When I'm sixty‐four

At ICN we scan all United Nations (UN) agency websites and examine hundreds of publications for relevance to our profession. While this may not sound exciting, it is essential if we are to influence and shape agendas and stay on top of issues that, in some cases, may not directly and profoundly impact nursing practice for another 40 years. Some of the publications we have read recently include the WHO World Health Report 2010 (World Health Organisation 2010); a UN report on World Population Ageing (United Nations Department of Economic and Social Affairs 2010); the Institute of Medicine's paper, the Future of Nursing (Institute of Medicine 2010); and the Lancet Commission's Health professionals for a new century (Frenk et al. 2010). Collectively these documents fall only a little short of 1000 pages. Although not explicitly stated, all four documents draw into sharp focus the challenge of achieving the right balance between the costs, quality and quantity of services. Each in their own way also highlights the critical need to ensure that there are sufficient people with the right skills to deliver services. With the exception of the population report, the documents limit their discussion to problems of today or, at best, the next decade. None of the reports asks the most difficult question: in view of the changing global demographic profile, how will we be able to meet health needs 40 years from now? Or as the Beatles asked 40 years ago: ‘Will you still need me, will you still feed me, when I'm 64?’ One indicator is the potential support ratio (PSR) – the number of persons aged 15 to 64 years for each person aged 65 or more – which predicts the number of workers per older person. For countries with publicly funded health services, the PSR also predicts how feasible it will be to pay for services through taxation. Between 1950 and 2009, the PSR declined from 12 to 9, and it is projected to drop to 4 by 2050. This means that we need to have a fundamental debate about who will provide care and how it will be funded forty years from now. We also need to think about the role that technology might play and how we can design care delivery systems that support an older workforce. Another consideration is the role that society can play in keeping itself healthy. We need to reverse the overwhelming growth in non-communicable diseases such as diabetes, and broaden the scope of what we view as non-communicable diseases to include addressing problems of mental health. Producing more nurses will only be part of the solution. Ensuring that they work to their maximum scope will be critical. Any sustainable solution must include coherent and dynamic career frameworks, appropriate benefits and adequate retirement pensions. Resolving the issues and challenges related to providing health care in future decades will take a long time. If our generation does not put in place solutions and start making the necessary course corrections, it is highly unlikely that we will have an answer to: ‘Will you still need me, will you still feed me, when I'm 64’? Instead we will know that our inaction contributed to a crisis of our own making and those who practice nursing in 2050 will have us to thank. We must put together the documents and read between the lines to target problems that are not yet on the priority list. Allow me to close with words from other Beatles songs. If we simply ‘let it be’, health care provision will certainly be ‘a long and winding road’. However if we take decisions that support our longer term and mutually agreed upon goals, I am sure that together ‘we can work it out’. I believe that we, the current generation, have a responsibility to our successors to do so.