Almost one in five people in England (19%, or 11m) are now aged 65 or over, and the Centre for Ageing Better projects a further 3.3m over the next 20 years. Yet the system supporting them was designed for a very different population, and the strain already shows in our hospitals, A&E departments and GP services.

Prime Minister Andy Burnham put figures on this in July: around 2m adults in England with unmet care needs; about 6m over-65s going to A&E each year, roughly double the 2010 level; and 13,600 patients medically fit for discharge but unable to leave (a monthly average). These are Government-cited figures.

With International Day of Older People today on 1 October, this is now a political debate too. In his conference speech on 29 September, Burnham, committed to a National Care Service (NCS) for England: free at the point of use, starting in the home, and part-funded by changing the state pension triple lock from April 2030. Reports speculate this will include home care but not bed and board. The proposal will go to voters at the next election, and Baroness Casey's review, now due by summer 2027, will define the design.

I welcome the ambition, but it is a proposal, not yet a service. The IFS says the pension change alone will not fund the NCS in the next Parliament, and Sir Ciarán Devane of the NHS Alliance notes that a universal service will not by itself better integrate with the NHS. Funding is only half the answer. Three shifts are needed to improve care for an ageing population: integrated care pathways, people-centred care and better use of data and AI.

1. Build integrated care pathways

Acute hospitals, care homes, home care, hospital at home and community services all matter. When they do not work as one pathway, people are passed between services, information is lost, care arrives too late and outcomes may be poor. Burnham's example is telling: a 15-minute home visit that cannot complete the task ends in a 999 call and, too often, an avoidable admission.

Healthcare is nationally funded and free at the point of use; social care is means-tested, locally administered and funded separately. Budgets, workforces, data and accountability all differ, yet an older person needs one journey. A National Care Service could close that gap, but only if pathways are designed jointly. I would make the home the starting point, with community nursing, virtual wards, hospital at home, care homes and home-care providers sharing responsibility for outcomes. The ambition to treat health and care as one workforce, building on the Fair Pay Agreement due in 2028-29, points the same way.

2. Put patients at the centre

Care should be organised around the outcomes that matter to each person, not the institution delivering it. The test for every setting should be: which one delivers the right outcome safely, at the right time? Hospital treatment today, rehabilitation tomorrow and support at home afterwards should be planned together, making care more timely and avoidable admissions less likely.

If bed and board sit outside the offer, a line between care and living costs is needed, and UK providers do not bill these separately today. How that distinction is drawn will determine how much of a home's income the state underwrites and how care home residents are treated is not yet clear.

Pooled funding and joint commissioning would help, because fragmented budgets encourage one part of the system to save money while creating cost elsewhere. The aim is the best safe outcome for the individual, not the cheapest option.

3. Use data and AI to support care

Integrated data should be a foundation of care. Every provider involved in someone's support, including care homes and home care services, should be able to access and contribute to one reliable record. Without it, no provider can be a full partner in an integrated pathway.

Data can also help staff plan ahead. Predictive tools and AI could flag deterioration or admission risk earlier and help commissioners plan beds, care hours and community capacity before demand becomes a crisis. Evidence of impact at scale is still emerging, so I would start with the basics: shared records reduce administration and free staff for the human contact that remains central to good care.

An opportunity to redesign care

Living longer should be an opportunity, not a stress test. Political commitment is welcome, but money alone will not deliver a better system. Integrated pathways, person-centred planning and well-used data will. The system must be turned upside down: start with the person at home, provide the right support around them and use hospital care when it is genuinely needed. The longer we wait, the harder that redesign becomes and the higher the bill for society.