Shaping the future of care of older people in Scotland

The changing shape of Scotland’s population

Some headline projections Scotland’s 65+ population projected to rise by 21% between 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 hrs Home care 10+ hrs Home 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)

Current service provision by service type

Current service provision by age group % 88% 60%

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 % 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!

The policy response: Shifting the Balance of Care Old Care Model Geared towards acute conditions Hospital centred Episodic care Disjointed care Reactive care Patient as passive recipient Self care infrequent Carers undervalued Low tech New Care Model Geared towards long-term conditions Embedded in communities Team based Continuous care Integrated care Preventative care Patient as partner Self care encouraged and facilitated Carers supported as partners High tech

EXAMPLE:TELECARE & DEMENTIA Wristcare Medication Reminder VideoPhone

Reshaping Care of Older People Vision and engagement Demographics and funding Care at home Care homes Planning for ageing communities Healthy life expectancy Workforce Care pathways

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

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?

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