Imperatives for Change: Shaping the Future of Care

Mike Martin - JIT

The changing shape of Scotland’s population

Some headline projections

> Scotland’s 65+ population projected to rise by 21% between 2006 - 2016

> By 2031 it will have risen by 62%

> For the 85+ age group specifically, a 38% rise is projected for 2016

> And, for 2031, the increase is 144%

Where to start?

Hospital admission

Past trend in Emergency Admission Bed Days for people aged 65 and over

2,400,000

2,500,000

2,600,000

2,700,000

2,800,000

2,900,000

1998/99 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07

Financial year

no

.of

bed

day

s

HEAT

Demographic change for population aged 65+ ScotlandPotential impact on emergency bed numbers 2007-2031

0

2000

4000

6000

8000

10000

12000

14000

16000

Y/E Mar 2007 Projected2011

Projected2016

Projected2021

Projected2026

Projected2031

Year

Be

ds

9%24%

41%

61%

84%

Calendar year ’07 estimate

P Knight Scottish Government

And in the community at large…

Demographic change for population aged 65+ Scotland Potential impact on specialist care services 2007-2031

0

40000

80000

120000

160000

200000

Actual2007

2011 2016 2021 2026 2031

N of

peo

ple

1-9 hrsHome care

10+ hrsHome care

Care Home

Cont h/care (hosp)

Projection

26%

94%

P Knight Scottish Government

Health and social care expenditure Scottish population aged 65+ (2007/08 total=£4.5bn)

Other Social Work

Care Homes

Home Care

FHS

PrescribingCommunity

Other Hospital care

Emergency admissions

£1.4bn

£0.8bn£0.4bn

£0.4bn

£0.4bn

£0.3bn

£0.6bn£0.2bn

Projected Health and Social care expenditure for Scottish populatiion aged 65+

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

2007/08 Actual 2011 2016 2021 2026 2031

£m

NHS Social Work

22%

74%

Extracts From:

Re-shaping Care for Older People Joint Leadership Summit

19th May 2009

Colin Mair, Chief Executive

Improvement Service

Finance & Demand 2009/10 – 2013/14 (% terms)

0

-2.04

-5.78

-9.18

-12.9

0

-2.04

-3.74

-5.44

-7.14

0

-2.04 -2.04 -2.04 -2.04

0

2

4

6

8

-15

-10

-5

0

5

10

2009/10 2010/11 2011/12 2012/13 2013/14

IFS

CPPR

UKTreasuryDemand

Budget & Demand Changes (Real Terms) 2009/10 – 2013/14

-13

-3.8

8.1

-2

-7

-14.5

-9.5

-4.5

0.5

5.5

Budget % Change Budget Cash Change(£Bn)

Demand Growth (%)

IFS

CPPR

The Treasury Forecasts

> Assumes more than trend rate of economic growth by 2012/13

> We will borrow at least £712 billion across next 5 years (we borrowed in total £500 billion across the last 350 years)

> We have not come out of any previous recession (1970’s, 1980’s, 1990’s) in this way

> 1.5 million unemployed still assumed

Longer Term (13/14 – 17/18)

> Structural gap in public finance opening up – 6.3% national income by 2017/ 18

> Tax rises & spending cuts (25/75 balance) will claw back 50%, remainder to be identified – “2 Parliaments of pain”

> If 25/ 75 balance maintained spending will rise 1% real terms per annum maximum across next 20 years

Facing the Challenges

- An Outcomes Focus…………..

An Outcomes focus – What it means

> Frail and vulnerable people supported to live at home

> Control and decisions with the individual> Strong, caring, supportive communities> Fairness and equity> High quality environment> Contributing to local economy

Growing old-

> Not an illness; a state of being

> Should we shift our focus?

Current service provision by service type

People aged 65 and over

hospital est

care home

home care

all others

Current service provision by age group

75-84

85+

65-74

97%

88%

60%

Some further Considerations

> Tenure implications – an equity stake> ‘Young until your dead’ – self image> Economically active> Politically active and influential> Best healthy life expetancy prospects> Pension provision> Older people provide far more care than they

receive

Sorry we’re

too busy just

now

Reshaping Care for older people

programme

Reshaping Care for older people …..

> Into the Spotlight Conference (Dec 08)>Lord Sutherland Review of Free Personal and Nursing Care (Dec 08)>Ministerial Strategic Group (Dec 08-March 09)>Joint Leadership Summit (May 09)>Engagement from Nov

Reshaping Care for Older People … 8 workstreams

> Vision and engagement> Care at home – a mutual care> Care homes> Care pathways> Planning for ageing communities> Workforce> Healthy life expectancy> Demographics and funding

It has to be … outcomes

>How well do our services help achieve our policy goals?

>How can we help people stay out of the formal care system?

>How can we support self care?> Is it a change of philosophy and approach –

support not services?>We are doing it now – in pockets – what’s

stopping the spread?