How do we give more people a better later life? This question is set to dominate public debate in the years to come says Anna Dixon, as we live longer, while pension provision is stretched and health and social care funding is squeezed. In her new job as chief executive of the Centre for Ageing Better, Dixon is one of those tasked with coming up with fresh ways of preparing for our rapidly ageing society.
“We think there’s lots of opportunity to change not only how we experience old age but some of the perceptions of what it is to grow old,” is how she puts it. “We have a great opportunity to make a big difference on one of the biggest public policy issues internationally. We want the work we do to mean more of us look forward to a good old age.”
Her organisation, set up with a 10-year endowment worth £50m from the Big Lottery Fund, is chaired by Lord Filkin. He also chaired a Lords select committee that concluded in 2013 that both government and society were “woefully underprepared” for the demographic change that will see a doubling in the number of people aged over 85 by 2030. Dixon shares his assessment of the scale of the challenge. “There’s a profound change occurring because of increased life expectancy,” she says. “On the one hand that’s something fantastic and something we should be celebrating. But the demographic shift with a larger proportion of the population in older age is something we’re not preparing for either individually, in terms of saving enough or thinking about what sort of houses we might need to be living in, or as a society.”
So how will the centre help? Dixon, who joined at the start of the month from the Department of Health where she was chief analyst and director of strategy, needs to hit the ground running. The organisation has faced criticism for a slow start, with its first chief executive leaving after just three months in the job and questions raised about the scope of its early consultation work. Dixon acknowledges these concerns but points out that an enormous amount of work went into securing the endowment and building the foundations for the centre’s work. “We have a big responsibility to spend money wisely – this is a 10-year journey.”
“We will be identifying innovative ideas and be able even to provide seed funding to pilot new things,” she says. “If we find that something that’s incredibly effective, then we will be looking for ways of scaling that up. This is absolutely about real change on the ground.”
Work is under way to set out the initial areas the centre will focus on. One where it might be able to make a practical difference, Dixon suggests, is employment. “A lot of things are being tried out now, like mid-career reviews, apprenticeships for older people and employment practices to support older people to stay longer in work, but there’s no evidence yet about which of those actually work,” she says. “That’s the sort of practical thing where we can help to evaluate some of the new approaches and spread that learning among employers.”
But what about perhaps the thorniest question of all – how to fund our health and social care provision as society ages? “We all know older people who are really struggling, whose needs aren’t being met by health and social care, who are having to navigate a pretty fragmented system and who struggle to manage at home,” Dixon says. Although the centre won’t be focusing on the funding issues – there are many others doing just that, she says – where it may be able to help is in looking “upstream” to help reduce the need for the most expensive care, through, for example, more tailored housing or better use of technology. “There’s a huge focus on residential care, but actually if you look at the population of over-65s it’s only about 3% who are in residential care, so what are we saying about the 97% living in their own homes? If we could do something to help them stay in their homes then we’re actually going to reduce the need to expand residential and institutional care.”
Early findings from research commissioned by the centre to identify the key challenges facing older people, suggest that it’s not just health and wealth that make for a good older age but a positive mindset and strong social ties. Dixon says her own father-in-law, who died earlier this year, was a prime example of how community involvement, in his case through the Scouts, older people’s forums and volunteering in schools, can make a huge difference.
“It was that social contact and that sense of community that gave him a huge purpose in life, so that even when he was physically ailing towards the end, that was a huge motivation for him to keep going,” she says. “People can be facing quite a challenging health situation, they might not be that well off by objective measures of income but if they have strong social relationships and a positive mindset that can make a big difference and that’s an area we would like to look at.”
Everything from “small acts of kindness and neighbourliness” to the social prescribing by GPs of activities to keep older people involved in their community are likely to be part of the mix in promoting a better later life, Dixon suggests. But she says she won’t shy away from raising some of the bigger issues facing older people, such as the lack of housing supply and financial incentives to move. After two years of near “radio silence” as a senior civil servant, that’s something she relishes.
“I recognise the privileged position you have in an independent role to speak truth to power,” says Dixon, who was previously policy director at the King’s Fund health thinktank. “You do it more quietly when you’re inside the civil service but it’s something I’m going to enjoy doing publicly again.”
She’s keen, too, to bust some of the myths and negative perceptions around ageing, such as the view that older people are a burden on the NHS when, for example, more people under 65 than older people are living with more than one chronic condition.
And with a more balanced view of ageing, she hopes more people will start to think ahead. “We have to help younger people in their planning and preparing for later life,” she says. Some of us might occasionally see financial adviser about pensions but mostly we don’t want to think about it and we certainly don’t want to imagine ourselves having dementia and needing personal care. We need to help people to do what they need to do and maybe make some different choices earlier so they get a better chance of experiencing a good later life.”A few years down the line, she hopes the Centre for Ageing Better will have helped improve the quality of life for older people – and she has a very personal perspective on what that improvement might look like. Her grandmother, who was disabled and virtually housebound for many years yet managed to live a very full life, is, she says, a role model in her quest to establish what ageing better means.
“It’s not necessarily being free of disability or disease, it is about feeling you’ve got value in life, that you are loved, that you can give as well as receive and be connected to other people.”
Curriculum vitae
Age 43.
Lives North-east London.
Family Married.
Education lkley grammar school, Yorkshire; Cambridge University, BA social and political science; London School of Hygiene and Tropical Medicine, MSc (Econ) health policy, planning and financing; London School of Economics, PhD social policy.
Career September 2015-present: chief executive, Centre for Ageing Better; 2013-15: director of strategy and chief analyst, Department of Health; 2008-13: director of policy, The King’s Fund; 2006-08: deputy director of policy, The King’s Fund; 2005-06: Harkness fellowship in healthcare policy, The Commonwealth Fund; 2001-05: lecturer, European health policy, LSE; 2003–04: strategy adviser, DoH; 1998-2003: research officer, European observatory on health systems and policies.
Public life Lay trustee, British Geriatric Society.
Interests Tending allotment, art, theatre and walking in the Lake District, Snowdonia and Scottish mountains.
