The first baby boomers are now in their early 60's. They have been a highly self-assertive generation throughout their lives. Their needs and demands (which are not the same thing) for health and social care will soon climb vertically. This will probably be an important electoral issue in 2010, and certainly a huge one in 2014 or 2015.
Our current systems and structures, both for service provision and funding, are simply insufficient to cope with what is coming. This demographic is going to force change across a whole swathe of areas. This is no longer an if; it's about when and how.
Pensions, care, and housing will all need to be funded. Decisions about any one of these will have an impact on the others. With smaller numbers in the next generation we also need to think calmly and clearly about workforce numbers, retirement and imigration.
We are already beginning to see personalised budgets in health and social care. Vouchers, passports, call them what you will, together with an acceptance of co-payments, are then the inevitable next step. New forms of housing and care homes will develop as people come together to pool resources. Also coming over the horizon will be tax breaks for people caring for older dependents and much greater flexibility over retirement with many people working (part-time at least) long past 65. There will be a sharp uptake in volunteering and many new mutual self-help groups.
None of this can be controlled centrally. It will require a genuine commitment to individual choice, directly accountable localism and respect for local priorities (rationing decisions). This is post-bureacracy. But it won't need hares or tortoises. It will require vision, boldness and the ability to plan and implement real change. The last of these is the least glamorous and the most important.
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