Review

Spin bowlers

They’ve had a good innings – can the NHS cope with an ageing population?
John Grimley Evans, Stephen Pollard, Karol Sikora, Roger Williams
Civitas, 2003. £5.95

This publication apparently followed a conference, although there is little indication that the authors have read each other’s papers. Far the best is ‘Population Ageing: Challenge and Response’ by John Grimley Evans, the only one who seems to understand the statistics. He shows that concepts of the ‘ageing population’ conflate two separate trends; increased life expectancy and an increase in the average age of the population, which itself is mainly due to changed patterns of childbearing and is self-limiting.

He also points out that the increased demand for healthcare by older people is another statistical artefact caused by the fact that dying is an expensive business whenever it happens but that most people are old when they die. The overall conclusion is that (as with the pensions debate) panic over the ‘demographic time bomb’ is largely misconceived.

The others are less useful. Karol Sikora is mildly informative on new cancer treatments but his attempts at drawing political conclusions defy rational explanation. As an example, he emphasises the need for increased expertise in diagnosis and treatment but still sees rising salaries in the NHS as bureaucratic waste.

Roger Williams is good (though not totally accurate) on the shambles in the provision of specialist services caused by repeated NHS reorganisations. The need for incremental change rather than incessant returns to the drawing board is obvious to everyone except every government since 1979. The specific relevance to older people is, however, unclear. All Stephen Pollard contributes is a puff for the US pharmaceutical industry.

The publication confirms that older people need and would benefit from more medical treatment and suggests that it seems entirely feasible and affordable to provide this, without the need for any structural change. This may not be the conclusion the authors wanted to hear.