In recent weeks a lot of ink and hot air has been expended, by both pundits and politicians alike, commenting on the seemingly ever rising levels of work related sickness absence in the UK.
Most recently, leading members of the cabinet have accused people of working age of creating a ‘sick note’ culture where it is acceptable to languish on benefits at the expense of the UK tax payer. In their attempts at an analysis of the root causes of the problem, many of those engaging in the debate have alighted on simplistic solutions.
As with all ‘wicked’ challenges, however, the real reasons behind the undoubted increase in the number of people off work due to illness are complex and will be different for each person. There are a number of factors contributing to the undoubted increase. But the solutions to the issue will need to be equally complex and sustained over a longer time frame than the usual five year electoral cycle with which we are familiar in the UK. I believe that this is where a systems leadership approach to addressing such complexity could be helpful. By setting out some of the drivers of the current situation, I think you might agree that we certainly need to try a different approach.
Firstly, over seven million people are waiting in April 2024 for NHS treatment, many of whom are in late middle or early older age. Waiting months or years to be seen and treated for conditions that naturally affect many people as a part of the natural ageing process is far from ideal. If you then add in the impact on mental health of being chronically ill, you begin to understand why so many people feel trapped in a downward spiral of despair.
They are certainly not malingering and enjoying an alternative lifestyle on benefits. As we approach another mental health awareness week (13th – 19th of May 2024) it would be great to think that we could have a more honest conversation about the need to understand that ‘wellbeing’ is only possible when both physical and mental health are supported.
At least two other major drivers are in play in this situation. The one more frequently cited is the recent Covid19 pandemic. Many people who developed ‘long covid’ are still living with it. Little is known about how to treat this condition. Many of those people who have it are finding it hard to make a full recovery, with effective support being limited. The latest ONS data showed 1.3 million individuals affected to some extent or other.
Many of them have been forced to give up work, claiming benefits and/or using savings to get by. Again, languishing in the twilight zone between paid employment and retirement, is it any wonder that many have given up any hope of working again? When they do feel well enough to try to return to work, they have limited options, facing low pay and long hours in entry level jobs.
The other, more often overlooked driver is the creation, over the last couple of decades, of a large group of men and women whose retirement age has been increased to 67 (which will rise further to 68 by the 2040s) for those born after April 1960. These changes were originally intended to equalise the state retirement age for men and women to 65. However, many people who would have previously retired earlier from manual, labouring jobs, now find themselves negatively affected. Some carry on trying to work, despite this undermining their health and wellbeing.
For others, unable to continue, there is little opportunity to gain new skills and change careers. No longer able to claim their state pension until their late 60s, they are forced to use what little money they had put away in savings or private pensions to get by. Throw in the impact of the cost of living crisis and you have a perfect storm.
Health inequalities are increasing as a result between the socio-economic groups in older age, with the gains in life expectancy made across all groups since WW2 going into reverse for the first time from 2015 for those in the lower groups. For people who have built up a healthy pension pot over a life time of full time work, the prospect of a retirement of leisure, travel and good health is still possible. For far too many, however, older age is yet again a time of poverty, ill-health and premature death. We are facing a national crisis of ageing and need an urgent national response to this.
Describing the situation is one thing, but coming up with solutions is another. There will need to be a real paradigm shift in how we approach older age as a society. This has been tried before with some small measures of success in the first decade of this century-ageing well programmes; a national service framework for the development of quality services for older people; health screening programmes; and a focus on ending pensioner poverty all helped to improve older age for those in the lower socio-economic groups. These all came to a juddering halt as austerity saw public funding for preventative measures slashed.
There is a real need to identify low cost but effective interventions that can be put in place quickly to begin to turn the curve. The many social prescribing services that have been set up over the past decade are well placed to play a part. But there is also a role for communities and civic society to get involved. Local government and the NHS have a contribution to make, but they both need to focus on what they do best and recover from the damage done to them over the past years. Local activists, applying local assets for the benefit of local people could be key to making older age better for many of our fellow citizens.
This is where I hope Do-Well can play a part-through its work in public narrative to support organisations and communities across North Wales and the North West.
Do-Well can engage the hearts, minds and enthusiasm of people who will be key to making lasting change for the benefit of older people where they live. If you would like to be part of a conversation about what older age could be and how that vision could be delivered, all of us at Do-Well would like to hear from you.
Things can be different, but only if we build from the grassroots up. What works for one community will not necessarily work for another, but by working across boundaries and systems, by having honest, positive conversations and by sharing knowledge of what works, I am sure we can all play a part in making older age more meaningful for us all.