Commentary on the ageing population is focused on increasing numbers. Reference Connolly1 Less often mentioned, but the critical factor, is the declining number in age groups traditionally providing informal care. In the European Union there are four people of ‘working age’ for each person over 65 years old and within 50 years there will be two. Reference Fahy, Mckee, Busse and Grundy2 Add geographical movement of younger age groups away from parents, changing lifestyle and changing roles of women, who provide the majority of informal care, and this challenge is both multiplied and underestimated. If informal care declines (currently providing £8 billion of care per annum for dementia alone in the UK), this will fall to the state. Here, the problem is not the attitude of younger people towards older generations but their availability to provide care.
Age discrimination legislation is a welcome step towards reducing inequalities of access to care, although we have yet to see in which direction this driver takes us. It is naive to trust that legislation will inevitably solve these problems and there is justified concern that hidden indirect discrimination could drive us in the wrong direction. Reference Anderson3 The law of unintended consequences is well known and is the reason why professional position statements and guidance remain important. Access to services is not sufficient to ensure equality.
Finally, there is need to address an increasing mental health workforce gap, Reference Anderson3,Reference Draper and Anderson4 where the greatest need for specialist expansion is in old age psychiatry, 5 yet it has the highest vacancy rate in specialist training, and to redress previous policy discrimination against older people by positive action. Reference Anderson3
The Welsh politician Aneurin Bevan described priority as the language of politics and so today's health and social care language is older people. Now is the time for a coordinated policy from government and professional bodies that makes explicit this priority because we cannot complacently wait for natural events to bring solutions. This message needs to be clear. Although hope is invested in ageing bringing more years of life in good health, and that may happen, current data are showing the opposite. Reference Fahy, Mckee, Busse and Grundy2
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