Bill Johnston & Craig Dalzell – 12 May 2022
The fact that Scotland’s population is ageing is rooted in our politics and popular media debate. Scotland is often framed as an “ageing nation” where more of us get to live longer lives but a greater percentage of our population is made of people living those lives into older age. This is often framed as a negative – especially when it is measured in terms of the ratio of “burdensome” pensioners vs “productive” people of working age. However, as we have demonstrated in our recent book All of Our Futures, the fact of our living longer should be consider a success of our civilisation – not a burden. Indeed, rollbacks in the life expectancy of the average person in Scotland is a direct consequence of more than a decade of harmful Austerity politics and has been to the profit of no-one except the financial sector. However, as more people live longer the generational profile for work, pensions, housing, health, and social care does change and these changes must be reflected in public policy. These are all areas burdened with entrenched inequalities and in urgent need of improvement. Key policy priorities for national and local government include:
- Combating ageism.
- Investing in healthy ageing.
- Creating age-friendly labour markets and workplaces.
- Renovating housing to meet changing needs as we age.
- Including all age groups in policy making, service design and decision making.
With so many of these areas also being within the remit of our Local Authorities surely our ageing population should have featured in this month’s local election?
This article is a timely attempt to answer the question by analysing the Party Manifestos and exploring the National’s valuable daily reports on each of Scotland’s 32 local authority in the weeks running up to the election. Following the 2021 Holyrood election, and preceding a possible IndyRef2 in 2023, the local elections provide a valuable source of insight into the politics of age, ageing and population change in Scotland.
The tale of the manifestos is quickly told – Unless the party in question has a particular interest in the National Care Service and sometimes not even then, very few promises were made in this election specifically about older people. The Greens were perhaps the strongest in this regard with a single snippet of policy about the kind of continuous age planning we’ve advocated for in our book and for provision of “a range of services for older people, recognising personal choice”. Labour’s policies for older people were all couched within Care with an offer for free personal care for over-65s. Policies for older people or on ageing were conspicuous in their absence in the SNP and Conservative manifestos and mentioned only indirectly in the Lib Dem plans with a single reference to improving wellbeing for care home residents.
Consequently, the rest of the article concentrates on impressions gained the National’s reporting to provide a snapshot – often from candidates themselves – of how our demographic realities played out up to the 5th of May.
Common Issues.
As The National reports are based on interviews, quotes, available knowledge and reporter observations, the following notes are selections from the content of the articles. Issues vary in kind and significance by area – urban, rural, island, well off, poor – within and between local authorities.
Representative issues described in the articles included: balance of industrial and tourism development; affordable housing; homelessness; housebuilding programmes; access to affordable rented accommodation; retaining young folk in the local area; local transport connectivity including ferries; maintenance of roads, pavements, and parking; local health services; Covid impact; lack of joined up Council thinking; depressed town centres; infrastructure developments; over-runs on capital projects; cost of living increases; fuel costs; waste collection services; community empowerment; attention to women and minorities; provision for disability; educational attainment.
Understandably these issues with local variations comprised the bulk of the articles and it is fair to say that our ageing population didn’t appear as a significant item. Of course, all the above could be related to the demographic profile of Scotland’s local authorities to help develop policies and allocate resources by sharpening focus and enhancing outcomes. There was a particular awareness of issues interacting with each other, for example an increase in younger families generating housing, education, and public transport needs. Brexit appeared in several articles in relation to staffing shortages, supply chain difficulties and a general sense that the supposed economic benefits have not materialised.
Ageing Population/Demographics as an issue.
Age, ageing and generational aspects of demographic change featured across the local authorities, particularly in terms of age profiles as they relate to politics, local economy, and need for services. Here are a few examples:
Age and Democratic Inclusion.
- Age profiles were sometimes linked to voting intentions (e.g. older more Tory/younger more SNP and Green) in addition farming community folk deemed very likely to vote Tory with differential turnout deemed a significant factor in determining the result in rural elections. Whilst often backed up by statistical evidence, this widespread stereotyping can result in the erroneous profiling of individual voters and thus either writing them off or taking them for granted without actually seeking their views.
- One then-incumbant Council leader was quoted as saying “It’s accepted with the demographic of the area it would be very unlikely anyone would achieve a majority. We have a lot of older people in the area, but also a lot of younger people and families because we have the best schools in the country, so there’s a real mix of views and voting patterns”.
- Faith in young voters and candidates by SNP/Greens in the light of the SNP/Green co-operation agreement, particularly as the electoral franchise has been extended to people aged 16+. This was reinforced by one candidate (age 68) giving their support for young people as a reason for standing.
- One candidate (age 25) is quoted as saying “The councillor I’m standing against has been there longer than I’ve been alive and we need fresh perspectives – that’s why I’m standing”. This might suggest that older people are somehow less “fresh” in their own perspectives.
- Against that, a former council leader standing again after a 10-year gap was quoted as saying: “I have now got a greater life experience 10 years on – I think I will probably be one of the oldest candidates locally.”
Two powerful themes emerge here. Firstly, local demographics are assumed to correlate to voting intentions and patterns, with a sense that the younger end of the spectrum is more likely to be ‘progressive’ whilst the older groups are more likely to be conservative.
Secondly, awareness of age as a potentially determining factor in the perceptions of candidates and their parties. So, in one case a younger candidate suggests that his older candidate’s age argues for a ‘fresh perspective’. However, several older candidates express themselves as both capable of making a good job of being a counsellor and motivated to represent and engage younger folk.
Evidently age matters as a factor in local politics, at least in the eyes of activists. This suggests that some form of wider organised debate around demographics, age and ageing would be relevant and could enhance the quality of local politics and representation from the start of the new term.
Socioeconomic Implications of Population Change.
- One Green candidate was quoted as saying “I would rather a Green councillor was in there contributing thoughts and ideas about sort of thing then, rather than a dogmatic thing typified by some of the blue people [presumably, Conservative], which is that basically they’re on their own and the market will take care of this.” Arguably this is a pithy expression of opposition to Neoliberalism!
- Population shifts and economic growth feeding through to the dynamics of local housing, employment, education, transport links and other services. “The demographics in East Lothian are changing, you tend to see families coming in”. “The local authority is the fastest growing in Scotland (Midlothian) with its population ballooning by 15.8% between 2000 and 2019”.
- Some contributions argued for population change as a significant dynamic in improving local society, declining and ageing population was linked to severe poverty seen as a local area ‘problem’.
- More specifically underinvestment in local authority environmental services is related to high absence rates in depots during the pandemic aligned to the workforce being older and having underlying health conditions. This perception illustrates many negative features of the way older workers and their employers experience work more generally although it is presented here as a partial explanation of local difficulties with refuse collection.
Clearly demographic profiles and changing population patterns are factors in planning and investment decisions within and between local authorities. It may well be that population data is considered as part of the behind-the-scenes processes of local government, however it could be that a much more transparent political process around population issues and trends would be beneficial in engaging people and justifying specific plans for services and proposals for investment.
Conclusions.
Scotland’s ageing population didn’t come up in the local elections on anything like the scale called for by incoming demographic (and climate!) transitions and when it did, it was still often framed within oft-told stereotypes, especially when it comes to voter intentions. This is disappointing but could be turned to advantage. For example, once the initial decisions over Council working arrangements have been agreed, it would be possible to raise demographic issues with the new administrations with the aim of raising awareness and suggesting ways of making Council decisions and resource allocations much more age sensitive. It is in the interests of all that we consider policies in light of older people but also how they impact and are impacted by the process of ageing itself – even those of us who are not yet old will experience those transitions in real time. As the conclusion of our book, All of Our Futures, says – Scotland could very well become a country that we can proudly grow older in and can feel supported as we do so. We all – from voter to elected officials – have a vested interest in ensuring that it does.
One of the things your analysis is missing for older people is the issue of Assisted Dying. I am getting old myself, currently 67 years old and with markedly declining health, and that issue is the one that is foremost in my mind regarding my own experience of ageing. It is also a common theme for many older people I know.
As all older people know living longer is a positive but it has a negative side as generally living longer also means living longer with progressively declining health, physical capacities and perhaps mental capacities (dementia etc.). This is never really addressed in a realistic way of what that means for the individual concerned. Most political organisations are focused on so-called ‘care’ for the elderly, which is to the good. However, this is always done from a perspective of what ‘we’ think is good for you and what ‘we’ will supply for you — which amounts to near zero concern for what the elderly might want for themselves.
The thing with assisted dying is that, done properly, it gives autonomy to the patient (mostly the elderly) to have control over their own deaths (should they so desire that control). But this seems to be a big No, No as far as the politicians are concerned — which is at very wide variance with what most of the public think should be the case. Keeping people alive at near to the end of their lives at all costs produces some of the most barbaric practices imaginable directed at elderly people. That is fundamentally wrong and does need to be addressed with considerably more compassion than is currently available in political society, medical practice and with the church cheerleading in the background with their cancerous mediaeval drivel leading the way to horrendous practices that they fully support. Death need not be traumatic if the option of the patient having some control is enabled and honoured. To die at a time and place of one’s own choosing (should one want that choice) has to be seen as a fundamental human right, and nothing less will do. It would be great to see what Common Weal thinks on this, so press please press yourselves somewhat and say what you think needs said on the matter.
P.S. Several months ago I emailed the Alba Party asking them what their policy was on assisted dying? I received no reply. I wasn’t surprised by that, just another instance of the matter being dealt with by sweeping it under the carpet. That is the kind of regard that is actually shown to the elderly and what they themselves want — next to none.
Hi Peter
Assisted dying is an important subject and one that is being increasingly talked about but it’s also one where various people (including within Common Weal) have extremely strong and entirely valid points on all sides of the argument. For this reason Bill and I deliberately chose to omit the discussion from our book – we’re simply not in a place where we’re able to offer our opinions (strong though those personal opinions might be) with any kind of real authority and in a platform that might suggest that Common Weal itself has taken a position on the subject.
That said and without any implication on my co-author, colleagues or on Common Weal itself, I do have a personal conviction in favour of the principle of assisted dying in some circumstances (rooted in the principle, like yours, that personal freedom ultimately should grant us the freedom to make the final decision we can ever make) but I am not yet ready to form that opinion into a general policy that is able to deal with the many, many cases where this could go wrong and where the avenue to correct things when (not if) things do go wrong is obviously clearly impossible (incidentally, this is an opinion that also forms the root of my objection to capital punishment).
Thanks for this comment. It sparked a great deal of thought in me.
Thanks for the response, Craig. The only thoughts I would have on what you have said would be something like:
At this point in time at least the following countries and States/jurisdictions have legal assisted dying practices in place:
“Aid in dying… in some form is legal in the Netherlands, Belgium, Canada, Colombia, Luxembourg, New Zealand, Switzerland, Spain, Germany, Austria, five of the six states in Australia (Victoria, Western Australia, Tasmania, South Australia and Queensland), and in 11 USA states (Oregon, Washington, Vermont, Montana, Colorado, California, District of Columbia, Hawaii, New Jersey, New Mexico and Maine). It differs per country how aid in dying is legalized.”
(Source: “World Federation of Right to Die Societies”, https://wfrtds.org/worldmap/ accessed on 14 May 2022.)
Obviously there is quite a range of variation in the laws passed in those places that enable assisted dying to take place — with what familiarity I do have with them they are all pretty good in terms of robustness of safeguards applied, there is nothing haphazard about them. Personally I favour the Swiss model as it proffers the greatest degree of autonomy to the suffering individual with respect to the qualifying conditions being met to enable assisted dying.
Could things go wrong? In some case yes, that could be a possibility, though I would reckon an extremely rare one, but I can’t see that as a reasonable objection on the basis that, I would assume, what you and others might want is outright ‘perfection’ in a system of so-called ‘safeguards’. Human societies don’t do perfection in any area and it seems to me to be unreasonable to place that expectation on assisted dying laws. For what I do know of the legislation in other countries every single one of them does have robust safeguards and there have been no reports of ongoing abuses recorded in any one of them. Also think of motoring. Every year thousands of people worldwide are killed by motorists, mostly accidentally, though sometimes quite deliberately and with malice. Does that raise the issue that perhaps we should ban people from owning cars because the laws on their use are not robust enough in terms of safeguards? No. We know it’s imperfect but we manage to live with that.
Motoring is pushing the analogy boat out a bit so how about the likes of a Harold Shipman? Shipman managed to do what he did because to the lack of safeguards around his practice. Assisted dying laws introduce legally enforceable safeguards including a paper-trail (where none at present exist) from that point of view it would be a step forward in producing a better system of oversight between the ‘patient’ and whatever a doctor is doing in the background with respect to that patient.
With respect to capital punishment I don’t think the two can be reasonably compared. In capital punishment the State wilfully kills another individual — and likely against that individual’s own wishes. So the State is enforcing a death on an individual. The situation with assisted dying could scarcely be more dissimilar. Assisted dying requires that the individual requests the means to their own peaceful and pain-free death, and most legislation I have read on the matter requires the individual to make the request repeatedly often in writing, or at least a signature applied, and always with involved oversight from at least two independent doctors and/or psychiatrists and other involved parties to ensure that no duress is being applied to the individual. Also it is the case that more often than not the individual who wants the assisted death must administer the fatal dose by their own physical capacities. At Dignitas the lead-up to the drinking of the fatal potion is video taped and the tape passed onto the police when they arrive following Dignitas immediately informing them them of the death. The opening section of that video tape shows the patient being quizzed by the Dignitas staff on the issue that they do know that if they drink the fluid that they will die, and is that what they wish? The drinking of the potion can only proceed if the patient responds in the affirmative and the tape always shows the patient drink the potion by their own efforts. Think of the circumstances of all that, Craig. This would likely be the most deeply heartfelt wish of the individual at that point in time. There is no equivalence between that situation and the enforcement of a death penalty by the State. Quite the reverse, where an individual wants to make such a request there are significant hurdles to be cleared before the request has any hope of meeting with official/medical sanction. And do keep in mind that the individual might well be in significant physical pain and emotional/psychological distress because of it while trying to clear those hurdles.
I do appreciate that what you are saying is that if something did go wrong (though there are very significant hurdles in place to prevent that) then the death cannot be ‘recalled’ and cancelled — the act is done and that is that as far as the dead are concerned. Yes, that is undoubtable true, but the chances of that happening, with good legislation being in place would, I would think, be very, very slim indeed.
Lastly, I am curious, what safeguards would you reckon would be necessary to ease your own mind on giving full approval to assisted dying legislation? I am quite baffled by this as the number of times I’ve come across objectors on this issue (I do realise you are not an outright objector) on public forums they frequently go on about safeguards, safeguards, safeguards! But if I actually ask them exactly what safeguards they would find acceptable, they never reply.
P.S. I am aware that this reply is subject to moderation and may not be published on the Common Weal website. If you decide that then I would be fine with that and would not take it ill. Just wanted to say what I said above — hope you understand.
I think Bill and Craig were right to leave this topic out of the book as it would have distracted from their core policy arguments. As I often do, I will share some personal info and then draw broader public policy issues out of that context.
I am 60. I have had a “living will”, drafted by a solicitor on file with my GP for the past 15 years setting out scenarios where I would not wish my life to be artificially prolonged. There is no guarantee that it will be honoured if those circumstances arise but better than nothing. On a personal basis I think I am sufficiently intelligent and informed on this subject and have direct “lived experience” of caring/visiting very ill relatives, friends and others in community, hospital and hospice settings (if circumstances allow, the “best” place to die is at home with the right support from community hospice services; “second best” a hospice; absolute worst place to end your life is a “normal” hospital ward). I have undertaken a study module of “law and ethics in medicine”. However, what I know I want for myself is not easily translated in to public policy as each individual has different views, experience, intelligence. At the risk of “labelling” we know that some people in our society are Not intelligent, emotionally or otherwise. We may meet (or strive to avoid) such people in our daily lives. Can we trust such individuals to make the right choices for themselves and to honestly fulfill the choices of others? The current public policy context is not encouraging: thousands of “excess”/avoidable deaths due to CV 19 esp in care homes; a very unequal society which seems to be becoming more unequal by the day; a NHS which is falling apart; a hospice movement which has to find at least 50% of its operating costs by charity funding etc? As Bill and Craig point out in their book, “the elderly”, esp the sick/frail elderly are often categorised as a public policy “problem/a drain of vital resources” etc etc!
More personal experience. My sister and I had power of attorney, financial and welfare for my mum. We were also the only beneficiaries of her will. My mum developed dementia and we had to start exercising POA in order for her to get proper medical/other care, not get ripped off financially etc. However, due to the system and GP dithering, the formal medical diagnosis of dementia did not occur until several years later. Whilst medical staff welcomed our interventions, Social Work staff took the view that my mum only had dementia from the date it was formally diagnosed and recorded! My mum subsequently died in a care home from natural causes. Had she lived another few years, the value of her estate (her house was sold) would have been eroded by care fees to almost zero! However, I always felt very uncomfortable being in the role of financial/welfare POA and estate beneficiary. This is quite common: the people who will financially benefit most from your death are also the ones you entrust to make financial and welfare decisions on your behalf! If that is not the definition of “conflict of interest” then what is?!
The whole subject of assisted dying is an emotional, ethical, legal, religious minefield and complex (I have yet to listen to a public debate where most participants do not display ignorance of what current law does and does not allow in terms of “artificially prolonging life with unnecessary medical treatment which may cause suffering”).
In summary: it is a valid topic for public debate but fraught with difficulty and sensitivity. Even if there were general agreement on principles, translating that into workable legislation would be very difficult (not impossible). The experience of other nations is relevant but only up to a point. I am not surprised that most politicians hide when the topic is raised.