The Scottish Government

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1.0 Introduction

A Changing Population

Scotland is changing in a fundamental way: older people form an increasing proportion of our population, and will play an increasingly important role in our prosperity and future. We are entering an unprecedented era in Scotland, and we are not alone. All over the world, other countries are beginning to consider the implications of radically different demographic structures in their populations.

Too often when we talk about the older population, we talk about the challenges - the needs, the burden, the drain on resources. But we need to focus on the demographic opportunity that Scotland now has.
The Rt. Hon. Jack McConnellMSP
First Minister of Scotland Lecture "Scotland's Future - thinking for the long term"
University of Stirling, 23 May 2006

The skills and life experience of older people are an asset in any nation, and Scotland can and should benefit from its changing age profile. Too often, population ageing is seen in negative terms, with the emphasis on an increasing burden on health and social care services, rather than on the value that older people bring. So we need to challenge current perceptions about ageing and at the same time promote a positive vision for the longer term, in which all generations can plan for and influence the agenda for an ageing population.

That is why the devolved government of Scotland has chosen to develop a strategic approach - to consider how best to respond to and plan for a Scotland with an ageing population.

We have learned much from our work looking at the future of Scotland and from the responses to the public consultation held last year. There is a great deal of very positive work and many innovative policy initiatives underway that now - and will in the future - help to improve the lives of older people in Scotland.

The implications of an ageing population for Scotland's development and for society as a whole are wide-ranging and complex and cannot be addressed easily in a single policy statement. Nor can we know exactly what the future holds. And so this Strategy does not attempt to provide all the answers for the future development of Scotland with an ageing population. Instead, this document is an important milestone in this process. The evidence gathered and the issues raised will form the basis for reflection, debate and forward planning in all sectors in Scotland. We believe that the Scottish Executive, all local authorities, public agencies, further and higher education bodies, the private sector and the voluntary sector and, where relevant, the UK government should work together to develop a shared understanding of the wider implications of an ageing population; work together to carry through the culture change we need; and plan effectively for the years ahead. The Scottish Executive is committed to promoting and fostering this process into the future.

For this Strategy we will focus mainly, though not exclusively, on the over 50 age-group; while recognising the importance of the full life course. This age is chosen not because it marks the start of "old age" or because we think all people over this age are somehow similar, but because for many it is a point at which life circumstances start to change in ways that have implications for the future. For example, many people start to change their working patterns, some leaving the labour market completely. Grown-up children may leave home, and parents have more time and possibly more money. People take on caring responsibilities perhaps for the first time, for example for elderly relatives. People also gradually become more likely to develop long term health conditions, such as diabetes and arthritis, which they may have to live with for many years. We stress that people's experiences will vary greatly, but in population terms, the events and changes above are more likely to happen in the over 50s.

Structure of the document:

Chapter 1 provides an introduction to the Strategy; it presents the context within which it has been developed and sets out the structure of the Strategy document. It also presents our vision for older people in Scotland in the future, identifies the challenges that we need to overcome to achieve this vision and sets out the actions that we need to take.
Chapter 2 considers the role of local government, public sector organisations and public services in shaping Scotland's future environment and the challenges that they face in helping to ensure that Scotland makes the most of its changing population.
Chapters 3 to 8 discuss 6 priority areas for strategic action as follows:
Chapter 3 explores the rich and diverse contribution that older people can and do make to Scottish society; acknowledges the barriers to contribution that can arise and identifies action to improve opportunities for older people.
Chapter 4 deals with the important issue of forging better links between the generations.
Chapter 5 describes what is in train and needed to improve and maintain the health of Scotland's people as they age.
Chapter 6 deals with the care, support, safety and protection of older people.
Chapter 7 describes the importance of the right housing, transport and planning infrastructure, and how that is being developed to progressively meet the needs of all ages.
Chapter 8 discusses lifelong learning and how that will develop to meet the needs of an ageing population.
Chapter 9 draws conclusions, sets out the way forward and identifies some immediate priority actions.
Annex A sets out longer term trends that are likely to shape Scotland's future.
Annex B provides detail on priority areas for action to improve health in Scotland and complements the discussion on health improvement and health care set out in Chapter 5.
Annex C lists the Members of the external Advisory Group who steered the work and shared valuable experience.

The demographic and social context

Scotland's population is changing. Lower birth rates mean that numbers of younger people will fall while numbers of older people will rise. Ageing is a personal, biological and demographic fact, and mass ageing - the survival into the eighth, ninth and tenth decades of ever larger proportions of the population - is the result of huge and successful shifts in society. Highlighted below are the key demographic and social trends that underlie Scotland's ageing population.

• In 1900, the average Scottish life expectancy was 40; in 2004, it was just over 74 for males and just over 79 for females, (General Register Office for Scotland 2006 and Government Actuary's Department 2005).
• By 2031 the number of people aged 50+ is projected to rise by 28% and the number aged 75+ is projected to increase by 75%, (General Register Office for Scotland 2006 and Government Actuary's Department 2005).
• Changes in the age structure of the population are not uniform across Scotland, (General Register Office for Scotland 2005b). One measure of ageing - the change in percentage of over 75s over the years 2004-2024 shows great variation across Scotland, with obvious implications for service planning at a local level.
• Ageing is a gender issue, and as age increases so does the proportion of women in each age band. This will lessen slightly over time as men's life expectancy increases, but women will form the majority of the older population for the foreseeable future.
• Historically, the number of older people from black and minority ethnic groups has been small, but as the 1960s immigrants age, the numbers in older age groups will increase; and our evidence is that these groups will have a range of different needs and expectations.
• Disability increases with age, both as people with an existing disability grow older and through the onset of age related disability, such as that resulting from hearing loss or musculoskeletal conditions. Although no Scottish projections exist, we can expect the number of disabled people to increase significantly just because of the increase in numbers of older people.
• The number of people with dementia, an illness whose prevalence increases with age, will increase.
• Households headed by someone aged 65+ are increasing and are predicted to continue to do so. There are also increasing numbers of older people, particularly older men, living alone, (General Register Office for Scotland, 2005a).

Changing expectations and aspirations

Expectations and aspirations are also changing. The "baby boomers" - the generation now entering their 60s - will, as they grow older, do so with aspirations and expectations very different from those of previous generations, so that traditional stereotypes of old age will become less and less relevant. Leisure activity, employment, volunteering in communities of place and interest, and spending patterns are all likely to change in ways that reflect the experiences, ambitions and relative affluence of that post-war generation.

UK and International context

The Scottish Executive recognises and supports the United Nations Principles for Older Persons and these underpin our approach. These principles are:

• Independence
• Participation
• Care
• Self-Fulfilment
• Dignity

We also endorse the World Health Organisation's approach to active ageing. Together with the UN principles, these underpin our approach and our determination to make an older Scotland sustainable, successful and a good place for all ages to live.

Active ageing is the process of optimising opportunities for health, participation and security in order to enhance quality of life as people age, (World Health Organisation, 2002) .

In 2005 the UK government published its strategy document "Opportunity Age", (Department of Work and Pensions, 2005). In drawing up this Scottish Executive Strategy we have taken "Opportunity Age" into account, particularly where joint working, between Scotland as a devolved administration and the UK, is needed to deliver results. Important relevant topics such as employment, pensions and benefits are reserved to the UK Parliament and, where they have featured in the consultation process for this Scottish Strategy, information has been passed on to the UK government.

Developing the Strategy

Over the course of 3 months in spring 2006, we sought views on age and ageing in Scotland and on the issues we need to think about for the future. We received over 1300 responses from individuals of all ages and from a wide range of groups and organisations. A separate report 'Age and Experience - Developing the Strategy for a Scotland with an Ageing Population - Consultation Analysis', (Scottish Executive, 2007b) summarises these. To complement that consultation, we organised a series of focus groups throughout Scotland, we commissioned valuable research and statistical evidence and we convened an external Advisory Group representing a wide range of interests. Members of the Advisory Group are listed at Annex C. Our research and analysis is described in more detail in the companion publication to this document 'All Our Futures: Planning for a Scotland with an Ageing Population: The Evidence Base,' (Scottish Executive, 2007c).

Our Aims and Vision for the Future

"I can imagine a world where older Scots entrepreneurs are leading the way in providing the products and services that their generation requires, using the skills they developed over a lifetime; where older Scots are taking youngsters under their wings, giving them the benefit of their wisdom and their insight, investing in the next generation. Perhaps, if we seize that opportunity now - if we apply our wit and entrepreneurial spirit, our compassion and our foresight, this profound change can be a force for progress."
The Rt. Hon. Jack McConnellMSP
First Minister of Scotland Lecture "Scotland's Future - thinking for the long term"
University of Stirling, 23 May 2006

Our future vision for Scotland is of a confident society that values and empowers people of all ages to use their knowledge, talents and skills to make the most of their lives, to help build up the fabric of our society and to contribute to Scotland's future success. We want to ensure that older people are valued, appreciated and - where necessary - supported to live full and fulfilling lives.

We want our older people to help build thriving local economies; to contribute to the work of the voluntary sector; and to participate in sport, culture and the arts in every capacity. We want more older people to take on leadership responsibilities in their communities, and to become involved in helping to foster understanding and mutual respect across generations.

The outcomes we want to see

We will know that the Strategy has been successful when we see a Scotland where:

1. All the years of life are fulfilling and the contribution of older people - irrespective of age, ethnicity, disability, gender, sexual orientation, or religious belief - is valued, appreciated and, where necessary, supported.

2. Age is not used to define or make assumptions about the role, value or potential of an individual.

3. People enjoy more years of healthy life and are enabled to manage long term health conditions.

4. People are enabled to continue to work for as long as they want or need to, in the way that suits them best, supported by flexible approaches to employment and retirement.

5. Older people have ready access to information technology and the internet.

6. Older people are able to participate in learning activities, both vocational and for personal development.

7. Older people are enabled to volunteer for as long as they want, in the way that suits them best, and that contribution is fully recognised.

8. Fewer older people than ever before will live in poverty.

9. Vulnerable older people are protected, safe, and are free from fear.

10. Older people have access to public services which are people-centred, accessible and joined-up; and can access quality services appropriate to their needs, when and where they are required.

11. Houses, buildings, communities, transport systems and infrastructure are well-designed and accessible, and can be used by older people in safety and with confidence.

12. Authoritative, up to date sources of advice and information are accessible to older people, when and where they are required and in a format that is accessible and user-friendly.

The Challenges We Must Address

First of all, we must recognise that there are over-arching challenges facing older people in Scotland at the present time which cut across all issues in relation to older people and Scotland's ageing population. For the Strategy to be a success and for Scotland to make the most of its changing population, we must ensure that these core challenges are addressed.

Ageism

The fact is that there is great diversity in later life: in health, in fitness, in activity, in participation, in life experience and in attitudes. If Scotland is to make the most of demographic change and opportunity, there can be no place for ageism and negative stereotyping which demeans people.

Scotland's older people - highly diverse, growing steadily in numbers, enjoying healthier and longer lives, participating more actively and contributing more widely to our society - will, as the consultation made clear, not tolerate the negative attitudes, discriminatory treatment and second-class status that ageism inflicts. People rightly resent any attempt to label them or make generalisations about them.

"If we were suddenly to acquire the same sensitivity to ageism that we have to racism and sexism, we would be in for a shock... Do we not realise that the best prospect for our own well-being in old age is to build a world in which equality, independence and active participation of all generations are positively encouraged?"

Source: Professor Tom Kirkwood, Reith Lectures 2001.

Tackling ageism is essential if the potential of Scotland's ageing population is to be maximised. The impact of ageism is insidious and damaging. It has been shown to affect wellbeing, damage confidence and abilities, and thus create a self-perpetuating cycle, diminishing and excluding many with much to give. Yet ageism is pervasive throughout our society, so driving it out is a challenge for all public and private organisations, and for all of us as individuals.

We will work with stakeholders to develop a campaign to promote positive images of ageing to help combat this insidious problem.

The Scottish Executive is committed to tackling negative images of ageing and actively promoting those which recognise the contribution and role of older people, and the positive opportunities presented by Scotland's ageing population. From December 2006, all new policies and all new legislation will be assessed for their impact on age as well as on gender, disability, sexual orientation and faith/belief. The requirement to assess legislation for impact on race is already in place. Consideration is being given, through the UK Discrimination Law Review, to the scope for harmonising the existing legislation on discrimination.

We will fund a campaign to combat ageism.

The Scottish Executive is determined to fulfil its voluntary and statutory commitments to equality mainstreaming for Scotland's older people, and has created a framework and accompanying tools which will help ensure that age equality is built into its core work, in terms of policy design and service delivery. In this way the Scottish Executive aims to be an exemplar for other public bodies. This Strategy, for example, has been impact assessed for equality issues.

For October 2007 age will for the first time be brought together with the other equality strands through the Commission on Equality and Human Rights. This will raise the profile of age as an equality issue, and drive forward the equality agenda across the board as well as providing a one stop shop for people experiencing discrimination.

Equality and diversity

All groups in Scottish society are ageing, including people from minority ethnic communities; disabled people; and lesbian, gay, bisexual and transgender people. Ageing can present particular difficulties for various groups. For example, for people for whom English is not their first language, cognitive impairment can mean the loss of fluency in English, so that services require to be adapted to meet someone's language needs; lesbian, gay, bisexual or transgender older people may have concerns about finding appropriate housing or residential care services; faith groups such as Muslims may find that services offered cannot be used if they do not meet dietary or other specific religious requirements. And for women, who predominate in the oldest age groups, we need to address the issues of gender inequality earlier in life, so that they may avoid inequity and poverty in old age.

Different ethnic minority communities have different age structures though in general the proportion of children and younger people from minority ethnic communities will become larger. Thus addressing the many issues of race inequality in education and unemployment is vital for all life stages.

Disability that arises with age can pose barriers for people. Although far more common, age-related disability is often regarded differently from disability acquired at birth or earlier in life. For the latter group, the social model of disability which sees disadvantage and discrimination as a result of the way we organise society, rather than due to impairment, is widely accepted.

Younger disabled people can also face barriers as they age. Services they may have used for years can be geared towards younger people, and older people's services are not always geared towards disabled people. For example, increasing numbers of people are now ageing with a learning disability which has implications for the services they need, the kind of support their carers need, and their own health.

We think that more needs to be done to increase understanding of age-related disability in these terms, particularly given the new public sector duty to promote disability equality which is relevant to disabled people of all ages and the responsibility of public bodies under the Disability Discrimination Act 2005.

We will work with stakeholder organisations and with the new Commission for Equality and Human Rights to increase understanding of age as an equality strand and the implications of ageing for different groups of older people.

Links Between the Generations

The evidence we gathered revealed the importance people attach to relationships between generations, recognising that building good relationships between generations brought all-round benefits. Conversely, the absence of this is at best a loss and at worst a threat for both younger and older age groups. Older people have a potentially strong role to play in the education and development of younger generations, and those generations can contribute much to the wellbeing of older people.

We think that more needs to be done to unleash the potential of intergenerational links in all settings - in schools, in communities and in the workplace. Chapter 4 has more on this important topic.

Rurality and geographic isolation

Some rural parts of Scotland will experience more extreme demographic ageing, which will pose particular challenges to local authorities and service providers. Living in more remote rural areas can pose challenges for older people as well. Lack of flexible and frequent public transport services can leave older people in rural areas much more dependent upon private transport than their urban counterparts, despite, in many cases, lower incomes. Services such as hospitals, health care centres, shopping centres, and community centres can be further away, compounding transport difficulties.

Small rural communities can be very dependent on informal volunteering through mutual aid and help, and less dependent on formal services. It is essential for the quality of life of the older people who make those communities viable, and ultimately for the sustainability of these areas, that local authorities plan effectively for local demographic change in their areas.

Lack of knowledge /information

The research and evidence from the consultation shows that older people require access to good quality advice and information across a whole range of topics, including benefits and entitlements; employment and training opportunities; volunteering opportunities; financial planning; planning for retirement - both financially and in terms of working out how to spend their time; leisure opportunities including lifelong learning; housing; and health care.

Better access to better advice would mean that everyone, including older people, could be more active and informed in making choices and having a voice in the decisions that affect them. The better informed older people are about what is available, the more they will be able to influence the development and delivery of services, and - by better understanding the options - the more choice and control they will have over the services provided to them.

In recognition of the importance of the provision of such information, we will continue to encourage developments such as the Scottish Helpline for Older People which provide the information people need through the right channels.

We will also continue to work with the UK Government and the Financial Services Authority, in developing their work on the provision of generic financial advice and financial education, including the workplace based 'Make the most of your Money' initiative. We will also consider the need for further, specifically Scottish, action in our review of the Financial Inclusion Action Plan during 2007. Successful financial education approaches were developed in our pilot project with Citizens Advice Bureaux and we will consider how these might be rolled out more widely.

Closing the Opportunity Gap

Although there have been significant improvements in recent years, some of the oldest people in Scotland remain some of the poorest. In addition, on average, women have lower pension incomes than men and minority ethnic pensioners are more likely to be poor. People who have an incomplete employment history, including many disabled people, are more likely to be poor once their working lives are over.

We are taking action across all Departments to tackle poverty and social exclusion. In particular we aim to:

• prevent individuals or families falling into poverty;
• provide routes out of poverty for individuals and families; and
• sustain individuals or families in a lifestyle free from poverty.

In partnership with the UK Government we are committed to tackling poverty among older people, and our Central Heating Programme, National Concessionary Travel scheme, and policy on Free Personal and Nursing Care are all helping to increase the disposable income of older Scots.

We are also encouraging the main energy companies to take appropriate measures to help vulnerable households avoid fuel poverty. This complements measures provided by the UK Government, including the Pension Credit, Council Tax and Housing Benefit, the Winter Fuel Payment and Free TV Licences.

Case Study: Increasing Benefit Take-up in Glasgow
Since October 2004, Glasgow Housing Association ( GHA) has been running five pilot projects aimed at increasing benefit take-up amongst its older tenants. These have been delivered variously in partnership with the Pension Service, three of the city's Citizens Advice Bureaux, and expanded welfare rights teams within other Registered Social Landlords. An additional £1.8 million was claimed in the first 12 months of operation, with the average gain of £2000 for a successful claimant. Evaluation of the pilots concluded that the most effective way of reaching older people to offer a benefit take up service is through direct phone contact. GHA is now seeking to roll out the service to all tenants over 60, and the 13,000 owner-occupiers of that age that it provides with factoring services.

It is estimated that overall take-up of benefits amongst entitled pensioner households is only around 60% and take-up rates are particularly low in some rural areas. Pensioners on low incomes are among the most vulnerable people in our society and we want to ensure as far as possible that they get the money they are entitled to.

We are helping improve benefits uptake through a range of measures. There are examples of good practice and initiatives through money advice and welfare rights services which improve benefits and services uptake across Scotland and we will continue to build on these.

Free benefits 'health checks' are offered to all those participating in our Central Heating Programme. Many local authorities provide a benefits check before billing people for care costs. People claiming Pension Credit and State Retirement Pension can also access Council Tax Benefit and Housing Benefit at the same time via The Pension Service: one phone call, one number, four benefits.

In addition, the Scottish Executive has spent over £294 million on fuel poverty programmes to date helping thousands of people to have warm, dry homes which are more affordable to heat.

A further £102 million has been set aside for fuel poverty programmes over 2006 - 2008.

In Scotland since 1997:

• 120,000 pensioners have been lifted from relative poverty, bringing relative pensioner poverty down from 30% to 16%;
• 200,000 pensioners have been lifted from absolute poverty, bringing absolute pensioner poverty down from 30% to 6%;
• Tax and benefit changes have meant an extra £30 a week for the average Scottish pensioner household, with the poorest 20% getting around £40 a week extra;
• The Pension Credit is giving 8% of Scottish pensioners an extra £70 per week and around 30% an extra £42 a week.

For those eligible for benefits, there is much to be done in promoting awareness and access to them.

The Scottish Executive will continue to examine what more it can do, itself and with relevant partner delivery agencies such as local authorities and the Pension Service, to share good practice with the goal of maximising the income of Scotland's poorest pensioners.

Challenges for the Future

As well as the current over-arching challenges outlined above, there are a number of challenges facing us in the future that we need to consider and plan for now if we are to achieve our goal of anticipating and actively managing Scotland's future success with an ageing population.

These challenges have been identified through analysis of Scotland's current strengths and weaknesses in a number of areas and through consideration of long-term trends and influences that are likely to affect Scotland over the next twenty years. They will require co-ordinated action on the part of Government, of local government and the wider public sector, of health care services and health improvement, of the business sector, of the learning sector, of employers, of the community and voluntary sectors and of families and individuals. Some potential roles and responsibilities of the various sectors in rising to take on these future challenges are explored in greater detail in subsequent chapters.

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