Governments of advanced capitalist economies are coming to terms with a significant growth in the number of people living longer, which, combined with low birth rates adds to ageing populations. The poorest and most vulnerable are at greatest risk.
In May this year the government announced a root and branch review of how social care for older people is funded. The demand for social care support — help with dressing, washing, eating and shopping — is set to increase significantly over the next decades as the “baby boomer” generation moves into old age. Over the next 20 years the number of people, aged over 85 in England will double and nearly two million more people will need social care support. The cost of that support will rise from £12.7 billion in 2007 to £24.1billion in 2026 and £40.9 billion on 2041.
None of the options being championed as solutions to the “demographic time bomb” by various think tanks and economists include free social care provision funded by taxation. Instead there will be a greater personal and family responsibility for providing funding for old age, with a system of social insurance where individuals are obliged to insure themselves against the risks of contracting dementia and other conditions, with the state supporting only those who could not afford the premiums.
The record of New Labour in providing care and support for older people is at best a mixed one. Brown and Blair have made education and employment and NHS funding priorities for government. However, investment in social care has lagged behind other health funding, especially hospital-based treatment.
The result is, that despite the growth in the older population, the actual number of households receiving social care services has declined: from 529,000 in 1991, to 387,000 in 2001, to 346,000 in 2007. In short it is very difficult to get social care support, with three-quarters of English local authorities limiting care to people with “substantial or critical needs.”
Increasingly family members, friends neighbours and charities have to provide support — around 65% of care is provided unpaid by carers. Studies show that the support older people value most — help with cleaning, gardening, and shopping — are in short supply and are often beyond the reach of the poorest pensioners. And of course the social care sector is now largely privatised with high staff turnover and a poor record on training.
In broader terms New Labour has failed to tackle poverty and exclusion faced by millions of pensioners.
Despite the introduction of winter fuel payments, free local bus transport and Pension Credit 1.8 million, or 17% of, pensioners live in poverty, of which nearly two-thirds are women. The complex and intrusive method of claiming benefits means that one third of Pension Credit goes unclaimed.
Significant investment in the NHS by New Labour has meant that access to many treatments has increased and improved. However, investment in community services have been under funded, so that around one quarter of people over 65 living in the community have symptoms of depression, with up to 60% of older people in hospital having mental health problems or developing them during their stay.
Around 40% of older people are malnourished when admitted to hospital and 60% in hospital are at risk of becoming malnourished while they are there.
Although life expectancy continues to rise, inequalities experienced throughout life continue into old age. For example someone living in Liverpool, will, at 65 on average, live seven years less than their counterpart in Kensington and Chelsea.
Workers as well as governments have to come to terms with the effects and implications of ageing populations. Recent strike action in France and Germany, by public sector unions is the clearest sign of workers defending pension provision. The nature of pension provision in the UK, along with a lack of clear leadership by key unions, has meant a low level of activity, and awareness of these issues, particularly among younger workers, who will have to work well into their late 60s before they can claim state pension.
So old age is an emerging battleground for class struggle: layers of non-unionised, casual and low paid workers face exclusion from the benefits enjoyed by higher paid workers who pay into well funded schemes, whilst the activity of the rich, increasingly through the ownership of property, and inheritance, will stimulate new and wider inequalities.
The left should bring forward plans and proposals including:
• Increases in pensions and an end to means-testing to end pensioner poverty;
• Investment in health and social care services to meet the needs of all older people who require support and care;
• An end to the privatisation of services;
• Targeted investment to improve the quality-of-life of older people who live in the most disadvantaged communities;
• An end to attacks on pension funds, and a move back to state-funded, rather than private systems.
The left has only started to assess the impact of ageing societies on its theory and practice, and a broader discussion needs to take place about the types of movements and policies needed to defend the interests of the poor and excluded.