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Ageing Population

9.22 p.m.

Lord Dholakia rose to ask Her Majesty's Government what changes they expect in public policy in the new millennium as a result of the ageing population.

The noble Lord said: My Lords, I apologise to noble Lords on all sides of the House that the debate is taking place so late in the evening. The fact that noble Lords are present shows the importance of this debate.

The debate does not concern what happens to our ageing population now, but what kind of policies we should pursue in the next millennium. It would be so easy to deal with this subject on a piecemeal basis by increasing pensions a little and making a little more provision for winter fuels as part of the annual budget provision. These are welcome measures, but I think we are talking about issues that go beyond that. The debate is about developing policies and programmes so that every aspect of the ageing process is taken into account.

Britain is getting older. One does not have to look simply at your Lordships' House to confirm that. The average age in our society is steadily rising as a result of falling birth rates and increasing life expectancy. Very soon, for the first time in history, the over 65s will outnumber the under 20s. We will be the oldest society that has ever lived on earth. How will we cope with these changes?

I want today to draw attention to the Millennium Debate of the Age. My purpose is to stimulate debate on this issue in your Lordships' House. The Debate of the Age is co-ordinated by Age Concern and was launched in the spring of last year with messages of support from all three main party leaders. So it has cross-party support. It is an action-based programme which aims to raise awareness of and influence policy about the implications of an ageing society on all aspects of our lives and to encourage government, organisations and individuals to plan how to meet the challenges of the next millennium.

Sally Greengross and her staff at Age Concern should be congratulated on undertaking this initiative. Over the past year Age Concern in the Debate of the Age has held over 1,000 events and debates. It has commissioned surveys and encouraged a mass of public participation through voting brochures, an interactive website and a free phone information line. Running parallel to these mass public participation events are the largest series of citizens' juries and the Millennium Papers. I cannot recall such a massive consultation ever being undertaken by a voluntary organisation. The formal research, public reaction and feedback will culminate in recommendations for future priorities and will be published as the Agenda for the Age, ratified at the final

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debate in December 1999 and presented to government in early 2000. But we should be highlighting our concerns now.

The debate is structured around five themes: the future of health and care; values and attitudes; paying for age; the built environment; and future work and lifestyles. Let us look at some of these aspects and the work done so far. It is in everyone's interest for older people to remain healthy and independent for as long as possible. But as life expectancy increases, how do we ensure that extra years are quality years? In Britain, the majority of expenditure on health goes on people over 60. When Britain's National Health Service was created 50 years ago, few people lived beyond retirement age. Now it is not unusual to live for 25 years in retirement. However, in those 25 years elderly people will be more likely than ever to require medical treatment. Consequently, the NHS will come under ever-increasing pressure. I am sure that my noble friend Lord Clement-Jones will have something to say about that.

A MORI poll carried out in the UK for the Debate of the Age showed that the British public still strongly support the principle of free treatment. Difficult choices will have to be made. We already know a lot about how to stay healthy. Should we be doing more now to ensure that people have healthy lifestyles? If we do our best to stay healthy, should we have to pay for those who become ill because of their own irresponsibility? Medical advancements continue to conquer many ailments. Will we be so healthy that we will not need medical treatment? Or will medicine become so expensive that it will need to be rationed? What are our priorities about who should be treated? Already there is evidence that treatment is being rationed on the basis of age, so the tough decisions obviously lie ahead. Who is responsible for caring for those who cannot care for themselves--the family, the community or the state? The noble Baroness, Lady Pitkeathley, is a member of the group of experts which produced the Health and Care interim report for the Debate of the Age. I am grateful to her for highlighting such concerns.

In looking at values and attitudes, what will life be like when there are so many more older people and fewer younger ones? The challenge is to think ahead, to plan the sort of society we want to live in. There is a danger that society could become more fragmented. In the future more people will live alone. In England by 2016 there will be almost 24 million households, 23 per cent. more than in 1991. More than one in three households will consist of people living on their own. From where will our values come? Should the opinions of young people carry more weight than those of older people? Should older people make the decisions? Should people have their say whatever their age?

Is it important to be independent, or should people rely more on their families? Or should all members of a family be responsible for each other? How can older people remain connected to society? One of the options is voluntary work, with the benefits that it provides to the individual and the community. But is there a danger of voluntary work replacing paid jobs?

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Then there are "end of life" issues. In British law euthanasia and "mercy killings" are murder or manslaughter. Should people have more of a say in how they die?

We talk about paying for age. How well off shall we be in the next century? If we are to make the most of longer, healthier lives, we shall all need enough money to live on. In the next century only half the population of the United Kingdom will be working. The other half may be people who are unable to work, including children and pensioners.

Many of these are being raised by the Government in their pensions Green Paper. Should private pensions be compulsory? Who should pay for those who have not worked? What about people who will not save enough? Should it be their choice; or should government help them from the contributions of everyone else?

Is it the responsibility of government or communities, or of families, to make financial provision for people who cannot work? Should young people pay more to fund a growing number of retired people? Are today's young people putting enough money into their pensions early enough? Those are some of the questions that must be asked.

Last week, we heard the Statement repeated by the noble Baroness, Lady Hayman, on the report of the Royal Commission on long-term care. The Government have called for a national debate on the issue. The Debate of the Age is already encouraging people to think about this issue, asking how long-term care should be paid for. Should it be paid from taxes for everyone who needs it, regardless of how well-off they are? Or is that unfair on the five out of six people in the UK who will never need long-term care? What alternatives are there for financing long-term care?

There is discussion about the built environment. Buildings and roads are made to last. So it is important to plan now for how we should be building for the future. Through the Debate of the Age plans are already under way for a nationwide programme for national policy proposals on building needs for the 21st century. The issues will include many points that concern us all.

Britain will need around 5 million new homes in just 20 years. Will they be built in towns, or in the country? Where we live in the next century depends on how far we travel, to work, or to stay in touch. How do we want to travel? And how do we wish to deal with the impact on our environment?

What should new homes be like? Will it be important that houses change to meet a person's needs as that person grows older? Or shall we choose to move into homes specifically designed for different stages of life? Now is the time to think about how to make more buildings, not just houses, more accessible than they are at present.

On the matter of lifestyles, my noble friend Lord Dahrendorf chairs the study group that is looking into this issue. He has considered such matters as changes in employment; future workforce reductions; attitude to paid work; age discrimination in the workplace; and lifelong learning.

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There are concerns that we can no longer assume a job for life. The number of men who are over 50 and unemployed is alarming. Who will resource re-training at a later age in life? How shall we equip young people better with the ability to take responsibility for their own learning throughout their lives?

I hope that I have outlined the numerous issues posed by the democratic shift towards an older society. The Government will have to respond to many of those issues. Indeed, in welcoming the Debate of the Age, the Prime Minister said:


    "We have got to assess the huge impact of the changes that are all around us which are going to affect all our lives, particularly as we grow old".

I welcome the Government's establishment of the Inter-Ministerial Group examining issues across government which affect older people.

It is worth noting that many of these issues are worthy of special consideration with regard to our ethnic minority communities. On Thursday 4th March, the Debate of the Age ethnic minorities consultation programme was launched at a reception in the House of Lords. Again, I am grateful to the noble and learned Lord the Lord Chancellor for allowing the use of his premises, and also for showing his support for the issues under consideration.

All I wish to do at this point is to highlight one particular problem. By the year 2030 the number of black and ethnic minority people over 65 in the UK will have increased tenfold from 175,000 to 1.7 million. Ethnic minority elders already face challenges with access to housing, healthcare and pensions and they could increase in line with the demographic shift.

All I ask at this stage is for us to be able to identify the issues that we need to tackle in the next 20 or 30 years. I thank noble Lords.

9.35 p.m.

Lord Dahrendorf: My Lords, like my noble friend who initiated the debate, I am involved in the Debate of the Age. As he mentioned, I am chairman of a group concerned with work and lifestyles and it is in that connection that I wish to make a few brief remarks. I am glad that we are having an intimate discussion here tonight because what I want to say may well be regarded as slightly delicate in your Lordships' House: it concerns old men who have nothing to do.

In his Budget yesterday, the Chancellor of the Exchequer was evidently concerned about men who are no longer employed. He was talking about those who are 50 and older, so hardly old men, or not at least from this perspective. He pointed to the important and serious developments which we face. In 1979 12.6 per cent. of 50 to 64 year-olds were out of work. In 1999, the figure is 27.4 per cent. of those aged between 50 and 64. The Government's answer is that every effort must be made to find employment for as many of those as possible. Who would dispute that intention? The Chancellor of the Exchequer has introduced, or is about to introduce, an employment credit system which is supposed to help those in that age group who find employment.

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That is fine so far as it goes, but the problem is much larger. That is not said with any intention of being critical of the Government's progress. In 1995 the OECD published figures comparing the position of different countries. There are interesting and important differences. The figures relate not to 50 to 64 year-olds but to 55 to 64 year-olds. In the United States, 85 per cent. are employed. In Japan, it is 80 per cent. At the other extreme, in France 38 per cent in that age range are employed, and in Italy 42 per cent. As in so many respects, the United Kingdom is somewhere in the middle, though closer to the European experience. In 1995 56 per cent. of the 55 to 64 year-olds were in employment. Is the glass half full or is it half empty? In that age range 44 per cent. are not in employment.

The UK is not an extreme case, but we are talking about millions of people, not small numbers, at a time when, for a man of 50, the remaining life expectancy is 27 years. For a man of 55, it is 22 years. That raises important questions, not just in economic terms, but in human terms. In economic terms the obvious question is the contribution that can be made by these men to our wellbeing, but in human terms the question is what kind of life people aged 50 or 55, who have perhaps 25 years to live and no firm place in the scheme of things, will have.

I believe that the two obvious answers are right but not sufficient. One relates to employment and the other to an attempt to introduce legislation against age discrimination. I am favourably inclined to both, but I do not believe that either gets to the heart of the problem. One does not stop a tide of this kind by legislating against discrimination, or suddenly find jobs for people who may desire them but who may not be wanted given society's present values.

Perhaps I may pose two or three questions in this connection which concern what governments may be able to do. Age discrimination is one factor. The time has come when we must change our attitude to the retirement age. We cannot continue, either in the UK or elsewhere in Europe, to give the impression that an early retirement age is a good thing. For both the individuals concerned and society as whole it may well be desirable to move in the American direction and not insist on ever-earlier retirement but open opportunities beyond what has come to be the traditional retirement age of 65, or perhaps as early as 55 or 60.

The American experience is quite useful. It shows that people in the higher age groups do not necessarily have positions of responsibility, but they can continue to work in the context in which they have worked in the past. The field that I know best, which is perhaps the easiest to adapt to this point of view, is the academic world, in which retirement is a pretty pointless exercise. It results in the loss to universities of some of the best experience. I believe that the American example is a good one in this respect. But this is by no means confined to universities. Attitudes to retirement age need to be reconsidered, and perhaps the Government can set an example in the areas under their direct or indirect influence.

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The second matter referred to by my noble friend Lord Dholakia is the vexed and difficult question of retirement savings. On what do people live in the long period in which they are not fully involved in the world of employment? We have only just begun to find ways to encourage more effective methods of saving for that period to enable people to make sense of their lives when they reach that stage.

The third matter, also referred to by my noble friend, relates to the voluntary sector. I have considerable involvement in the voluntary sector. I am aware that we are experiencing a paradoxical reality in that those who have the most time are not necessarily those who are the most active in voluntary activities. On the contrary, it is those who have full-time jobs who are prepared to give a great deal of time to that activity. Very often it is women who are prepared to do that, not men aged 55 or 60. They are the mainstay of small and medium-sized charities, or they volunteer in other ways.

An interesting question is whether there should be a change in values, and perhaps in training, to encourage men to become carers. That is one of the obvious and greatest needs. I would not rule out a change in mood, values and lifestyles which encourages men to move in that direction. I think, for example, of our splendid and justly admired doorkeepers. When they retire, many become guides around these buildings. I have taken many student groups through the buildings and have admired the way in which the doorkeepers use their experience in order to inform others about institutions of great importance to us all. That is one example among many of what can be achieved once people are no longer in active employment.

There is a fundamental issue here. It is not for government to resolve. How do we encourage men to take a more flexible attitude to work and life, as women have had to do for some time? It is one of the reasons why there is less unemployment among young women, and why older women on the whole find it easier to cope with the predicament at which I have hinted.

I hesitate to recommend yet another government commission. After many years in which I think that we had too few commissions looking into issues, we may now have sufficient; I shall not say that we have too many. We receive plenty of reports, but if the Government were able to encourage the production of a report on those men who are and will be lost to society, I, for one, would regard that as a good idea. It might stimulate not only debate but further action in relation to an issue of considerable importance to many people.

9.47 p.m.

Lord McNair: My Lords, it may be a record in your Lordships' House that on a day of Liberal Democrat debates we now have four Liberal Democrat speakers following one another. I am pleased to speak in the debate in support of my noble friend Lord Dholakia. I have to declare an interest as one who fully anticipates that he will be intimately concerned in comparing experientially the answer that the Minister will give tonight with the way events work out in practice.

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At this stage in the debate, most of the obvious points have been made. I am not charged with winding up the debate, so I have to put forward a relevant point which has not been raised. Fortunately, I do have a contribution to our discussions which I hope your Lordships will feel is useful. I have had the good fortune to spend a little time in countries with a less technologically sophisticated culture, in which the flow of knowledge, wisdom and useful, and generally accepted advice is from the previous generation to the next generation. In those cultures, men and women acquire status and respect as they accumulate experience and years. In Britain, as in other high-tech countries, that process is reversed. As technology becomes more and more highly sought after, the importance of a lifetime's experience of human affairs appears to pale in importance and usefulness. That can only add to the feeling of exclusion which may make one's years of retirement a trial rather than a welcome relief. If one has been lucky enough to remain in full-time work until the official retirement age, the rite of passage which signals the change from a productive existence to a less purposeful one can be a painful process. In our complex economy, rites of passage often have significant economic consequences.

As chairman of the Unitax Association, what I want to say this evening has an important bearing on the economic transformation of retirement. I am always in a quandary when contributing to debates where the benefits of resource economics and Unitax would have a significant bearing on the subject under discussion, because the benefits may seem remarkable without an understanding of the mechanism which underlies what I am going to say. But this is not the time for digression into theory and I shall confine my remarks to the effect that such a change would have on the way the process of growing into older age is perceived by those experiencing it.

The Unitax mechanism, taken to its logical conclusion with a basic income or citizen's income, would provide under the present calculations a basic income of about £117 per week for every citizen from 16 years of age to the end of life. Because the burden of direct taxation has ended it also abolishes the distinction between employment and non-employment, self-employment and retirement. If noble Lords were to think about this as a new idea and ponder on the difference that it would make to the economics of ageing, it will be realised that it is definitely an idea worth considering.

At the most simple level it is obvious that this would give hugely more freedom of choice to people of all ages as to how they manage their working and leisure activities. It should also make possible a gradual reduction in working hours and make it easier to follow the advice in the wonderful poem, I suppose it was, set to music in the late 1960s called "Desiderata". The advice was,


    "Take kindly the counsel of the years Gracefully surrendering the things of youth".
I hope that I can follow that advice.

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There is another hugely important fiscal benefit to the changes I am suggesting. Our present direct tax situation has come under worried scrutiny as we face the prospect, foreshadowed by my noble friend's Question and much discussed this evening, that when my age group reaches retirement age there will be so many more of us than now relative to the number of the working population. Any change from direct to indirect taxation will transform that situation. However that is achieved--I notice my noble friend Lord Dahrendorf smiling--if one moves from direct to indirect taxation, then whoever breathes consumes. If one consumes, one contributes to the tax take.

It is so simple that it is hard to find too much to say about it. In replying to this debate, I do not expect the Minister to have much to say in detailed reply to my suggestions because I did not provide the Department of Health with advance information about Unitax and resource economics. Some basic information is now with officials. Perhaps the noble Baroness will be able to study the papers and write to me after she has studied the previous set of papers about something completely different which I passed to her the other day.

I have one suggestion to add to the point that my noble friend Lord Dholakia dwelt on in his remarks; namely, the cost of healthcare. On a number of occasions I have mentioned in your Lordships' House the question of hydrogen peroxide. I do not believe that my hair is lighter than it was because I take a teaspoonful of hydrogen peroxide every morning, when I remember, against the advice of the Medicines Control Agency. It tastes disgusting, but it is the best prophylactic measure in terms of general healthcare that anyone could possibly adopt. I guarantee that if my generation follows my example the cost of growing old to the National Health Service will be greatly reduced.

9.55 p.m.

Lord Clement-Jones: My Lords, it is not often that I have the pleasure of summing up after three noble friends have spoken, and I must be careful when doing so. I thank my noble friend Lord Dholakia for giving us the opportunity to take part in the Millennium Debate of the Age. As he and my noble friend Lord Dahrendorf said, it is an ongoing problem and important questions are being raised. But far be it from me to attempt to answer many of them. I firmly intend to stick to my last in terms of the health agenda, perhaps touching on a couple of other areas, too.

The recent Royal Commission, which is the vital starting point for the debate, laid to rest some of the more doom-laden scenarios and stated that there is no demographic time bomb. Before Christmas the noble Baroness, Lady Cumberlege, initiated a debate based on the BMJ book, Clinical Futures. It contains an excellent chapter by Professor John Grimley Evans on ageing. He is the professor of clinical geratology at Oxford University. The book contains some good quotations, such as:


    "Immortality is a minority taste, and the notion that all humanity is in pursuit of it is merely a health economist's fantasy".

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What is even more reassuring for health economists, he also states that:


    "There are good grounds for scepticism about claims that immortality or massive increases in human lifespan are within the general grasp next century".
The Department of Health can take some comfort from that!

The report of the Royal Commission was described by The Times leader as being widely off message, but I wonder whether its proposals are as radical as painted. Its basic conclusion was that public support for the genuinely catastrophic costs of care is needed. My noble friend set the scene, which is glossed by Professor Evans, but there is general agreement that costs will rise and by how much. However, there is less agreement about the significance of that. That was evidenced by the fact that there was a majority report and a dissenting report. There is general agreement that costs will rise from £11 billion to £45 billion in 2051, excluding social security costs. However, as a proportion of GDP, it appears that that will not be a huge rise; approximately 1 to 1.1 per cent. in terms of the existing system. The general view was also that the costs of carers will rise because the supply of informal carers will decrease over time. Again, that was not underpinned by the evidence to the commission.

One of the problems highlighted by the Royal Commission was the poor quality of available data--that is a very important point--particularly that underpinning assumptions about trends in health expectancy. The commission suggested that that was a prime role for the new national care commission. There are also few data about preferences; whether older people will always prefer to be at home and favour domiciliary over residential care in most cases. Anecdotally, there are clear differences of opinion and we do not have the evidence on which to base future preferences. However, we know that the role of government must be to enable choice and that that must be the starting point.

I wonder whether, given time, the Royal Commission might have reached agreement. It had a breakneck timescale within which to reach its conclusions. I agree with the statement of the dissenters that there should be no distorting ideological preference for publicly-provided over privately-provided activity, or vice versa, but I do not agree with the dissenters' conclusions drawn from that. I believe that crucial to the debate--and one can be quite objective about it--is the efficiency of universal benefits over means-tested or targeted benefits. Interestingly, I notice that in this week's Budget there was no resiling from universal benefit. Child benefit was not taxed and continues at a higher rate. I firmly agree with the Chancellor that there are considerable advantages in universal benefit.

Then again, there is the question of how efficient the NHS is as a universal service. I am rather prejudiced in favour of a universal service and I am greatly in favour of the kind of language which the Royal Commission used in terms of risk-spreading or risk-pooling, which is similar.

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We also have some of the emotional arguments, the perceived unfairness. There is a considerable difference between the way some of those with illness or a chronic disabling disease may be treated. One has to look only at the difference between the way in which cancer patients and those suffering from Alzheimer's are dealt with. There is a wide variation in the charges levelled by local authorities for home care. There is more consistency for residential care but home care is the key area.

I believe that the majority report got it right. I cannot yet speak for my party as a whole because it has not yet reached its conclusions on the matter. It is easy to characterise the majority report as speaking from the heart and the dissenters as speaking from the head. There was an attempt by the press to characterise it as such. But I believe that, by and large, the majority got it right--for example, in relation to asset disregard, the need for clear rules, the need for a contract between government and the people and between the generations. That is not just romantic language. It is extremely important that, when you start work, you should know what to expect when you retire and when you begin to need long-term care. Also, there is the whole question of personal care. It seems to me that the logic in the conclusions is right in terms of hiving off personal care and seeing that as something which should be provided universally in the same way that NHS care is provided.

Also, the question of respite for carers was not ignored. It was suggested that government support should be doubled or more than doubled from the recently announced figures in the Government's carers strategy. The report rightly picked up on the need to switch priorities towards supporting people in their own homes and adapting those homes for the use of older people. Of course it deals with the whole question of carers and services provided to those people in their own homes. That will be extremely important.

At the end of the day, it seems to me that the figure which it achieves of £1.1 billion--which is something like 1/44 of the NHS bill--is relatively modest. Yesterday we heard how public spending is coming down as a percentage of GDP. The Chancellor engaged in a bit of old-fashioned redistribution and I applaud him for that. Perhaps I may put into context the figure of £1.1 billion mentioned in the Royal Commission's report. Yesterday, the Chancellor announced £3 billion-worth of measures for older people, and that was in one Budget. In contrast, he announced that £1.7 billion is to be spent on a new computer initiative. It seems to me that the £1.1 billion suggested by the Royal Commission, when put in context, has considerable advantage for us all in the longer term. Therefore, if the Government had the will to implement the Royal Commission's recommendations in full, I am sure that they do have and will have the resources to do so.

I could talk about some of the other solutions--for example, private insurance. Those matters were referred to by the dissenters as having advantages. In particular, David Lipsey talked about the four-year care cover so that there would be a limit on the amount for which one would have to insure. It seems to me that some of those ideas are attractive but they are only for those who have

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more than moderate assets. The Royal Commission did not believe that those solutions--equity release schemes, insurance or whatever--would hit the 60 per cent. of those in longer-term care, and I agree with that.

The whole question has been raised--and I raised it on the Health Bill--of joint working and pooled budgets and whether that goes far enough. Although great detail is not gone into, there is agreement with the Health Select Committee's conclusions and I believe that the Royal Commission was influenced by the Audit Commission's report, The Coming of Age, which illustrates in detail the effect of separate health and social care management.

The commission welcomes the direction of government policy but said that the lack of "coterminosity" may hinder proper working in the future. The dissenters went further than that, which was interesting, and said it could be done via the new primary care route rather than by local authorities. That may be an attractive route and I have no particular ideological preference. But certainly the bringing together of those two strands, which I know goes further than current government thinking, is something in which we on these Benches firmly believe. At the end of the day nearly all those who have looked in detail at this issue believe that a one-stop shop is essential.

Touching briefly on the issue of discrimination, my noble friend Lord Dholakia mentioned this. We welcome many of the actions which the Government are taking: a long-term care charter, the ministerial group on old people, the better government for older people initiative, national service frameworks and so on. However, there are gaps, and we have drawn attention to them. We have drawn attention to the rationing of Aricept and to the Department of Health's own report, Not because they are old, by HAS 2000. Again, there are major points that my honourable friend in another place raised in a debate on discrimination and rationing. These issues are very important and we hope the Government will carry them forward.

Unashamedly, I have dwelt on the question of the fourth age and, as Peter Lazlett recently pointed out, that must be distinguished from the third age. My noble friend Lord Dahrendorf raised key issues relating to employment among the over 50s and the fact that they could not be dealt with merely by non-discrimination provisions or job creation. He also raised the issue of going beyond the traditional age of retirement. The Carnegie Report, which I reread in preparation for this debate, contains some very important conclusions and I very much hope that the Government will dust down that report and have a look at it again because I believe that, taken together with some of the points made by my noble friend, it contains key issues and recommendations which, if put into practice, would be of enormous significance.

10.6 p.m.

Earl Howe: My Lords, the noble Lord, Lord Dholakia, is to be congratulated for bringing such a broad and fascinating subject to the Order Paper this

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evening. We have heard from all the contributors but perhaps especially from the noble Lord, Lord Dholakia, himself, how broad and multi-faceted a subject it is. That is why I shall not attempt in summing up to distil what has been said into a neat portmanteau-type summary. I shall leave that to the more expert skills of the Minister, but what I can do is to pick up some of the themes that have been raised in the debate which to me carry a particular resonance.

The starting point for the Question raised by the noble Lord, Lord Dholakia, is of course demography. For governments whose chief and quite proper concern is to plan for the short and medium term--typically a five-year time-frame--it does no harm to focus exclusively for once in a while on more distant horizons. In asking the kinds of questions posed by the noble Lord, Lord Dholakia, we can at least hold on to one reasonably firm framework of predictable fact; namely, the trends in general population growth and the likely patterns in the growth and shrinkage of different age groups.

It is possible to say now with a fair degree of certainty what those patterns will look like in 2020 or in 2035. However, as we have heard this evening, once we start addressing within that broad framework some of the particular issues which most concern government day-to-day--health needs, housing requirements, transport networks and so on--we find ourselves beset by a whole host of variables: so many variables that the marginal benefits of spending departmental time gazing into the very distant future become less and less evident. That is not to say that we should not be doing it at all; only that we should be aware of the limitations of such an exercise in terms of its usefulness to policy making today.

That feeling came over to me very strongly in reading the report of the Royal Commission on Long-term Care. We know roughly how many people over 65 there will be in 30 years' time, but we do not know how unhealthy they will be. We do not know the extent to which changes in society will increase or reduce the availability of informal unpaid care from families or relatives and we do not know what paid care will cost. We can of course carry out sensitivity analyses, as the Royal Commission did, to show the effects of different assumptions in the key determinates. But the range of those assumptions is so great that what the commission's report refers to as "the funnel of doubt" rapidly begins to resemble one of those brass horns on an old phonograph.

That is why I have some sympathy with the commission in one of its main recommendations, which is the establishment of a national care commission, the remit of which would include the job of updating the projections of long-term care need in the light of changing circumstances. I am not entirely certain why that task should be thought to warrant the setting up of a brand-new, purpose-built body when it could as readily be carried out by an interdepartmental committee of officials. However, there is absolutely no doubt that these matters need regular scrutiny and review.

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However, it would be a mistake to think that there are no areas of public policy-making in 1999 which have a bearing on the way the world will be in 2049. In environmental policy, one need think only of greenhouse gas emissions. With long-term care, just because one needs to monitor and update the projections every few years in the light of new data does not mean that very long-term influences are not also at play. Perhaps the most obvious example of such an influence is preventive medicine. I am not thinking particularly of hydrogen peroxide, with respect to the noble Lord, Lord McNair. A dental technician at this week's RCN Congress referred to cigarette smoking as "slow suicide". The success of an anti-smoking campaign today will yield huge benefits long into the future. In general, the more we can build up awareness now of what a healthy lifestyle actually means, the more healthy our elderly population will be in the years to come.

Nutritional advice--always seen as the classic manifestation of the nanny state--is nevertheless very important when we consider the increasing trend towards the consumption of processed and fast foods. I have nothing against processed foods, but the fact is that some of them contain a great deal of sugar, and others contain a great deal of salt. We need to be generally more aware of what levels of those substances we are ingesting.

The mention of greater awareness leads me to an area to which the noble Lord, Lord Dholakia, referred and on which we touch regularly in our debates on health matters. I refer to rationing. As I visit hospitals, doctors regularly say to me, "If only politicians would be more honest with us about the rationing of care instead of sweeping this issue under the carpet". Perhaps my biggest worry over the new national institute for clinical excellence and the commission for health improvement is that they will act as covert mechanisms for the rationing of healthcare. I should naturally like to think that that is not their primary purpose, but I fear that it will almost certainly be one of their effects.

The three hurdles of safety, quality and efficacy which a new drug treatment has to surmount is now to be joined by a fourth hurdle--that of cost-effectiveness. That hurdle, when combined with an adherence to the fashionable principles of evidence-based medicine, is bound to mean a curtailment of the availability of new treatments. But that curtailment will not necessarily be apparent to the patient and, when it is, it will be the doctor who will appear to be the author of what is actually a politically-driven decision.

If we accept, as I believe that we must, that the demand for healthcare in this country will continue to rise in the years ahead, we owe it to ourselves to have an open and inclusive debate on what treatments are and are not affordable. That debate should not be conducted behind closed doors in Whitehall, because the result of that, as the recent case of Viagra shows all too clearly, tends to be an arbitrary fudge that makes little clinical sense.

The question of affordability brings us back to one of the most important parts of public policy-making. I refer to the management of the economy. If I were to identify

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one of the weaker aspects of the report by the Royal Commission on Long-term Care, it is the rather skimpy treatment that it gives to the need for sound economic management as a means of ensuring that its proposals are affordable in the long term. The report contains some rather blithe assumptions about the growth in GDP over the next 50 years and about higher industrial productivity. Yet the stark truth is that, whereas in 1999 there are nearly four people of working age for every pensioner, the equivalent figure in 2040 will be only two, and the number of pensioners will almost double. That may lead us to reflect on what the noble Lord, Lord Dahrendorf, was saying about the age of retirement, but it also has serious implications for the cost of care.

While the commission's main report projects an increase in personal care costs that it deems affordable to the public purse, the minority report takes issue with that conclusion and the assumptions underpinning it. As the minority report emphasises, small changes in the assumptions can make a big difference to the end cost, so enlarging the "funnel of doubt" even further.

Those factors are extremely important for policy makers because the potential sums of money involved are large. But it is important for another reason as well. One of the main criticisms of the current system, as mentioned by the noble Lord, Lord Clement-Jones, is that people cannot plan ahead with certainty because the availability and quality of long-term care facilities is patchy depending on where one lives. Many people are not in a position to know clearly what they are entitled to in their old age. I suggest that it should be one of the Government's objectives to eliminate that uncertainty in whatever response they make to the commission's recommendations. If free personal care is to be made universally available, then that must be a clear long-term pledge from government. To make such a pledge with conviction, the Government need to be satisfied that, over the long term, it is affordable from the projected growth in national wealth.

If we on this side of the House have a concern about the Government's macro-economic policy, it is that they are making that necessary growth in national wealth less and not more likely. The thrust of the past three Budgets, including yesterday's, has been to increase significantly the tax burden on business. That is not the way to maintain either inward investment or the UK's international competitiveness. The UK is a low-cost--though not a low-wage--economy. The more the Government load British business with additional social costs (as I am afraid they have done by signing up to the Social Chapter and accepting the working time directive) the less competitive we shall be and the more we shall struggle to maintain our flexible labour market which underpins job creation, the importance of which the noble Lord, Lord Dahrendorf, reminded us.

Simultaneously, the Government's decision to tax savings and pensions is already resulting in a fall in the savings ratio--a predicted 7.5 per cent. this year compared with 10 per cent. when Labour came to office. That is not the way to ensure that men and women of

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working age are able to support themselves in the future, once they become pensioners. And the radical reform of pensions that we were promised has not yet come about.

But I want to end on a positive note. The fact that we are able to look forward to greater numbers of elderly people in this country is something which we should celebrate and be proud of. I pay tribute to Age Concern, which has been in touch with me about this debate and whose work in improving the lives of elderly people and raising issues of importance to the elderly is to be wholeheartedly applauded. My noble friend Lady Carnegy, had she been able to take part in this debate, would have wished to hand out similar bouquets to Age Concern (Scotland).

It is time to stop classifying the elderly as a burden on society and time to emphasise instead the contribution that the older generation makes to the economic, cultural and spiritual life of this country. As Age Concern emphasised, it is grandparents who are childminders for the working generation, carers for their peer group and counsellors to young adults--all for free. It is right and proper that public policy should value the older generation appropriately and work consistently towards the quality of life and living standards that our society has a duty to provide.

10.19 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Hayman): My Lords, the noble Lord, Lord Dholakia, has instigated a debate which has been fascinating, though short. It has ranged very wide. I believe that the House will understand if I do not follow the noble Earl, Lord Howe, through some of the issues of macro-economic policy arising form yesterday's Budget and the Government's management of the economy overall. Nevertheless, it was an important issue to raise, especially in this United Nations Year of Older Persons. I agree with the noble Earl that it is important to have the opportunity to take a longer term perspective which has been offered to us tonight than the normal time span of a politician, which was recently characterised to me as that of an intellectually challenged goldfish.

It is valuable to step back and look at the issues, although I must say that I had not perhaps characterised them as the noble Lord, Lord Dahrendorf, did tonight. I always knew that we had a problem with young men with time on their hands, but the idea that older men with time on their hands were also a problem was a new one to me. A little later in my response I may go slightly off message and talk more about the flexibilities and the gender differences involved because they are most interesting.

However, I return to the point at which the noble Lord, Lord Dholakia, started. The Government are also grateful to Age Concern for initiating the Millennium Debate of the Age to raise awareness about ageing among the entire population of this country. That is most important; indeed, it is an issue which is too important to be left to the elderly, if I may put it that way. It is of interest and of significance to the whole population.

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As has been pointed out many times in tonight's debate, people are living longer and older people make up, and will make up, an increasing percentage of the population. By the year 2031 we estimate that 42 per cent. of the country will be over 50, 23 per cent. will be over retirement age and 6 per cent. will be over 80. However, it is important to make the point made by the noble Lord, Lord Clement Jones, namely, that gloomy talk of a demographic timebomb is not justified. Two authoritative pieces of work, the Royal Commission's report, published last week, and the pensions Green Paper, make clear that there is no need to be so dismal about the possibilities of rising as a society to the challenges which will undoubtedly be posed by those demographic changes.

In his foreword to our document Building a Better Britain for Older People, the Prime Minister said;


    "Among the greatest achievements of this century has been the increase in life expectancy. We can now look forward to many more years of healthy active life. But society has not kept up with this change ... This Government's goal is to build a country where all are valued and where everyone, young and old, can play their full part".

As has been said tonight, we need to recognise the significance of more older people with a lifetime of skills and experiences, who are more active and keen to continue a productive life. We also need to recognise that older people will have more disposable income and will become a powerful consumer force in their own right. Similarly, we need to recognise that the structure of the elderly population will also change; in other words, there will be more single older people, many of whom will be living alone. As the noble Lord rightly pointed out, that has implications for planning policies and for the built environment. It has implications, too, for transport policies. Moreover, we must recognise that there will be more older people from black and ethnic minority groups and the needs of that particular group of elders must be considered.

Perhaps I may put it in the context outlined by the noble Lord, Lord Dahrendorf. We will see a generation of elderly women who are less dependent in many ways, both financially and in terms of their social experience, than was the case with the generations of elderly women who lived on their own in the past. So we must also consider that change.

In all this there are many uncertainties, as has been pointed out. However, the Government have an important role both in changing people's perceptions about ageing and in identifying and helping remove the barriers that stop older people fulfilling their potential. Following the early work of the Inter-Ministerial Group on Older People--I am grateful for the welcome that has been given to that today--we published a consultation document, Building a Better Britain for Older People, in November. This brings together the different strands of the Government's overall strategy. Many individual departments have made their own significant announcements in the past year or so.

The older volunteers initiative aims to increase the quality and quantity of opportunities across England for older people to volunteer. That is an important role that we need to consider alongside the possibilities mentioned by the noble Lord, Lord Dahrendorf, of

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extending paid employment. We need to ensure that people have a role and make a contribution. That may not be exactly the same as the role and contribution they make while in full-time employment.

As regards crime reduction strategies, it has been made clear to local authorities that they need to involve older people specifically in drawing up those strategies. The "Foresight" programme over the next two years will consider the changing age structure, particularly in terms of its social and commercial interface, and some of the possibilities and implications of developments in information technology. That is an interesting area. I understand that the fastest growing group of people using the Internet comprises the over-60s. Interesting possibilities are offered by information technology.

As has been mentioned, we have already consulted on the code of conduct on age discrimination in employment. As announced in yesterday's Budget we shall introduce a New Deal to help the over-50s get back into work. Yesterday's Budget also included measures which will benefit pensioners now, such as the new higher winter fuel payments which will provide much needed help to around 10 million pensioners.

The noble Lord, Lord Dholakia, pointed out that many of the issues which relate to elderly people have particular health aspects. I wish to endorse the attitude that has been put forward that we are not just talking here about health in terms of services but also about health overall. Investment now in children's fitness and in effective anti-smoking measures for young people--the noble Earl, Lord Howe, referred to this--will pay dividends in future generations in terms of the health of the elderly.

I say to the noble Lord, Lord McNair, that I shall certainly read his comments and consider the document he mentioned. I do not undertake to follow his example with regard to hydrogen peroxide. My hair seems to be turning white perfectly well through the natural ageing process and ministerial office. I am not sure that the Chief Medical Officer would endorse the approach the noble Lord mentioned.

We should consider not just health and the importance of improving health for the individual and society in the future, but also the other initiatives. The NHS and social services White Papers, among many other important proposals, aim to break down the barriers between health and social services as regards the care of the elderly and promote better commissioning of social services which are more individually tailored to users, particularly those from ethnic minorities. The need for services to be culturally sensitive was recognised in the Royal Commission report.

The national priorities guidance gives priority to helping adults achieve and sustain maximum independence. The national service framework for older people will set national standards and define service models, put in place strategies to support implementation and establish performance measures and tackle some of those areas regarding access to services about which concern has been expressed.

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In addition, the long-term care charter will be a framework for informing the setting of local standards by authorities, giving users and carers ideas about what local standards might be. Discussions have been held with users, carers, professional bodies, voluntary organisations and statutory agencies about the possible details of the charter and a draft is now being prepared for formal consultation. The National Strategy for Carers is important. Not only do carers look after elderly people but we should not forget that more than a quarter of carers are themselves over 65.

As far as concerns the United Nations Year of Older Persons, we will have a programme of work based on three key themes. One is on active ageing. This will focus on practical measures to help older people to remain active through work, volunteering, mentoring and supporting families. That reflects some of the flexibility to which the noble Lord, Lord Dahrendorf, referred. It is interesting how inactivity in old age has never been considered a social problem for women but it has been for men, even though women retire earlier and live longer. In the same way, generations of women, when working patterns were different, did not need paid employment to define their role in society. There are interesting compare and contrast issues between the sexes.

On care, we need to follow up the Royal Commission report and ensure that the debate it stimulates provides a way of ensuring that people have access to high quality long-term care that is fair both to individuals and to the taxpayer. I agree that what elderly people seek second

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only to good health is financial security and certainty--that ability to plan ahead. That is what the Government are seeking to deliver through the debate based on the Royal Commission's report.

On consultation and involvement, we can only make the most of an ageing society with the involvement of older people themselves. We want a strong public voice in health and healthcare decision-making. We must include those individuals and groups who have traditionally been more difficult to reach; for example, older people and black and ethnic minority groups. If we are to provide a health service that is effective and suitable for meeting needs, we have to ensure that groups like older people who make most use of it are properly consulted.

Across government we are looking at how we can best involve older people in influencing government locally, regionally and nationally. The Better Government for Older People programme is working with local people and local service providers to find out what services they need and how those can best be provided. The Cabinet Office-led programme is already focusing on listening and responding to the voices of older people at a local level, stimulating good practice that can be spread through local government.

I, too, will conclude on an optimistic note, and perhaps most aptly, with the Prime Minister's words in Building a Better Britain for Older People. He said:


    "Our population is getting older and is set to get older still. This is not a burden, as often painted, but an opportunity. The task of this Government is to make sure we all seize this opportunity".

        House adjourned at twenty-seven minutes before eleven o'clock.


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