The shrunken state expects families to fill the voids in health and social care. Woe betide those without children | Gaby Hinsliff

3 months ago 3

It was visiting time at the hospital, and the corridors were full of dutiful middle-aged sons and daughters. The woman who held the ward door open for me was balancing a formidable stack of Tupperware boxes: home-cooked food, in case the nurses were too busy to make sure her elderly father ate. Why hadn’t I thought of that? But there’s always something more you probably should be doing; always a ball you might have dropped.

So much about looking after ageing parents reminds me of early motherhood, that old juggling act that, in retrospect, looks almost like a rehearsal. Hello again, my old friend nagging guilt. And hello again, that sense of needing to be in two places at once – except now it’s three, if you are so madly ambitious as to want a job, children and parents.

The frantic tag-teaming is back, too, though this time it’s with my sister, not my husband: if you can take them to this hospital appointment, I’ll do the next. And then there are the nights out with friends that inevitably begin with swapping war stories, because everyone my age seems to be grappling with some version of the same thing. They’re sitting for 36 hours in A&E waiting for an 80-year-old to be found a bed, or chasing hospital follow-up letters that invariably go astray, or spending evenings (as one friend does) opening all the letters her mother can no longer seem to make sense of, wondering if it’s time to get power of attorney.

Since not long ago our mothers were the ones dashing down the motorway to bail all of us out of some childcare emergency or another, it seems fair enough for my generation to be dashing back the other way, now that our toddlers are hulking teenagers. But the risk of a shrunken state relying on families to fill the aching voids in health and social care is that for an increasing number of older people, that kind of family – the kind currently providing 92% of all unpaid care in the UK – just won’t exist.

Already one in 10 people over 60 don’t have children, but for the over-50s that figure jumps to roughly one in five. For some, that will have been by happy choice, but for others it’s the painful consequence of infertility or loss, divorce or never having found the right person, or of having been born gay in an era when adoption or fertility treatment wasn’t an option.

By 2032, the number of childless older people with disabilities who are living alone is expected to have risen by 80% compared with 2007. That’s an awful lot of people without close family to advocate for them, either in a social care system so threadbare that you have to fight for every scrap, or in busy hospitals where the focus often seems to be on patching people up just enough to discharge them, rather than on getting to the root of what is wrong. And by 2045, the Office for National Statistics estimates the number of octogenarians with no children in England and Wales will have tripled.

These numbers have serious human consequences, not just for those involved but for the taxpayer: older people who don’t have children to help look after them are 25% more likely to need to go into a nursing home, according to the campaign group Ageing Without Children. And even for those who do have children, the demographic trend towards smaller families means fewer siblings to share the load – assuming they live near enough, or get along well enough, to try.

We live in the era of “beanpole families”, where falling fertility rates and higher life expectancy together create long spindly family trees, with more generations alive at once than in the past but fewer people in each one. Yet social care services seem built around an imaginary 1950s extended family, who all live round the corner from each other and have a full-time housewife at their heart, free to pop in every lunchtime and cheerfully put a wash on.

The last thing I want to do in raising this is add to a mean-spirited moral panic about what Donald Trump’s new right-hand man, JD Vance, so dismissively called “childless cat ladies”. Making people feel guilty – or worse still, frightened – about not having had the children some of them desperately wanted to have but couldn’t, is cruel and futile, since for the average older person finding themselves in need of care it’s about 30 years too late for regrets. Instead, what we need are services shaped for the way families are now, not the way that proponents of a smaller state would like them to be.

Nearly 27 years after Tony Blair set up his first royal commission on long-term care, there is talk of the new Labour government launching another one, not because it somehow still hasn’t worked out what the options are, but because none of them are easy. Last month the chancellor, Rachel Reeves, scrapped the previous government’s increasingly fictional plan to cap social care costs for people in England from October 2025, blaming her predecessor, Jeremy Hunt, for not setting aside enough money to make it a reality.

While successive Conservative governments have been busily kicking this can down the road ever since the economist Andrew Dilnot recommended a cap to the then prime minister, David Cameron, more than a decade ago, Labour has only ever been lukewarm about the idea. Keir Starmer’s manifesto was artfully vague on the subject, and his new government is committed only to a much broader package of reforms aimed at creating a national care service. Back to the drawing board again it is, presumably.

If the cavalry isn’t coming over the hill any time soon on social care, the very least we can all expect in the meantime should be a significantly more reliable NHS that doesn’t depend on families to hold everything together. That means settling with the GPs – whose work-to-rule action is a particularly frightening prospect for older people in England – and throwing everything at reducing brutally long waiting times, but also improving the often chaotic bureaucracy and poor communication that make services so hard for frail or confused older patients to navigate alone.

The quid pro quo for delaying broader reforms yet again, meanwhile, must be that the final package genuinely reflects the way family life is changing. Let’s just hope that this time, they don’t leave all the really tough decisions until the sons and daughters currently queueing up for visiting hour are lying in hospital beds themselves.