M-RCBG Associate Working Paper No. 236

A better old age? Improving health and care outcomes for the over-65s in the UK

Camilla Cavendish
Gabriel Moberg
Jessica Freedman


Britain’s health and care system is in a precarious state. The pressures of an ageing population, common to many industrialised countries, are being compounded by post-pandemic waiting lists for National Health Service (NHS) treatment which number around 7.7 million people. Public satisfaction with the NHS has fallen to historic lows of 24%, a drop of 29 percentage points since 2020. Part of the problem is insufficient social care capacity, which is overburdening hospitals. At times, up to a third of hospital beds in some regions have been occupied by older people who are medically fit for discharge but who cannot live independently, and cannot get access to social care.

Satisfaction with social care is even lower with only 13% of the British public reporting satisfaction with the system. Already, the system is failing to meet the demands placed upon it. Currently, 16% of people aged between 65 and 74 struggle with one or more of the activities of daily living (ADL), according to the English Longitudinal Study of Ageing (ELSA). Of those aged 85+, 44% struggle with one or more ADLs. AgeUK estimates that 1.6 million people over 65 have unmet needs for care and support. 

To make matters worse, demand for social care from the over-65s in England is increasing as the population ages and grows. The annual number of requests for social care to local authorities by over-65s rose from 1.32 million to 1.37 million requests between 2017/18 and 2021/22. Furthermore, projections by the Health Foundation suggest that 1 in 5 people in England could be living with major illness in less than two decades’ time as the prevalence of chronic diseases increase. 

Compounding the problems has been a lack of meaningful reform by both main political parties. In 2010, a Labour proposal to fund universal social care through a new inheritance tax was dropped after being labelled a ‘death tax’. In 2017, a Conservative manifesto pledge to increase individuals’ contributions towards social care was dropped after being criticised as a ‘dementia tax’. The 2021 Conservative plan for a Health and Social Care levy was dropped in 2022.10 All attempts at setting the financing of elderly care on stronger ground have failed in part because of the political difficulty of raising taxes to fund a system which few voters understand, for a sector which has had little voice.

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