Health Service Focus

Getting facts straight

Does the ageing population present the NHS with a disproportionately sized challenge? Deputy director of the population and statistics division at the Office for National Statistics (ONS), Ben Humberstone, covers the facts.

The increasing number of elderly patients and their effect on the health service is said to be a key challenge for the NHS – but before we get carried away by the scaremongering, let’s get the facts straight.

Ben Humberstone, deputy director of the population statistics division at the ONS, gave evidence at a recent House of Lords inquiry into the impact of demographic change on public services, reporting later this year.

NHE spoke to Humberstone to separate the assumptions from the statistics.

Population projections

Humberstone highlighted the different ways in which the population can, and is changing. Population projections estimate a huge increase, because of more births, longer life expectancy and positive net migration.

An ageing population means more people with diseases and conditions associated with ageing – often multiple conditions – and thus spiralling demand and funding pressures.

But the ONS also projects an increasing number of younger people due to an upward trend in the birth rate and increasing numbers of working-age people because of net migration.

So is it a question of when the younger people will ‘balance out’ the old? Unsurprisingly, as a statistician Humberstone cautioned that “it’s not quite as straightforward as that”. He described the ‘old age support ratio’ which calculates the proportion of people over state pension age compared to those of working age.

He said: “What we’ve seen with that is that there isn’t actually that much of a change because all the age groups are increasing proportionately.”

And because the state pension age is increasing as life expectancy rises, the number of people of working age will also rise.

“So the old age support ratio, which is a horrible term but it’s the one that we use, is generally quite stable over that period,” Humberstone said.

Evidence-based policy

Commenting on the importance of using ONS data when considering future policy decisions, he added: “The data we provide through the projections is provided for exactly this purpose. We produce the projections so government departments, policy makers for local authorities and others can plan how they are going to provide services in the future.

“It’s vitally important they’ve got this information if they’re going to produce evidence-based policy and evidence-based interventions that meet the needs of the population they’re serving in the future.”

Misconceptions 

For many NHS trusts, the issue at stake is whether healthcare needs to gradually adapt as the demography shifts – or whether a more radical system redesign is needed now to deal with spiralling demand among for care among older people with multiple conditions.

Humberstone said: “The important thing is that they know what the population is going to look like. There are certain misconceptions, for example assumptions that fertility is falling, that aren’t borne out by our data and our projections.

“It’s really important that people know about the increase in the ageing population and the proportion of the population who are going to be those older ages, particularly in the 85-plus range.

“The change in population is driven in part by improvements in treatments, cardiovascular diseases and so on, so it puts more pressure onto those services because people are living longer and they require more healthcare in the future.”

Describing the content of some of these misconceptions, he added: “There have been occasions where we’ve had to correct people because their assumptions have been incorrect.

“For example, over the next 25 years we’re expecting to see the proportion of the total population aged 85 and over to go up from 2.3% of the population to 4.8% – that’s a jump from 1.4 million to 3.5 million.”

This means the NHS must think carefully about the scale of the challenge and how best to respond.

Humberstone commented on the growing awareness of the public sector, including the health service, of the statistics behind population change and the potential implications they will present.

He concluded: “There’s an onus on ONS through the UK Statistics Authority to push our statistics out and make sure they’re relevant, they’re what people need and that people are actually using them appropriately.”

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