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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To build its emerging “megaregions”, the USA should turn to trains

Under construction: high speed rail in California. Image: Getty.

An extract from “Designing the Megaregion: Meeting Urban Challenges at a New Scale”, out now from Island Press.

A regional transportation system does not become balanced until all its parts are operating effectively. Highways, arterial streets, and local streets are essential, and every megaregion has them, although there is often a big backlog of needed repairs, especially for bridges. Airports for long-distance travel are also recognized as essential, and there are major airports in all the evolving megaregions. Both highways and airports are overloaded at peak periods in the megaregions because of gaps in the rest of the transportation system. Predictions for 2040, when the megaregions will be far more developed than they are today, show that there will be much worse traffic congestion and more airport delays.

What is needed to create a better balance? Passenger rail service that is fast enough to be competitive with driving and with some short airplane trips, commuter rail to major employment centers to take some travelers off highways, and improved local transit systems, especially those that make use of exclusive transit rights-of-way, again to reduce the number of cars on highways and arterial roads. Bicycle paths, sidewalks, and pedestrian paths are also important for reducing car trips in neighborhoods and business centers.

Implementing “fast enough” passenger rail

Long-distance Amtrak trains and commuter rail on conventional, unelectrified tracks are powered by diesel locomotives that can attain a maximum permitted speed of 79 miles per hour, which works out to average operating speeds of 30 to 50 miles per hour. At these speeds, trains are not competitive with driving or even short airline flights.

Trains that can attain 110 miles per hour and can operate at average speeds of 70 miles per hour are fast enough to help balance transportation in megaregions. A trip that takes two to three hours by rail can be competitive with a one-hour flight because of the need to allow an hour and a half or more to get to the boarding area through security, plus the time needed to pick up checked baggage. A two-to-three-hour train trip can be competitive with driving when the distance between destinations is more than two hundred miles – particularly for business travelers who want to sit and work on the train. Of course, the trains also have to be frequent enough, and the traveler’s destination needs to be easily reachable from a train station.

An important factor in reaching higher railway speeds is the recent federal law requiring all trains to have a positive train control safety system, where automated devices manage train separation to avoid collisions, as well as to prevent excessive speeds and deal with track repairs and other temporary situations. What are called high-speed trains in the United States, averaging 70 miles per hour, need gate controls at grade crossings, upgraded tracks, and trains with tilt technology – as on the Acela trains – to permit faster speeds around curves. The Virgin Trains in Florida have diesel-electric locomotives with an electrical generator on board that drives the train but is powered by a diesel engine. 

The faster the train needs to operate, the larger, and heavier, these diesel-electric locomotives have to be, setting an effective speed limit on this technology. The faster speeds possible on the portion of Amtrak’s Acela service north of New Haven, Connecticut, came after the entire line was electrified, as engines that get their power from lines along the track can be smaller and much lighter, and thus go faster. Catenary or third-rail electric trains, like Amtrak’s Acela, can attain speeds of 150 miles per hour, but only a few portions of the tracks now permit this, and average operating speeds are much lower.

Possible alternatives to fast enough trains

True electric high-speed rail can attain maximum operating speeds of 150 to 220 miles per hour, with average operating speeds from 120 to 200 miles per hour. These trains need their own grade-separated track structure, which means new alignments, which are expensive to build. In some places the property-acquisition problem may make a new alignment impossible, unless tunnels are used. True high speeds may be attained by the proposed Texas Central train from Dallas to Houston, and on some portions of the California High-Speed Rail line, should it ever be completed. All of the California line is to be electrified, but some sections will be conventional tracks so that average operating speeds will be lower.


Maglev technology is sometimes mentioned as the ultimate solution to attaining high-speed rail travel. A maglev train travels just above a guideway using magnetic levitation and is propelled by electromagnetic energy. There is an operating maglev train connecting the center of Shanghai to its Pudong International Airport. It can reach a top speed of 267 miles per hour, although its average speed is much lower, as the distance is short and most of the trip is spent getting up to speed or decelerating. The Chinese government has not, so far, used this technology in any other application while building a national system of long-distance, high-speed electric trains. However, there has been a recent announcement of a proposed Chinese maglev train that can attain speeds of 375 miles per hour.

The Hyperloop is a proposed technology that would, in theory, permit passenger trains to travel through large tubes from which all air has been evacuated, and would be even faster than today’s highest-speed trains. Elon Musk has formed a company to develop this virtually frictionless mode of travel, which would have speeds to make it competitive with medium- and even long-distance airplane travel. However, the Hyperloop technology is not yet ready to be applied to real travel situations, and the infrastructure to support it, whether an elevated system or a tunnel, will have all the problems of building conventional high-speed rail on separate guideways, and will also be even more expensive, as a tube has to be constructed as well as the train.

Megaregions need fast enough trains now

Even if new technology someday creates long-distance passenger trains with travel times competitive with airplanes, passenger traffic will still benefit from upgrading rail service to fast-enough trains for many of the trips within a megaregion, now and in the future. States already have the responsibility of financing passenger trains in megaregion rail corridors. Section 209 of the federal Passenger Rail Investment and Improvement Act of 2008 requires states to pay 85 percent of operating costs for all Amtrak routes of less than 750 miles (the legislation exempts the Northeast Corridor) as well as capital maintenance costs of the Amtrak equipment they use, plus support costs for such programs as safety and marketing. 

California’s Caltrans and Capitol Corridor Joint Powers Authority, Connecticut, Indiana, Illinois, Maine’s Northern New England Passenger Rail Authority, Massachusetts, Michigan, Missouri, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Texas, Vermont, Virginia, Washington, and Wisconsin all have agreements with Amtrak to operate their state corridor services. Amtrak has agreements with the freight railroads that own the tracks, and by law, its operations have priority over freight trains.

At present it appears that upgrading these corridor services to fast-enough trains will also be primarily the responsibility of the states, although they may be able to receive federal grants and loans. The track improvements being financed by the State of Michigan are an example of the way a state can take control over rail service. These tracks will eventually be part of 110-mile-per-hour service between Chicago and Detroit, with commitments from not just Michigan but also Illinois and Indiana. Fast-enough service between Chicago and Detroit could become a major organizer in an evolving megaregion, with stops at key cities along the way, including Kalamazoo, Battle Creek, and Ann Arbor. 

Cooperation among states for faster train service requires formal agreements, in this case, the Midwest Interstate Passenger Rail Compact. The participants are Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, and Wisconsin. There is also an advocacy organization to support the objectives of the compact, the Midwest Interstate Passenger Rail Commission.

States could, in future, reach operating agreements with a private company such as Virgin Trains USA, but the private company would have to negotiate its own agreement with the freight railroads, and also negotiate its own dispatching priorities. Virgin Trains says in its prospectus that it can finance track improvements itself. If the Virgin Trains service in Florida proves to be profitable, it could lead to other private investments in fast-enough trains.

Jonathan Barnett is an emeritus Professor of Practice in City and Regional Planning, and former director of the Urban Design Program, at the University of Pennsylvania. 

This is an extract from “Designing the Megaregion: Meeting Urban Challenges at a New Scale”, published now by Island Press. You can find out more here.