Our subject had been on Ditchley’s “some time” topic list for several years. Its securing of a firm place reflected not any specific event but a mounting if imprecise sense, in public debate within most of our countries, that there was a big problem looming ahead.
The demographic projections we heard were striking enough - worldwide, an increase approaching threefold, over the next thirty years, in the numbers aged over sixty-five; among developed countries, falling birth-rates contributing over the same period to a decline in the “support” ratio - of working-age to retired people - towards 3:1 or even lower (though rates of change varied widely, with Britain for example already near that level and Japan and the United States coming to it more steeply). It was wrong to depict the increased longevity that contributed to this as a problem rather than a success, and the rate of predicted change in ratio was moreover in some countries no sharper than that accommodated in the past. The shifts nevertheless raised issues that had to be faced, especially alongside later average entry by the young into the workforce, and an uncomfortable general rise in unemployment which most Western countries had yet to master. This latter factor -which technological advance might ease as in the past, but was not certain to - underlay many of the concerns currently grouped under the “ageing populations” label. Whatever the diagnosis, however, some of the extrapolations of public financial burden, given unchanged policies, were daunting - German state costs for those beyond customary retirement age, for instance, were projected to absorb an extra five per cent of gross domestic product by 2025.
We noted the case for more upward flexibility in standard retirement age expectation, and, perhaps also for some gradation of pension to maintain work-finding incentive in the earlier years following customary retirement from “main” careers. We noted also that some common labour-market practices were scarcely calculated to ease the problems; redundancy schemes which gave priority to removing those least likely to find other employment - the older workers - seemed perverse on a long and society-wide view, understandable though they might be given pay structures which made these the most expensive employees almost regardless of productivity. We were tolerably sure that it was mistaken to suppose, as a general proposition (“the lump of labour” fallacy), that correspondingly more work would be left available in the economy for younger workers; again, however, we accepted that trade-off in particular situations might be undeniable.
The theme recurred powerfully throughout our discussions that our societies needed to accelerate and reinforce the trend in perceptions - including, not least, the perceptions of older individuals themselves – away from the notion that the years after customary retirement age were a time of decline and likely dependency. That notion diverged increasingly from reality as life spans, and health during them, improved; it tended to marginalise and devalue a key component of human life. There was both economic and social need to foster the concept of the years after sixty as holding opportunity for continued contribution (not merely activity) and fulfilment, for using the resource which older people constituted and for imparting a sense of dignity, independence and choice. Beyond that, we were sure that society (and the vocabulary it habitually used) needed to view the post-retirement phase both more positively - stressing continued competence rather than limitation and taking sensible practical steps (as over kerb heights) to reduce avoidable limitation - and less rigidly - recognising that calendar age was an increasingly poor proxy for effective capability.
We found it easier to say all this in general terms than to identify concrete operational ways of making change happen. We judged that greater flexibility in remuneration patterns could play a part, and that there might be especially valuable roles for older people as experienced helpers, facilitators and carers for the young, for example in schools. We saw merit in the widespread provision of advice on how to stay healthy, and in reinforcing the availability - which sometimes ceased on retirement - of facilities to help in that. Almost all of us were minded to think that legislation against age-based discrimination, though its effects might be limited, had a valuable part to play both in practical terms and as a declaration of society’s attitudes. It was suggested that in logic this should be partnered by an end to automatic age-based concessions, as for example in Britain on the cost of travel and medical prescriptions.
All this being acknowledged, we recognised also that there remained a range of major questions about dependence among the aged, and its costs. There was no neat correlation between age and health-care costs - these costs were heaviest in the last years of life, at whatever age, and their fast-growing scale in recent decades primarily reflected much greater take-up of medical help and the growing unit cost (amid advancing technology, though the financial consequences of that did not run exclusively upwards) of its provision. Nevertheless, the total duration of significant impairment and consequent need for support had on average increased by absolute (though not proportion-of-life) measures, especially as the numbers surviving to the middle eighties and beyond rose several-fold. There were therefore financial problems to be tackled.
Cost aside, there was a growing need to distinguish more clearly between the medicine of old age and that of acute healthcare. The medical profession was mostly not well structured, for example in multi- disciplinary terms, to reflect that distinction; moreover, though the former element was attracting good research effort there were still shortcomings in the distillation, coordination and dissemination of the fruits of that effort. Structures of care were often over-rigid and poorly matched to real need, risk and opportunity, with the dependent elderly taking up acute-care capacity when their needs - including maximising scope for rehabilitation - would be more relevantly and more economically served by more extensive convalescent or nursing-support provision. Public-financing patterns and divisions of responsibility, as in Britain, sometimes risked intensifying the mismatch by creating distorting incentives.
We paused on the provision of care in families. For all that the weakening of once-standard family structures had heightened the need for other forms of support, and that moreover longevity itself increasingly threw the domestic burden of care for the dependent elderly upon family members - especially women - themselves no longer young, the merits of maximising care in the home pointed to strengthening social esteem for the caring role, improving training and guidance for it, and perhaps increasing the scale of its economic support and incentive. There was scope for more systematic experimentation in this field, and for more analysis and dissemination of its results. We heard with interest - while recognising that paying for voluntary service was not without risks to motivation - of experiments at provincial level in Canada in making quite substantial public subvention available to encourage home care. We were at the same time inclined to agree that individuals would have to be expected in future to make fuller provision, by insurance during working life, for the costs of their own care (whatever its form) in any later years of dependence; and we accepted that in practice such an expectation might require an element of compulsion.
Pensions, we all seemed to accept, were an area where current patterns could not be generally sustained. The state could not continue to meet all expectations, even if - as in several countries now - the proportionate salience of any basic state pension continued to decline though linkage to inflation rather than to increasing national wealth. That decline might well attract opposition - as, still more, would any attempt to remove automaticity of entitlement irrespective of wealth - but governments would store up immense fiscal problems unless they sought to shift the burden increasingly towards responsible provision by the individual throughout working life. Such provision was no doubt not made easier by the significant scale of unemployment or job-insecurity; but there seemed no viable long-term alternative, even though we accepted, as a fundamental social value, that our communities could not abandon the unprovided elderly to poverty. Funded pension systems, we felt sure, must increasingly replace pay-as-you-go provision, and defined-contribution schemes defined-benefit (including final-salary-based) ones.
It was implicit throughout much of our debate that our societies would have to face the need to spread the returns earned by the individual during the main in-work period of life more evenly across the whole span, and that this amounted to an adjustment in the inter-generational balance (better seen, if possible, as trade-off between one’s own present and future than between one’s own present and that of older people). We noted an awkwardness, not readily avoidable, during any transitional period when the in-work population had to sustain both pay-as-you-go for the already-retired and funding provision for its own future retirement. This underscored the need for more thorough and more candid education of the public, especially the young, to understand the realities of through-life income. Failure in this understanding, and in timely action upon it, had already created much hardship among those leaving work; the failure, if it persisted, and the demographic prospect - especially as the post-1945 birth-boom moved into a post-retirement surge, and older people perhaps began to use their electoral leverage more coherently - could create damaging and disruptive political pressures.
But that would be the wrong note on which to end this account. Our conference, if not quite a celebration of life’s later phases, laid its main stress upon the need and the opportunity to exploit them more richly. We believed that much more could and should be done.
This Note reflects the Director's personal impressions of the conference. No participant is in any way committed to its content or expression
Chairman: The Rt Hon The Lord Jenkin of Roding PC
Chairman, Friends Provident Life Office; formerly Secretary of State for Health and Social Services
LIST OF PARTICIPANTS
BRITAIN
Mrs Terri Banks, CB
Project Director, Retirement Income Inquiry
Mr Robin Birch, CB
National Chairman, Age Concern England
Mr Donald Brereton
Under Secretary, Social Security Policy Group, Department of Social Security
Mr Clive Brooke
General Secretary, Inland Revenue Staff Federation
Lady (Sally) Greengross, OBE
Director General, Age Concern England
Sir Simon Hornby
Chairman, Lloyds Abbey Life pic
Ms Tessa Jowell, MP
Opposition Front Bench Spokesman on Women’s Issues; formerly Director, Community Care Programme, Joseph Rowntree Foundation
Ms Pamela Meadows
Director, Policy Studies Institute
Professor Peter H Millard, MD, PhD, FRCP
Head, Division of Geriatric Medicine, St George’s Hospital Medical School; President, British Geriatrics Society
Mrs Jill Munday
Directory, Reach (Voluntary work opportunities for retired business and professional people)
Sir Michael Partridge, KCB
Lately Permanent Secretary, Department of Social Security
Dr Ann Robinson
Director General, The National Association of Pension Funds
Mr Clive Smee
Chief Economic Adviser, Department of Health
Mr Donald Steele
Executive Director, Association of Retired Persons over 50
Mr David Willetts, MP
An Assistant Government Whip; formerly Director of Studies, Centre for Policy Studies
CANADA
Dr Thomas J Courchene
Janislowsky-Deutsch Professor of Economic and Financial Policy, Queen’s University, Kingston, Ontario
Mr Donald Gauer
Senior Vice President and Advisor to the Chairman, Sun Life Assurance Company of Canada
Ms Susan Peterson
Assistant Deputy Minister, Federal-Provincial Fiscal Relations and Social Policy, Department of Finance
COUNCIL OF EUROPE
Mr Robin Guthrie
Director of Social and Economic Affairs
FRANCE
Monsieur Paul Paillat
Scientific Adviser, National Foundation of Gerontology
GERMANY
Frau Stefanie Wahl
Senior Researcher, Institute for Economic and Social Research, Bonn
USA
Dr W Andrew Achenbaum
Deputy Director and Research Scientist, Institute of Gerontology, University of Michigan
Dr Elbert C Cole, ThD
Member, Board of Directors and past Chair, Forum on Religion, Spirituality and Ageing, American Society on Ageing
Mr Thomas E Donlan
Editor, Editorial Page, Barron’s National Business and Financial Weekly
Mr Craig S Karpel
Journalist and broadcaster
Professor Theodore R Marmor
Professor of Public Policy and Management and Professor of Political Science, Yale University
Professor Abraham Monk
Professor of Social Work and Chair, Field of Practice in Ageing, Columbia University School of Social Work
Ms Carol V O’Shaughnessy
Specialist in Social Legislation, Congressional Research Service, Library of Congress
Mr Arthur L (Pete) Singleton
Member, Social Security Advisory Board
Mr James T Sykes
Associate Director, Institute on Ageing, and Senior Lecturer, Department of Preventive Medicine, University of Wisconsin, Madison
Dr Lawrence H Thompson
Principal Deputy Commissioner, Social Security Administration
Dr Bernice Weston
Chairman and Chief Executive, AGEPOWER International, Inc.