Читать книгу The Moral State We’re In - Julia Neuberger - Страница 7

Terrible though the problem of poverty is for many older people, and disastrous though some parts of our pensions system have turned out to be, particularly for those whose company pensions have simply disappeared, the main focus of this chapter is not older people in general. For the majority of the relatively young ‘older people’-the Third Agers, up to 75 or 80-life tends to be quite pleasant, reasonably financially stable, and, until ill health sets in, fun. There is much to be written about this age group and its changing expectations, and our own, as working longer seems likely to be the norm in order to fund future pensions.

But for a particular group amongst the elderly, life is very different: the very old, the very frail, people who need continual care of one kind or another. Much of the media’s attention has focused either on older people who make up the bulk of patients in any NHS ward-especially those amongst them who do not need to be there and who are termed, unflatteringly and unfairly, bed blockers-or on those who have Alzheimer’s disease and other forms of dementia. But the majority of very frail older people are neither bed blockers nor people with dementia, yet they need our support and respect.

So who are they? There were some 737,000 people between the ages of 85 and 89 in the UK in mid 2002,* and a further 387,000 aged 90 and over. That’s over a million people over 85, and growing. The total population of England and Wales is only expected to grow by 8 per cent between 1991 and 2031, whilst of those aged 85+ it will have grown by 138 per cent. So the so-called dependency ratio will escalate. By 2031 there will be 79 dependants for every 100 of working age. This is expensive, and new. It is costly for both pension provision and healthcare, for the over-85s already cost the health and community services five times as much as those aged 5-64. Some 10 per cent of all hospital and community health resources are spent on people of age 85 and over.^† The impact on families will be huge. The State is unlikely to be able to provide the full costs of care. The implications for families, and for the individuals themselves, are colossal.

It is a vast change, and we have not kept pace with the changes it demands of us, either ethically or politically. The ‘time bomb’ argument was very fashionable in the late 1980s and the 1990s, and still rears its ugly head, despite the fact that people are now more worried by growing suspicion that our increasing longevity has only resulted in pushing the period of frailty to a later age. Indeed, it may be that by increasing our calendar age we are imposing upon ourselves a longer period of frailty and dependence than hitherto. We are certainly seeing an increase in the numbers of people with Alzheimer’s disease, and the Alzheimer’s Society suggests that there will be around 840,000 people with Alzheimer’s in the UK by 2010, rising to more than 1.5 million by 2050. This echoes US figures, where the Rush Institute for Healthy Aging claims that more than 13 million Americans will have Alzheimer’s by the middle of the 21st century.*

cases?’ Community Care (2003).

Whilst demographic predictions have been wrong before, the increase is certainly taking place and the theory that longevity may not always give one a healthier old age is beginning to look worth examining. However, others argue that the high-dependency period, particularly in terms of NHS hospital use, has simply shifted to an older age and is still roughly parallel with previous experience, being the last three years of life at whatever age.^† But it also has to be said that since 1969 admissions of people over 64 to NHS beds has quadrupled, whilst for the rest of the population they have barely doubled. It is not clear how much of this is to do with more recent technology-cataract surgery and hip replacements, for instance-and how much to do with the longer term disabling conditions for which there is no ‘quick fix’.

There are also many who argue that concern about the ageing of our society carries heavy ideological baggage-precisely the people who believe we cannot afford welfare support for the frail and needy. If we have more elderly people, frailer and more dependent, then somehow we will have to provide welfare support for them if they cannot provide it for themselves; and that, for those who wish to draw back the provisions of the State, is a highly unsatisfactory situation.

This is perhaps best expressed by the author Phil Mullan in his excellent book The Imaginary Timebomb. Mullan argues that the preoccupation with ageing has little or nothing to do with demography in itself but is much more to do with ideology–in this case, the curbing of the welfare state. He also argues–as does Frank Furedi in his excellent introduction–that the ‘problematization’ of older people coincides with ‘the tendency to marginalize the elderly from the labour market and from society at large’. The real problem, according to this argument, is not that there are not enough younger people working to support a growing population of older people, but that older people still find it hard to find employment. In the late 1970s and early 1980s, the employment rate of older male workers declined sharply. These rates have improved slightly in recent years, but they are still below the employment rates seen in the 1960s.*

The argument here is that it is the shortening of the period of working life that is likely to be the cause of difficulties, in financial terms, rather than demography per se. There is plenty of evidence to support this theory. The Chartered Institute of Personnel and Development (CIPD) surveyed its members, arguing that Europe’s population would age faster than almost anywhere in the world, and found that two out of every five workers felt they had been discriminated against on the basis of age. Older people are seen as doddery and out of touch, whilst the young are seen as immature and unreliable. In looking at the data, Patrick Grattan, Chief Executive of the Third Age Employment Network, identified the media, fast-moving information technology, financial services, and manufacturing as industries that have yet to embrace an equal age policy.* Mike Saunders, the 66-year-old owner of an employment agency entitled Wrinklies Direct, argues that older people also sometimes lack the right attitude at interview, arguing that ‘They have to sell their experience; they have to stand up against the young and be counted.’ There is cynicism amongst employers, too. Older workers in traditional sectors like banking tend to have built up expensive employment rights, such as increments and pension entitlements. By making people redundant early, firms save themselves a lot of money.^† Nor are government schemes particularly effective: ‘New Deal 50+’, launched in 2000, is open only to those already on benefits, rather than to all those over 50 who are finding it hard to get new jobs.^‡ Even more significantly, Mullan argues convincingly that the fear of the demographic time bomb, rather than its actuality, is what promotes insecurity and a lack of inter-generational trust. If older people cannot trust the next generation down to look after them when they are frail and dependent, an increasingly individuated way of caring for oneself will develop. Meanwhile, if the next generation down fears that the older generation will consume all the assets of the family or the state, then respect and care are likely also to be in short supply. This truly is a vicious circle, and Mullan is on to something when he points to the fear of the demographic time bomb as an example of the generalized lack of trust between individuals in our society, particularly between the generations.

So the responses to this apparent demographic threat are many and numerous. Some say that this supposed time bomb is not all it seems because the UK will be importing a huge amount of labour from overseas to carry out the caring jobs and to feed our economic growth. According to this argument, the panic is unreasonable, we should stop worrying and simply get on with providing better care for very frail older people. At the other extreme is the enormous change in attitude, both in younger and older people, towards the euthanasia argument.