supplementary written evidence; Department of Health, Resource allocation: Weighted Capitation Formula Seventh Edition, Table 2 and Table 12, 2011. Back

250 Department of Health, Improving the health and well-being of people with long term conditions: World class services for people with long term conditions - Information tool for commissioners, January 2010. Back

251 Department of Health, Improving the health and well-being of people with long term conditions: World class services for people with long term conditions - Information tool for commissioners, January 2010. Back

252 Department of Health, Improving the health and well-being of people with long term conditions: World class services for people with long term conditions - Information tool for commissioners, January 2010. Back

253 The King's Fund, supplementary written evidence. Back

254 Professor Carol Jagger, Newcastle University. See also Alzheimer's Society. Back

255 Professor Philip Rees, supplementary written evidence. Back

256 Professor Philip Rees, supplementary written evidence. Back

257 Department of Health, Improving the health and well-being of people with long term conditions: World class services for people with long term conditions - Information tool for commissioners, January 2010. Back