Which cities will be hit hardest by the social care crisis?

Blackpool, which may be uniquely placed to have a really awful time in the next few decades. Image: Detroit Publishing Co.

The latest instalment of our weekly series, in which we use the Centre for Cities’ data tools to crunch some of the numbers on Britain’s cities.

We have a problem. People aren’t getting any younger, their brains aren’t getting any healthier, and the NHS that was founded to care for them isn’t being particularly well funded.

The wonders of medicine seem to have brought us to a place where people can be physically fit, relatively speaking, for years and years longer than ever before, but where debilitating degradations of the mind such as Alzheimer’s and dementia are snatching more and more of our loved ones from us, replacing them with forgetful, changed shells.

And it’s on that cheerful note that we’re faced with an NHS that hasn’t seen serious increases in funding since the end of New Labour in 2010, and a social care system that has only been further frustrated by the disastrous part-implementation of the Lansley reforms during the Coalition government.

So. We know there’s a problem. And as we know that cities aren’t really mythical lands of young people strolling around being fresh and hip: our urban centres will have to tackle the demographic shift of people getting older and living longer, too. Whether it’s ensuring our cities are accessible, guaranteeing at-home care for the elderly in urban flats, or building assisted living retirement villages alongside homes for first-time buyers, there’s planning to be done.

But which cities will face the biggest burden? There are three ways to handle this question, from a data-led perspective.

The easiest answer is demographic.

The cities with the highest proportion of people aged over 65, as per the most recent census in 2011, are Bournemouth, Blackpool, Worthing, Southend, and Birkenhead.

The top ten cities by proportion of population over 65. Click to expand. Image: Centre for Cities

But though there are only three cities with more than 20 per cent of the population over 65, a hefty 32 cities have more than 15 per cent of retirement age.

And those proportions will undoubtedly grow.

The top ten cities by proportion of population aged 45-64. Click to expand. Image: Centre for Cities

At least 28 cities count 45-64-year-olds as more than a quarter of their populations – scattered from Blackpool in the lead to Swindon in 28th place, with Swansea and Glasgow somewhere in the middle.

While some of those may retire out of cities and into the countryside, the bulk will stay, putting added pressure on city services just as many try to keep themselves attractive and affordable for younger people to move, work, and produce.

The wealth of cities is an important factor, too. For many older people, care problems are solved privately, with baby boomers sitting on tidy nest eggs that can be slowly dribbled out to private care homes in the twilight years. Properties can be sold when their residents move into homes or granny annexes, and the proceeds used to pay for visiting nurses, so on and so forth.

As per usual, the richer you are, the sweeter a deal you get. Data-wise, the poorer a city, the more likely it is that more people will have no financial option other than to turn to the good old NHS.

The bottom ten cities by average weekly workplace earnings. Click to expand. Image: Centre for Cities

Southend, Wigan, Huddersfield, and Birkenhead fall at the bottom of the list for average weekly workplace earnings, based on data from 2016. Norwich, Worthing, Doncaster, Stoke, Swansea and Barnsley make up the remainder of the bottom ten, whilst cities like London, Reading, and Crawley predictably fill up the top spots.

Obviously housing costs are something to bear in mind when it comes to actual day-to-day disposable income and wealth, but with regards to your ability to pay for a private care home, a low disposable income living in a £1.5m Chiswick town house is probably going to do you more good than a relatively higher disposable income living in a rented property in say, Swansea.

The bottom ten cities by mean house price. Click to expand. Image: Centre for Cities

Take a look at the mean house prices in 2016, and cities such as Burnley, Hull, Blackburn, Barnsley and Sunderland take a star turn languishing in the bottom ten – which suggests that even homeowners in those cities may have less equity to flash around if a home is sold to pay for private social care. 

In a similar vein, looking at the data for welfare spend per capita may also provide clues as to which cities will face higher demand on state provision for social care.

The top ten cities by welfare spend per capita. Click to expand. Image: Centre for Cities

Data from 2014 shows Cambridge and Oxford clocking the lowest welfare spend per capita, while the top five are Sunderland, Swansea, Birkenhead, Liverpool, and Blackpool.

Bringing up the rear of the top ten highest welfare spends per capita are Burnley, Dundee, Middlesbrough, Blackburn, and Newport.

By this point, it’s noticeable that certain cities keep cropping up.

Cambridge, Oxford, and London have people with higher incomes who cost less in terms of welfare spend per capita – and also don’t have particularly high proportions of people over 65.


By contrast, Blackpool repeatedly tops charts of high welfare spends, low weekly incomes, and high proportions of people over 65. Birkenhead crops up repeatedly, while the cities of South Wales and the south coast clock in a few appearances.

The social care crisis will be felt by all of us as our grandparents, parents, and – eventually – we grow older.

If you’re in Surrey, you’ll probably get on just fine. But in Blackpool, Birkenhead, or south Wales?

Best of luck to you. 

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More than 830 cities have brought essential services back under public control. Others should follow

A power station near Nottingham: not one owned by Robin Hood Energy, alas, but we couldn't find anything better. Image: Getty.

The wave of cities worldwide rejecting privatization is far bigger and more successful than anyone thought, according to a new report from the Transnational Institute, Reclaiming Public Services: How cities and citizens are turning back privatisation. Some 835 cities in 45 countries have brought essential services like water, energy and health care back under public control.

The persistent myth that public services are by nature more expensive and less efficient is losing its momentum. Citizens and users do not necessarily have to resign to paying increasingly higher tariffs for lower standard services. The decline of working conditions in public services is not an inevitability.

And the ever larger role private companies have played in public service delivery may at last be waning. The remunicipalisation movement – cities or local authorities reclaiming privatised services or developing new options – demonstrates that cities and citizens are working to protect and reinvent essential services.

The failure of austerity and privatisation to deliver promised improvements and investments is part of the reason this movement has advanced. But the real driver has been a desire to meet goals such as addressing climate change or increasing democratic participation in service provision. Lower costs and tariffs, improved conditions for workers and better service quality are frequently reported following remunicipalisation.  Meanwhile transparency and accountability have also improved.

Where remunicipalisation succeeds, it also tends to inspire other local authorities to make similar moves. Examples are plentiful. Municipalities have joined forces to push for renewable, climate-friendly energy initiatives in countries like Germany. Public water operators in France and Catalonia are sharing resources and expertise, and working together to overcome the challenges they meet.

Outside Europe, experiments in public services are gaining ground too. Delhi set up 1,000 Mohalla (community) clinics across the city in 2015 as a first step to delivering affordable primary health care. Some 110 clinics were working in some of the poorest areas of Delhi as of February 2017. The Delhi government claims that more than 2.6m of its poorest residents have received free quality health care since the clinics were set up.


Local authorities and the public are benefiting from savings too. When the Nottingham City Council found out that many low-income families in the city were struggling to pay their energy bills, they set up a new supply company. The company, Robin Hood Energy, which offers the lowest prices in the UK, has the motto: “No private shareholders. No director bonuses. Just clear transparent pricing.”

Robin Hood Energy has also formed partnerships with other major cities. In 2016, the city of Leeds set up the White Rose Energy municipal company to promote simple no-profit tariffs throughout the Yorkshire and Humberside regions. In 2017, the cities of Bradford and Doncaster agreed to join the White Rose/Robin Hood partnership.

Meanwhile, campaigners with Switched on London are pushing their city to set up a not-for-profit energy company with genuine citizen participation. The motivations in these diverse cities are similar: young municipal companies can simultaneously beat energy poverty and play a key role in achieving a just and renewable energy transition.

Remunicipalised public services often involve new forms of participation for workers and citizens. Remunicipalisation is often a first step towards creating the public services of the future: sustainable and grounded in the local economy. Inspiration can be found in the European towns and villages aiming for 'zero waste' with their remunicipalised waste service, or providing 100 per cent locally-sourced organic food in their remunicipalised school restaurants.

Public services are not good simply because they are not private. Public services must also continuously renew themselves, grow, innovate and recommit to the public they serve.

The push for remunicipalisation in Catalonia, for example, has come from a movement of citizen platforms. For them, a return to public management is not just an end in itself, but a first step towards the democratic management of public services based on ongoing civil participation.

Evidence is building that people are able to reclaim public services and usher in a new generation of public ownership. The momentum is building, as diverse movements and actors join forces to bring positive change in communities around the world.

You can read the Transnational Institute report, “Reclaiming Public Services: How cities and citizens are turning back privatisation”, on its website.