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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Here’s a fantasy metro network for Birmingham & the West Midlands

Birmingham New Street. Image: Getty.

Another reader writes in with their fantasy transport plans for their city. This week, we’re off to Birmingham…

I’ve read with interest CityMetric’s previous discussion on Birmingham’s poor commuter service frequency and desire for a “Crossrail” (here and here). So I thought I’d get involved, but from a different angle.

There’s a whole range of local issues to throw into the mix before getting the fantasy metro crayons out. Birmingham New Street is shooting up the passenger usage rankings, but sadly its performance isn’t, with nearly half of trains in the evening rush hour between 5pm and 8pm five minutes or more late or even cancelled. This makes connecting through New Street a hit and, mainly, miss affair, which anyone who values their commuting sanity will avoid completely. No wonder us Brummies drive everywhere.


There are seven local station reopening on the cards, which have been given a helping hand by a pro-rail mayor. But while these are super on their own, each one alone struggles to get enough traffic to justify a frequent service (which is key for commuters); or the wider investment needed elsewhere to free up more timetable slots, which is why the forgotten cousin of freight gets pushed even deeper into the night, in turn giving engineering work nowhere to go at all.

Suburban rail is the less exciting cousin of cross country rail. But at present there’s nobody to “mind the gap” between regional cross-country focussed rail strategy , and the bus/tram orientated planning of individual councils. (Incidentally, the next Midland Metro extension, from Wednesbury to Brierley Hill, is expected to cost £450m for just 11km of tram. Ouch.)

So given all that, I decided to go down a less glamorous angle than a Birmingham Crossrail, and design a Birmingham  & Black Country Overground. Like the London Overground, I’ve tried to join up what we’ve already got into a more coherent service and make a distinct “line” out of it.

Click to expand. 

With our industrial heritage there are a selection of old alignments to run down, which would bring a suburban service right into the heart of the communities it needs to serve, rather than creating a whole string of “park & rides” on the periphery. Throw in another 24km of completely new line to close up the gaps and I’ve run a complete ring of railway all the way around Birmingham and the Black Country, joining up with HS2 & the airport for good measure – without too much carnage by the way of development to work around/through/over/under.

Click to expand. 

While going around with a big circle on the outside, I found a smaller circle inside the city where the tracks already exist, and by re-creating a number of old stations I managed to get within 800m of two major hospitals. The route also runs right under the Birmingham Arena (formerly the NIA), fixing the stunning late 1980s planning error of building a 16,000 capacity arena right in the heart of a city centre, over the railway line, but without a station. (It does have two big car parks instead: lovely at 10pm when a concert kicks out, gridlocks really nicely.)

From that redraw the local network map and ended up with...

Click to expand. 

Compare this with the current broadly hub-and-spoke network, and suddenly you’ve opened up a lot more local journey possibilities which you’d have otherwise have had to go through New Street to make. (Or, in reality, drive.) Yours for a mere snip at £3bn.

If you want to read more, there are detailed plans and discussion here (signup required).