A Life Worth Living

A Life Worth Living
Alan Sinclair


When asked how we want to live as we grow older most Scottish people express a desire to remain at home, to be well-supported emotionally and socially by people we know and to be able to remain as independent as possible for as long as we

Despite some excellent examples of person-centred health and social care services supporting elderly people in Scotland and elsewhere there is still a mismatch between what we hope for and what we are most likely to get. This mismatch  alone  demands a serious rethink of how we marshal and deploy all the available resources, public and private.

We are living longer and we need to make sure that the extra years are worth living.

The current landscape

As a consequence of the baby boomer bulge, by around 2035 there will be more people claiming state pensions, more people managing multiple health conditions and more people requiring care in very old age.

And there will be fewer young people to support them. Currently, three people of working age support the costs of one  pensioner; by then it will be down to two.

Demographics plus our strained fiscal position mean that a new order is needed.

The state, NHS and local authorities, as well as the third sector, have to find ways of collaborating to help people stay healthier and happier in their own communities and out of hospitals and nursing homes. A wholesale move towards personalising care will help. So too will be new types of contributory pension schemes to cover health and care costs.

But this is not enough. Getting old is not a clinical condition. It is a stage of life. If people are to flourish and benefit from longer lives, then a new balance needs to be struck between the relative responsibilities of individuals and the state.  There is also the matter of death – another stage in life. But we are not good at talking about it. There are worse things than dying. Most older people say that they value quality of life over longevity. Currently, our health practices value longevity over quality. We need a new mind set.

What the third sector can do

We need the values and vigour of an active third sector to complement the role of the state if we are to make the changes
required. The third sector will be vital for mobilising people as carers, volunteers and as the cement for building communities.

Already, care organisations are changing in order to provide very personalised care to individual old people. These are organisations which have successfully moved beyond a checklist approach to care, to look at what people need, what they can do for themselves and what family and neighbours can realistically contribute.

For example, organisations which already orchestrate thousands of volunteers are looking at how the transferable credits model
available to volunteer carers in Japan can transfer to Scotland. This “time banking” addresses the reality of families divided by geography. 

We need to find new ways for individuals, the public sector and the third sector to work together.

Quality of life includes providing good “end of life” care. Our current mind set and systems do not make for an “easy death”. Palliative care has helped. But many people are kept alive at all costs when quality of life has completely diminished. We need to address “quality of death” as much as “quality of life”.

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