Caring For The Elderly Biggest NHS Challenge

An increase in the ageing population might be one of the biggest challenges to the delivery of health care in the Highlands, bigger perhaps than smoking, alcohol abuse and obesity.

This has been suggested by Dr Eric Baijal, the Inverness-based director of public health with NHS Highland, in his annual report, released today.

Dr Baijal says the ageing of the population, together with the increasing prevalence of risk factors for long term conditions (LTCs), for example increasing obesity, will lead to a significant increase in diabetes, will further increase demands on the NHS from LTCs.

At the same time a falling population of working age will reduce the tax base needed to fund public services and limit the available workforce and number of younger informal carers.

He states: “The implication is, that with resources likely to diminish relative to demand, and evidence that current practice is not coping, the NHS will be unsustainable unless new ways of working are implemented.”

Dr Baijal says: “Some 80% of NHS activity relates to the management of LTCs and their consequences. There is evidence that the health and social care services are struggling to manage the increasing prevalence of LTCs in an ageing population.

“One example of this is the significant increase in hospitalisation of the elderly over the past 20 years, disproportionate to the actual rise in the elderly population.

“Almost all of this increase has been in the over 75s

“Only around 30% of it can be explained by the increased numbers of over 75s in the population – leading to the conclusion that social/ ultural factors and the way we provide health and social care are also contributors.

“Some of this increase in admissions may of course be entirely appropriate.

“However, more importantly there is evidence that streamlining the way we deliver care and increased social support in the community would improve the quality of care for many patients.

“Reducing avoidable hospital admission which is neither good for patients, nor the NHS would an additional bonus.”

The answer to the problem are initiatives to promote healthier lifestyles applied to the whole population to stem the tide by preventing LTCs says Dr Baijal, along with integrated care programmes drawn up with GPs. Most people with LTCs will, with proper advice about what to expect, be largely able to manage their conditions themselves, he believes, and the role of social care will be as important, if not more, than that of health care in meeting the needs of many of these patients.

It is estimated that over the next 30 years, the prevalence of dementia is expected to triple.

In Highland, 35,000 people are predicted to be affected by dementia in the year 2024, doubling the current numbers.

Dr Baijal reports that there is a new national emphasis on earlier diagnosis and treatment, including appropriate support after diagnosis.

Now all NHS areas have to develop new treatment pathways for dementia by 2010, and an NHS Highland group, with representatives from all areas of Highland, is developing this at present. Part of their work will be identifying ways of supporting rapid early diagnosis and support.