APPENDIX 3: CALL FOR EVIDENCE
The House of Lords Committee on Public Service and
Demographic Change, chaired by Lord Filkin, was set up on 29 May
2012 "to consider public service provision in the light of
demographic change, and to make recommendations".
The main, though not the only, demographic change
is the very significant increase in the older population of the
United Kingdom now and over coming decades. Living longer and
healthier lives is to be welcomed, but it increases the need for
and cost of public services, as the Office for Budget Responsibility
(OBR) set out in its Fiscal Sustainability Report, July
2012.
If current policies go unchanged, the OBR advises
that the cost of public services will increase to unsustainable
levels. We cannot borrow more, yet there is a limit to how much
extra society is willing to pay in taxes. This forces us to consider
wider ways to respond.
There have been official inquiries into aspects of
this. What has been lacking is an overall consideration of the
implications of demographic change and an ageing population, for
publicly funded services, individuals and localities.
An ageing population will pose challenges and choices
for individuals, families and government and requires a re-thinking
of attitudes and expectations about work, retirement, savings
and the welfare state.
It is also necessary to consider whether the services,
funding and support for older people are ready and able to cope
with this major change, and the efficacy of wider public services.
The Committee will look as far ahead as 2040, but
will pay particular attention to the next 10-15 years.
We invite you to contribute written evidence to this
inquiry by 1st September 2012.
The scope of the inquiry is wide-ranging, so respondents
should select from the issues below according to interest and
expertise.
The Committee is exploring the implications of an
ageing society for public services[524]
through the following six questions which it considers are fundamental.
We invite you to address them.
(1) Does our culture about age and its onset
need to change, and if so, how?
(2) Do our expectations and attitudes about work,
savings, retirement and independence need to change, and if so,
how?
(3) Do the extent and nature of public services
need to change? If so, how, and how should they be paid for?
(4) Do we need to redesign and transform public
services for these challenges? If so, how?
(5) What should be done now and what practical
actions are needed?
(6) How can we stimulate national debate about
these issues?
The appendix gives some background, but respondents
should not be limited by this.
Appendix
A. What challenges will an ageing population pose?
(1) The population projections from the Office
for National Statistics show the very significant growth of the
older population, and there will be many social benefits from
this. But the OBR's recent Fiscal Sustainability Report, July
2012, forecasts a worsening fiscal deficit as a consequence. Do
these forecasts capture the challenges or underestimate them?
(2) If life expectancy rises further but healthy
or disability free life expectancy does not there will be costs
for health and social care, for state pensions and for public
sector pensions. Are these risks and costs adequately shared?
(3) Raising productivity in the NHS and in public
services generally is fundamental to coping with the immediate
fiscal challenge. Do you think it will happen? If not, what are
the implications for the coming demographic challenges?
(4) What will an ageing society be like? What
might this imply for individuals, families, and communities? What
are the implications for individuals' capacity to work longer
and live independent lives, and for productivity, competitiveness
and inequality?
(5) Do the additional fiscal deficits caused
by an ageing society, the increased demand for services and better
outcomes require a radical re-think by central and local government
and the NHS to prepare and change to address them? What should
be done?
B. What strategic choices need to be addressed?
(6) There are many benefits from an ageing population,
but growing public sector demands and a growing fiscal challenge
are consequences too. If society will not accept substantial tax
increases what are the big choices for what the state does and
what individuals do? Who should pay for what?
(7) The increasing cost of an ageing population
could put great pressure on expenditure on other priorities and
investment. Will free health services, improved social care and
decent state pensions all be affordable? What are the choices?
(8) We will be better off in the future but there
will still be a need to re-shape our expectations and our welfare
state for an ageing population. Which attitudes and expectations
need to change about our welfare state, about retirement, the
age of retirement and inheritance?
(9) Do we need greater clarity about what the
state will and will not fund for the future, and a more explicit
contract between the state and individuals? What should this be?
(10) Do the dates when the state pension age
rises reflect these coming changes? Are the risks and costs of
public sector pensions shared fairly between beneficiaries and
taxpayers?
(11) How might inter-generational fairness be
achieved? If we need to encourage younger people to save more
for their own retirement, their social care and their higher education,
can they also pay more taxes for an ageing population?
(12) How are countries with similar ageing populations
adapting?
C. What reforms to public actions are needed?
General
(13) The additional demands and fiscal challenges
caused by an ageing society, plus dissatisfaction with current
services and outcome, require all public services to change for
the better. Is this recognised, is it happening, if not what must
be done?
(14) Fundamental service re-designs may be needed.
What might be the principles behind such re-design and are there
attitudinal, structural and cultural impediments to making them
happen such as silo structures and budgets, lack of preventative
actions?
(15) Where is it important for the state to reduce
demand or transform its actions? Should we look at where expenditure
is high yet outcomes are poor such as the management of long term
conditions?
(16) Which preventive programmes are most needed?
Could new funding mechanisms such as social impact bonds make
this happen?
Older people
(17) How good are current services for older
people? Services for older people are highly fragmented and subject
to unhelpful financial incentives. What evidence is there of good
practice in resolving these issues in the UK or abroad?
(18) How should labour markets, employment law
and practices change to enable older people to work?
(19) How might government best stimulate and
regulate markets to respond to the varied risks faced by vulnerable
elderly people? What are the limits to such markets?
(20) How can public actions help extend individuals'
health and independence in older age? How can voluntary and community
actions contribute more? How should housing services change better
to support independent older living?
(21) Funding constraints have already squeezed
the resources available to private providers of long term care
and NHS geriatric care. There have been concerns about standards
in all sectors. What more should be done to improve standards
and public confidence?
D. What should be done now?
(22) Addressing these challenges requires public
debate about choices, attitudes, and expectations. How can this
happen? How can the public be stimulated to address the likelihood
that they will live longer?
(23) What should central government and local
government and the NHS be doing now to address these challenges?
(24) Changes to state priorities and efficacy
for the medium term should arguably be significant considerations
in the next public spending round. Is this happening?
The deadline for written evidence is 1 September
2012.
524 Public services are defined broadly to encompass
all publicly funded actions including welfare payments. The welfare
state itself takes about 2/3 of public expenditure net of debt
payments. Back
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