We are faced with unprecedented ageing. Those over 85 will reach 2.8 million by 2030, a doubling of present numbers. Such numbers are enough to raise panic in the Treasury, if the prevailing scenarios of cost are to be believed.
Conversely, I have always thought that we should celebrate our increased longevity as an enormous success story for society. I have been encouraged in my belief by the increasing evidence of the contribution that older people make and the progress that is being made, albeit slowly, in reducing the years we spend in ill health.
Speaking recently with media I was struck by the number of presenters who, like me, concluded that ‘we’re not really ready for this, are we?’ It is one thing to age and another to age well, but the revolution in longevity is going to completely re-structure society.
We will need new solutions, new approaches and most of all new evidence on what truly works. Simply increasing expenditure in itself is not an option because there is little evidence that much – some would say any – of what we do is cost-effective. Consider the escalating NHS budget: £43.5bn in 1988; £64bn in 1998 and a staggering £120bn (8% of GDP) in 2008 – without any corresponding reduction in demand or focus on outcomes.
The improvement in healthcare in the last fifty years must rank as one of the most impressive periods of advancement in human history. For some 2,000 years, doctors sought in vain for ‘magic bullets’ to resolve the multiple health problems of the society around them. Then, suddenly and apparently without warning, they came cascading out of the research laboratories. Antibiotics, open-heart surgery, transplants, new drugs, CAT-scans and test tube babies. All of them based on evidence. Rich, certain, empirical evidence. We have witnessed Cochrane, NICE, systematic reviews and randomised clinical trials – all of it providing a mandate of evidence on which to base policy and practice.
The same cannot be said of social or even economic policy. The quality of evaluation is variable. Evidence is weak in some areas, conversely strong in others. It is often uninformed by user experience and is too rarely directly applicable. Moreover, simply presenting evidence and expecting policy makers to act on it is unlikely to work: policy processes are complex, rarely linear or even logical. It is therefore unsurprising that policy itself can be weakly informed by evidence.
Such a situation cannot be allowed to persist. We need change. It will only be achieved by the adoption of a new paradigm, one in which the use of evidence, open dialogue between users and researchers and one which ensures that users themselves, at all levels, can access evidence which is relevant and effective. Making use of the best available evidence will mean we can deliver services which are effective, user centred and improve the lives of older people.
I welcome the initiative to deliver a Centre of Excellence on ‘Ageing Better’. Age UK is in a privileged position to influence many of these processes and we will work with others to ensure that evidence is relevant and of high quality, reaches those who need it the most, and delivers the impact we need to improve the lives of those in later life.
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