Shaping the future of careof older people in Scotland

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%

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

Bed

s

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

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%

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%

What this all means for Scotland …A new 600 bed hospital every 3 years for

20 yearsA 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 201622% 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 … outcomesHow 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