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%
9% 24% 41% 61% 84% Calendar year ’07 estimate P Knight Scottish Government
Demographic change for population aged 65+ Scotland Potential impact on specialist care services 2007-2031 1-9 hrs Home care 10+ hrs Home care Care Home Cont h/care (hosp) Projection 26% 94% P Knight Scottish Government Community Care - Impact
Health and social care expenditure Scottish population aged 65+ (2007/08 total=£4.5bn)
What this all means for Scotland … A new 600 bed hospital every 3 years for 20 years A new 50 bed care home every 2 weeks for 20 years £2.8 billion investment in sheltered housing to “stand still” Virtually all school leavers into the care sector by 2030
all this will require by 2016 22% increase in health and social care expenditure [extra £1 billion!] while 8% reduction in public expenditure* [* Institute of Fiscal Studies estimate] it just doesn’t add up!
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 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 expectancy prospects Pension provision Older people provide far more care than they receive
Home Care – some observations Huge variations across Scotland 45% local authority home care staff 50+ years old 40,000 of 65+ provide 20+ hours care per week 3,000 65+ receive more than 20 hours per week paid care 1:2 ratio of 10 hours and home care to care home
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) Engagementfrom Now Emerging proposals to MSGDec 09 Wider engagementJan 10
Reshaping Care for Older People … 8 workstreams Vision and engagement Care at home – a mutual care approach 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?
Care at Home – some emerging ideas …… Better integrated approaches -across health, housing and social care -across paid, unpaid and volunteer care More anticipatory and preventative care -support to unpaid carers/volunteers - telehealthcare -“contact and connect” support Better crisis care - appropriate rapid response -24/7 cover - telehealthcare
Develop and support volunteer and unpaid care -older people as carers -“back-up” for unpaid carers -? Fiscal incentives (reserved matters) More complex care at home - integrated approaches across acute, primary and social care -telehealthcare Focus on re-ablement/outcomes/goals -rehabilitation -support to do not services done to -more personal budgets/Self Directed Support
Other emerging ideas …… Remodelling care homes to provide more specialist care Improved ‘care pathways’ – especially in/out hospital New models of sheltered housing – very sheltered and ‘hub and spoke’ Promoting healthy lives – self management of long term conditions – active ageing Building the workforce – integration across health and social care – integration across paid and unpaid and volunteers and finally – Need to model the costs and the funding options for the size and scope of care services we will need over the next 20 years