Better Health For All

Sometimes I think politicians must be smarter than they seem when baying during Prime Minister’s Questions.  I’ve spent the past couple years or so discussing pension reform with relevant actors within the social policy process (academics; civil servants; employers; politicians; professions; think tanks; trade unions) without realising that UK Members of Parliament had built an escape clause into the legislation.  As Therese Coffey (Secretary of State for Work & Pensions) explained to the House of Commons last 4^th December: Section 27 of the 2014 Pension Act demands a second Government Review of the State Pension Age by May 2023, for which already she has commissioned independent reports from Martin Clarke (Government Actuary) and Lucy Neville-Rolfe (Peer of the Realm). 

If you look at the ONS Longitudinal Study, it is clear that at each decennial census since 1971 the proportion of women in their 50s who describe themselves in labour market terms (paid employment; unemployed; permanently sick; retired) has increased steadily, so it is reasonable that women and men should have the same State Pension Age, although why the gender difference should have been equalised up (first to age 65 years, now 66 years and soon 67 years, then 68 years) rather than down (to age 60 years), is less obvious.          

The official reason is the increase in life expectancy during recent decades.  One problem with this explanation is that the rate of increase in life expectancy now appears to have stalled and that, if and when it resumes, it is likely to lack its previous vigour.  The bigger problem is that being alive is not the same thing as being capable of holding down a job; hence the need to think in terms of healthy life expectancy.  Here the devil is in the detail and Lucy Neville-Rolfe has been tasked with adjudicating.  John Cridland’s previous review opted to measure the healthy part of healthy life expectancy in terms of self-assessed health, although many consider that the absence of physical or mental disability would have been more appropriate.    

I am one among the number who would prefer to see the State Pension Age linked to disability-free life expectancy, but my concerns are not limited to this technical issue.  I am also part of an informal group of public health specialists who wish to draw attention to the possible unintended consequences of raising the State Pension Age and contribute to discussion of how to mitigate these.        

Our concerns are that extending work-life may: (1) worsen the health of those with pre-existing illnesses; (2) overwhelm sparse occupational health and over-stretched general practitioner services; (3) hinder informal caring at a time when the need for it is projected to increase; (4) deter the volunteering which supports the NHS and the many charities upon which public health depends; (5) trigger overt disease in those with asymptomatic pathology or previous good health.  Our report, detailing each of these items, can be downloaded free here.       

We suggest that our concerns could be mitigated by [1] commissioning two pieces of research to establish (a) evidence-based triage criteria to guide occupational health & general practitioner services in deciding which older employees are most at risk; (b) whether extending working lives will increase the mortality risk of older employees in the most disadvantaged occupations. And [2] two changes to administrative regulations to accept (a) greater flexibility in the age range 60-68 years, to accommodate patterns of relapse and remission in chronic disease; (b) that paid employment is not the only type of socially necessary labour at these ages, with informal caring and volunteering as appropriate and legitimate alternatives.

Finally, there are issues of financial loss and workfare.  Many of those now working until age 66 years spent most of their life paying their National Insurance contributions when its regulations increased the size of their State Old Age Pension in line with any years worked beyond the state pension age; the increase in the state pension age removed this entitlement, at a cost per person of up to £300 per month for life which, for Pension Credit recipients, could be the difference between living with or without the older person’s Minimum Income for Healthy Living.  To add insult to injury, now these same individuals find themselves subject to conditionality (fitness for work testing) and sanctioning (benefit cuts), which those who saw the Dispatches report on the subject (Channel 4, 17^th December 2021) will find it hard to believe that MPs intended when they voted through the 2014 Act.    

David Blane
Professor Emeritus of Imperial College London

CORRECTION WITH APOLOGIES

“all three of whom, it may be relevant to note, will be entitled to solid gold pensions when they retire (non-contributory, defined benefit, final salary).” – removed from final line of Paragraph One.

Civil service and parliamentary pensions are contributory (at 6% of salary) and paid on the basis of career average salary; inflation-indexed defined benefits remain.