DOI: https://doi.org/10.58248/HS71

Overview

There has been a steady increase in life expectancy in recent decades. In 1999, around one in six people in the UK were 65 years and over (15.8%), increasing to around one in five people in 2019 (18.5%). The Office for National Statistics have projected this could rise to one in four people in the UK (23.9%) by 2039.[1] However, there has not been significant increases in healthy life expectancy at birth in the UK, or disability-free life expectancy at aged 65.[2]

Improving healthy life expectancy has been a priority for former governments[3] In 2019, Public Health England (PHE) and the Centre for Ageing Better issued a consensus statement on ‘Healthy Ageing’. The Statement (reissued in 2023 by PHE’s successor organisation Office for Health Improvement and Disparities, OHID) states a vision to make England “the best place in the world to grow old” and deliver on the 2017-2019 government’s commitment for everyone to have five extra years of healthy, independent life by 2035, and to narrow the gap between the richest and poorest.[4]

In 2024, the Independent Investigation of the NHS in England (the ‘Darzi report’) described an ageing population as the most significant driver of increased healthcare needs. This need is compounded by a reduction in public funding for social care despite the demand for it. [5]

Increasing healthy life expectancy and addressing unmet needs of ageing populations is a global challenge. The UK is a member of the United Nation’s ‘Decade of Healthy Ageing (2021-2030)’ initiative, implemented by the World Health Organisation (WHO). The global collaboration aims to improve the lives of older people and their communities through “years of concerted, catalytic and collaborative action” and shared learning between members.[6]

Challenges and opportunities

As the UK population grows and ages, rising demand for treatment, care and support, plus increasingly complex healthcare needs, are putting further pressure on the health and social care system. This is in addition to changing demands for other public services and infrastructure, such as housing, transport and employment.[7] NHS England has acknowledged that, without improving the health and social care support for older populationsit will struggle to meet the increasing demand for resources and changes to patient’s needs.

Improving the evidence base on healthy ageing may provide a greater understanding of the changing needs of the older population. The NHS intend to work with health and social care partners to: reframe frailty as a long term and preventable condition, promote proactive frailty case finding, identify and support best practice interventions for key stages for frailty, amongst other related activities.[8]

Older people are more likely to have multiple health conditions.[9] In 2015, 54% of people aged over 65 had two or more health conditions. By 2035, researchers estimate projections could rise to 67.8%.[10] Living with multiple conditions has been shown to lead to greater complexity in care, a higher risk of hospital admissions and re-admissions, longer hospital stays, delayed discharge, and lower quality of life.[11]

The previous government sought to address this challenge through a Major Conditions Strategy (2023), and a new emphasis on addressing the “multimorbidity challenge” by adapting the care the NHS delivers.[12] In the 2022 ‘Integration and innovation: working together to improve health and social care for all’ white paper, the government proposed two forms of “integration” to address an ageing population with multiple diseases: integration of services within the NHS and integration of the NHS with others, including local authorities and social care services.[13]

Experts have highlighted the need for policy interventions that support active and disease-free ageing, encourage independence in later life, maintain brain health and reduce social isolation.[14] The National Institute for Healthcare Excellence (NICE) guidelines state that local authorities and service providers should be aware of the effect poor mental wellbeing and lack of independence can have, both on an older person’s mental and physical health as well as their social interactions. NICE emphasises that, in particular, service providers should target people identified as being most at risk of a decline in their independence and mental wellbeing.[15] The WHO argues that assessing healthy ageing requires consideration of a person, and their environment.[16] Previous governments have explored the role of community support programmes for older populations, including interventions by pharmacy staff to help older people to lead more healthy and independent lives.[17] Experts in primary care have researched the potential benefits of social prescribing in improving older people’s wellbeing, for example through connecting people to local groups, and charities in the cultural sector.[18]

Stakeholders such as the WHO have emphasised the importance of leveraging other interventions and resources, which can accelerate innovation, for example digitisation, monitoring outputs and collaborative efforts (PN670).[19] [20] In 2021 the government, as part of one of its Grand Challenge missions, set out to explore how innovation could meet the needs of an ageing society.[21] For example, research into the use of the arts in the management of dementia has been identified as an opportunity for more personalised interventions.[22]

The physical locations of ageing populations in the UK has been identified as a significant challenge for policymakers.[23] Older populations are growing fastest in rural and coastal areas; in some local authorities in these regions, one in three people are aged 65 and over, compared with one in five across the country.[24] These areas are commonly the most under-served in terms of health and social care services.[25] Experts, including the Chief Medical Officer, Professor Sir Chris Whitty, have observed that, in the past, policymakers have not given enough attention to the older populations’ access to public services, including appropriate transport and housing.[26]

The UK’s older population is becoming increasingly diverse. Expert groups, including the Centre for Ageing Better, have highlighted the need for policy interventions that address the health inequalities experienced by different ethnic groups, which can become more significant in older populations.[27] The Centre also notes that diversity in sexual orientation and gender identity among older people will increase significantly in the next few years.[28]

Key uncertainties and unknowns

  • The impact of reducing waiting lists and improving discharge rates from hospitals may lead to improvements in healthy life expectancy, however the significance of these initiatives alone is unclear.
  • Demand for social care is rising and expected to continue. This is projected to lead to a significant increase in demand for social care staff. It is unclear how the provision and funding of social care in the UK will be secured.
  • Integrated Care Systems (ICS), established in 2022, are local partnerships that bring health and care organisations together to develop shared plans and joined-up services. Due to their infancy, it is unclear how health and social care will be integrated, and to what extent regional inequalities will be addressed, or will as a result.
  • The NHS Long Term Workforce Plan recognises that healthcare need has been growing significantly, driven by ageing and increasing morbidity, and outstripping the growth in workforce.[29]
  • The UK’s aging population and declining birth rate may lead to insufficient workforce and service provision. Policymakers may need to consider allocating resources and technological innovation to address this issue. This includes using collaborative approaches, for example engaging with the expertise of current the older population for future learning.

Key questions for parliament

  • Will plans to address staffing shortages in health and social care be sufficient to meet the projected demands on services due to an ageing population?
  • How can we support people to age better and live a healthier lifestyle prior to ageing?
  • What personalised care, technical and innovative interventions are required to meet the unmet needs of an increasingly diverse older population?
  • How can local resources and communities support and learn from the older populations in their own communities?
  • How prepared are government, NHS England, and Integrated Care Systems to forecast health and social care provision for an ageing population?
  • How can government address inequalities in access to age-appropriate public services by older populations?
  • Have existing policies to address health inequalities had an impact in older populations? If yes, to what extent?

Related Documents

Independent investigation of the NHS in England , A consensus on healthy ageing, Improving care for older people

References

[1] Office for National Statistics (14 January 2021), Overview of the UK population,

[2] Office for National Statistics (4 March 2022), Health state life expectancies, UK

[3] Office for Health Improvement and Disparities (1 June 2023), Understanding the drivers of healthy life expectancy: report

[4] Office for Health Improvement and Disparities (updated 10 February 2023), A consensus on healthy ageing

[5] Department of Health and Social Care (12 September 2024), Independent investigation of the NHS in England

[6] World Health Organisation, WHO’s work on the UN Decade of Healthy Ageing (2021-2030) (accessed on 11 July 2024)

[7] Age UK (11 July 2023), The State of Health and Care of Older People, 2023 (abridged). See also: Centre for Ageing Better (21 November 2023), Summary report: The State of Ageing 2023,

[8] NHS England, Improving care for older people (accessed on 15 July 2024)

[9] Kingston, A et al (24 January 2018), Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model, Age and Ageing, Volume 47, Issue 3, May 2018

[10] As above

[11] As above. See also: Marengoni, A et al (September 2011), Aging with multimorbidity: a systematic review of the literature, Ageing Research Reviews, 10(4):430-9; Salive, M (31 January 2013), Multimorbidity in Older Adults, Epidemiologic Reviews, Volume 35, Issue 1, 2013, Pages 75–83

[12] Department of Health and Social Care (updated 21 August 2023), Major conditions strategy: case for change and our strategic framework

[13] Department of Health and Social Care (11 February 2021), Integration and innovation: working together to improve health and social care for all

[14] Crocker, T et al (March 2024), Community based complex interventions to sustain independence in older people: systematic review and network meta-analysis, BMJ 2024: 384;  Sabayan, B et al (May 2023), The role of population-level preventive care for brain health in ageing, Lancet Healthy Longevity, Volume 4, Issue 6, June 2023

[15] NICE (December 2015), Older people: independence and mental wellbeing

[16] WHO (14 January 2021), Decade of healthy ageing: baseline report

[17] Public Health England (19 March 2019), Productive healthy ageing: interventions for quality of life

[18] Gorenberg, J et al (February 2023), Understanding and Improving Older People’s Well-Being through Social Prescribing Involving the Cultural Sector: Interviews from a Realist Evaluation, Journal of Applied Gerantology, Volume 42, Issue 7

[19] WHO (14 January 2021), Decade of healthy ageing: baseline report

[20] For more information, see: POSTnote, Innovation in adult social care (May 2022)

[21] Department of Business, Energy and Industrial Strategy (updated 26 January 2021), The Grand Challenge missions

[22] See, for example: Tischler V (18 September 2023), Together yet apart: Rethinking creativity and relational dementia care during the Covid-19 pandemic, Geriatric Nursing, Volume 54, Nov-Dec 2023, 99-107; Walker, N et al (February 2022), Singing and music making: physiological responses across early to later stages of dementia, Wellcome Open Research, 14:6, Schneider, J (June 2018), The Arts as a Medium for Care and Self-Care in Dementia: Arguments and Evidence, International Journal of Environmental Research and Public Health, 15:6; Government (April 2020), Evidence Summary for Policy The role of arts in improving health & wellbeing

[23] See: Whitty CJM (10 November 2023), Chief Medical Officer’s Annual Report 2023 – Health in an Ageing Society,. See also: Age UK (11 July 2023), The State of Health and Care of Older People, 2023 (abridged). See also: Centre for Ageing Better (21 November 2023), Summary report: The State of Ageing 2023,

[24] Nuffield Foundation (April 2020), Classifying the older population

[25] Whitty CJM (21 July 2021), Chief Medical Officer’s Annual Report 2021 – Health in Coastal Communities

[26] Whitty CJM (10 November 2023), Chief Medical Officer’s Annual Report 2023 – Health in an Ageing Society,

[27] Centre for Ageing Better (21 November 2023), Summary report: The State of Ageing 2023,

[28] As above

[29] NHS England (30 June 2023), NHS Long Term Workforce Plan

Horizon Scan 2024

Emerging policy issues for the next five years.