Prof John Ashton, formerly Cumbria’s Director of Public Health and now president of the UK Faculty of Public Health, argues towns must be made more ‘old age friendly’

RECENT concerns about Westmorland General Hospital’s future have put the spotlight on medical care in the South Lakes, highlighting people's anxieties about their security and vulnerability in old age.

I understand this but feel the target is the wrong one. Having lived in Cumbria since 2006, I have confidence the range of services now available in Kendal and being developed are exactly the kind of clinical services we will need as we enter the period of our decline.

My concern is about the lack of ambition to reshape our living environment to support a healthy, independent and safe old age. The issues which should be concerning us are much more about town and country planning.

People are now living into their 80s, 90s and beyond. The problems facing us now are how to fashion and shape neighbourhoods to enable us to live a full life as long as possible.

In Cumbria over 6,000 people suffer from dementia and that could almost double over the next few years. This toll could be reduced if everybody had access to the best quality general practice services to control blood pressure and other related conditions.

In Cumbria we are making significant progress in the quality of general practice through the Closer to Home approach. But if you do have dementia it is possible to remain at home, living independently for an extra year or two with the right kind of housing, safe environment and good neighbours and social support.

For 10,000 people to be able to be at home for an extra year or two translates into possibly 20,000 bed years not requiring a hospital, care home or residential care home bed. But to pull that off means we need to re-engineer our villages and towns to be ‘old age friendly’.

Many acute ambulance call outs are because of falls. Many falls can be avoided if people live in the right housing type with no stairs, hazardous carpets and flexes. Fire and rescue services have begun to carry out risk assessments in older people’s houses as part of their new role in public protection when fitting smoke alarms, but much more can be done.

Every year tens of millions of pounds are being spent on new or refitted housing in the county but we are still not using that investment to reshape our communities to cope with the demographic tsunami of old age which will soon be upon us.

We can't hold a candle to the Victorians, who redesigned our towns and cities to avoid epidemics and industrial pollution by zoning living and working areas and through vigorous town and outcry planning.

Around a third of widows are depressed, suffering from isolation and loneliness and often afraid to go out because of fear of crime or traffic.

The majority of able bodied older people cannot cross at a Pelican crossing in the time allowed because we have allowed the motor car to dominate our lives.

We know from Japan that elderly people who live within walking distance of small areas of green space live longer than those who don't. They are able to meet friends for a chat, maintain contact with the world and get some exercise just by redesigning our neighbourhoods to having pocket handkerchief parks.

And if these include children's play areas they are able to keep in touch with the younger generations.

We need some Elizabethan vision to match that of the Victorians. We need new blueprints to shape our urban and rural villages and neighbourhoods whenever investment or planning decisions are made.

In embracing a new vision we can massively reduce the need for motorised transport and restore the active transport of walking and cycling to its rightful place.

So what is stopping us? Lack of vision? Lack of leadership? Inertia?

The agenda is clear. We need to realise that money spent on producing child and elderly friendly neighbourhoods will translate into huge savings on the NHS and economic renewal for us all.