The Rt Hon Alan Johnson MP Secretary of State for Health (2007-2009)

THE AGE OF OPPORTUNITY?

Speech by the Rt Hon Alan Johnson MP, 7 April 2009, Secretary of State for Health (2007-09), at the Age Concern/Help the Aged Conference.

In this century and the last, both Age Concern and Help the Aged have been relentless in campaigning for a better society.

With this merger, you will provide an even more powerful voice for what I believe will be an age of opportunity for those whose interests you have so skillfully advanced.

The dramatic increase in life expectancy over the last 60 years has challenged traditional concepts of old age.

A 65-year-old man today can expect another 17 years of active life. A 65-year-old woman can expect another 20. They will spend most of those years in good health.

When the state pension was first introduced by Lloyd George in 1908, the pension age was set at 70. Given that life expectancy then was 49 for men and 52 for women, even this act of Liberal generosity would only have benefited the lucky few who would live long enough to be considered too old to work.

By 1948, the proportion of people of pensionable age had risen from 6 per cent to 13 per cent. It was then that the post-war Labour government went even further than William Beveridge’s proposals to radically overhaul the system.

Jim Griffiths, Minister for National Insurance, rejected Beveridge’s proposal to gradually phase in the increases to the state pension, insisting that they should be paid in full within three months of the bill becoming law.

It was unacceptable to him that those who had survived the First World War, endured the indignities of the depression and stood firm in the nation’s hour of need during the Second World War should have to wait 20 years for the increased payments to be implemented in full as Beveridge originally suggested.

In those days, of course, the payments at 60 for women and 65 for men were called the old age pension. And it was certainly true that for most, turning 65 marked not the beginning of old age but the beginning of the end. In 1948, Attlee’s cabinet — whose oldest member was 61, pipped by Jack Straw in today’s cabinet, who is a vigorous 62 — were looking increasingly physically frail and, according to Herbert Morrison’s biographers, Bernard Donoughue and George Jones, “gossiped about their health like old village women”.

Griffiths and the other architects of the modern welfare state could never have been so imbued with self-belief to have anticipated the dramatic rise in life expectancy in the first 60 years of the welfare state — that there would be more pensioners than children and that one in four children born today would live to be 100.

The fact that most people live longer and spend more years in better health is clearly a cause for celebration rather than consternation. But it nevertheless poses serious problems for our society and our economy.

The most profound is the so-called dependency ratios. Whereas at the beginning of the last century, there were seven working people for every retiree, there are now around three today and, on current trends, by 2050 there will be two.

So if we do nothing to buck the trend, in 40 years time a society with a pay-as-you-go system of pensions and national insurance will have two people working for every person who is retired.

That is why, of course, the whole concept of a normal retirement age must eventually be consigned to history, along with depressing stereotypes such as Philip Larkin’s “palsied old step-takers”, in his poem, Toads Revisited.

But Larkin, the great miserabilist, dreaded the aching loneliness that could come with old age, talking of pensioners whiling away their remaining years sitting on park benches with “nowhere to go but indoors, no friends but empty chairs”. That can still be the sad reality for many older people today.

While the ‘One Voice’ report published by Age Concern and Help the Aged rightly highlights the challenges that many older people face, I hope that even our most vehement critic would accept that there have been substantial improvements in the lives of older people over the last 12 years.

Since 1997, average pensioner income from the state has risen by 25 per cent (7 per cent in real terms) — more than the rise in earnings over the last decade. A million pensioners have been lifted out of abject poverty.

The introduction of the winter fuel allowance has helped older people to keep warm and well during the colder months.

The transformation of the NHS — an end to long waits, improvements in access to primary care, reduced infection rates, an increased focus on dignity and respect — has particularly affected older people.

As more and more people spend their 60s and 70s in good health, they expect more from the services they access and more from life.

In terms of their leisure time, people in their 60s and 70s are more likely to be riding a mountain bike than playing dominoes in their local day centre. Or going to music festivals — not as spectators but as performers.

Shirley Bassey was 70 when she recently played Glastonbury. Leonard Cohen was 74, Neil Diamond 67 and Iggy Pop a relative junior at 61.

As Betty Davis once said, “Old age is no place for sissies”.

But the most profound change is in the world of work. People’s contribution to their communities and to the economy does not stop when they turn 65. The over 50s account for 80 per cent of national wealth and 40 per cent of consumer spending. They make up the majority of carers and two-thirds of all volunteers.

Our ageing society presents a golden opportunity. The only challenge is how to ensure that we maximise its huge potential to build a better future.

While the facts about ageing have changed, the fiction remains. And attitudes towards older people are firmly stuck in the past. As the One Voice report cites, over two-thirds of older people say that once you reach a certain age people treat you like a child. Nearly a third say that health professionals see them as a nuisance.

This is despite the fact that research has shown that workers over 55 adapt better to change than younger employees and are happier to take on new tasks or projects.

Too often, it is tacitly assumed that advice on diet, alcohol and help to stop smoking is of little use once people reach a certain age.

And, as last week’s report by the Healthcare Commission points out, despite the fact that one in four older people suffer from depression, too often they find it extremely difficult to access psychological therapies and other treatment — their symptoms are downplayed rather than addressed.

It is estimated that two-thirds of people with dementia are never diagnosed, at least in part because their symptoms are often dismissed as an inevitable consequence of old age.

As the NHS Constitution launched in January makes clear, the NHS should provide a comprehensive service to all irrespective of gender, age, race, disability or sexual orientation. No patient should be discriminated against, or because of, their age.

The forthcoming ageing strategy will set out the actions that we will take across government not only to improve services for older people but also to capitalise on the opportunity that a longer living, healthier population presents. And the Equality Bill, which will be introduced to Parliament shortly, will strengthen and extend protection against age discrimination.

We all want change to happen instantly, but we all know that truly ending age discrimination in the NHS and social care, not just legislatively but actually, will take time. This is not only an issue of resources, commissioning and access to services, it is also about the attitudes I spoke about earlier.

When older people talk about poor quality services, they talk about not being listened to, about being talked down to, about health and care professionals who read the age rather than see the person. So the support available for some older people with long-term mental health problems is defined not by their condition, from which they might have been suffering from for many years, but the fact that they’re over 65.

So there are complex issues to be resolved if we are to meet our joint objective of ending age discrimination in health and social care as quickly as possible.

I have asked Sir Ian Carruthers, Chief Executive of South West strategic health authority and Jan Ormondroyd, Chief Executive of Bristol City Council, to lead an in-depth review of how the NHS and local authorities can effectively tackle discrimination against older people.

The review will be supported by the Age Equality Advisory Group, which I have asked John Dixon, President of the Association of Directors of Adult Social Services, to chair jointly with Sir Ian. Their findings will enable all strategic health and local authorities to begin the work of ending age discrimination once and for all.

Let me turn now to the reform of adult social care, where Help the Aged and Age Concern have played such a productive and crucial role. When politicians talk about reforming public services, the valid complaint is often made that we only ever talk about schools and hospitals.

The more intangible, less easily encapsulated work of care services, which is diffuse by its nature, rather than being institutionalised in public buildings such as schools or hospitals, remains below the radar.

But the future of social care is, in my view, the biggest political problem of the next 10 years. That is not to deny that there have been notable improvements, or that those often undervalued people who work in the sector are making heroic efforts to raise standards.

Funding for adult social care has increased by 50 per cent in real terms since 1997.

Putting People First — a unique partnership between local and central government and the voluntary sector — is delivering greater choice and enabling more older people with care needs to maintain their independence.

Preventative programmes like POPPs (the Partnerships for Older People Projects), which are operating in 29 pilot locations, are improving older people’s quality of life and cutting long-term costs by, for example, targeting older people at risk of falls.

There’s a much greater focus on integrating health and social care, so support for people with multiple care and health needs is more co-ordinated and easier to navigate.

I sometimes worry, as you must, about the terminology used in this debate. Personalisation, for instance, can sound like meaningless jargon dreamt up by the sultans of spin. But anyone who has seen the incredible power of personal budgets will know that the terminology is far too prosaic.

It doesn’t describe how the life of the carer whose husband is blind and has Alzheimer’s has been transformed, because she can use direct payments for respite care and to get help with household chores, or the 92-year-old teacher, who is passionate about her work and still wants to be involved in teacher training. This she is able to do whilst living in her own home using her personal budget to pay for daily support from a carer, who she has recruited herself.

There are thousands of inspirational stories demonstrating how these changes have been revolutionary. But they do not alter the simple and inescapable fact that, in general, the current social care system is inconsistent, incoherent and no longer sustainable. The number of people suffering from dementia, which currently affects 700,000 people in the UK, will double in the next 30 years, and the number of people with care needs will rise by 1.7 million in the next two decades.

Even if the current inadequate system was to continue, there will be a funding shortfall of around £6bn by 2020.

But the question of the future of social care is about much more than how it is funded.

The last 12 years have been marked by an unrepentant aspiration to improve and invest in public services.

In our vision for the care system of the future, we need to maintain the same level of ambition.

As the 60th anniversary celebrations last year demonstrated very clearly, the NHS remains one of our most cherished national institutions. Our objective should be nothing less than a social care system that is venerated and admired around the world in the same way.

Whilst we can point to areas of our country where people receive excellent care, this is by no means true for everyone.

As many carers and older people who have developed care needs following a fall or a stroke will testify, the descent from robust health to dependence can happen with frightening rapidity.

Whereas in some parts of the country, people with care needs will get help to stay independent in their own homes, others are offered only institutionalisation — shuffled off into a care home.

Some families will find it easy to navigate the system but most will spend days, or even weeks, making endless phone calls simply to find out what they are entitled to.

So, while the question of funding is of the utmost importance, the reason we are having this debate is because we want a better care system: a system that respects people’s dignity, where people aren’t just passive recipients of whatever the local authority and primary care trust have decided to offer but have genuine choice in a service whose basic characteristics are the same, whatever their postcode.

When we publish the Green Paper later this year, it will not simply be a list of potential funding options — it must also present a vision for the kind of care system that will match and exceed the expectations of older people.

The historian Peter Hennessey described the role of the Attlee government as to “cauterize, finally, the wounds of the industrial revolution”.

The legacy of that government reaches every corner of modern life, but it is arguably most visible in our demography. Our longer lived, healthier lives are in part a product of the modern welfare state, and we owe its architects a debt of gratitude. It would be a terrible injustice if we were to repay this debt with resigned toleration rather than active celebration of our ageing population.

We need to approach the reform of social care with the same urgency and determination and, above all, imagination of those who created the post-war consensus on welfare reform.

No responsible government can sideline this issue, or ignore it, in the vague hope that it will gently retire to the wings as previous generations of older people were expected to do.

Better care, better services and greater inclusion are not only issues important to older people, they are critical issues to the health and well-being of our society.

And they are crucial not just to establishing the age of opportunity but to recognising the opportunity of age.

Biography of the Rt Hon Alan Johnson MP, Home Secretary

He was elected to Parliament in 1997 and represents the Hull West and Hessle constituency.