Ageing population presents challenges for health NHS and care sector

BY 2036, according to a recent Public Health Wales report, there will be more than 184,000 people aged 85 years and over in Wales.

That equates to a rise of 145 per cent on the figure in 2011 (around 75,000). Rates vary across Wales and in the Aneurin Bevan University Health Board area covering Gwent, the projection is that the increase will be slightly higher.

We are living longer – the average age creeps higher every year – and the projections suggest that is a big factor in an estimated nine per cent increase in the population of Wales from 2011-36, to more than 3.3 million.

This population increase will be bolstered too by a likely increase in 65-84 year-olds of around 40 per cent over the same period. Meanwhile, the number of people aged under 65 is set to fall by a little over one per cent.

The issue of an ageing population is one that occupies governments the world over, and the Welsh Government is no different.

It was identified as a key issue for the last Assembly, a research service publication questioning whether the policy of enabling older people to maintain their independence and stay in their own homes was sustainable in the face of public spending cuts.

That question is just as, if not more, relevant today after several more years of those sorts of cuts, and with the prospect of increasing numbers of older people requiring help to be looked after.

The Welsh Government, the NHS, councils and the care sector will all play a key role in managing and providing for the needs of an ageing population. That task requires a great deal of working together, but with each having different sets of priorities and targets, things will not always run smoothly.

There is too, as ever, a responsibility on individuals to live healthy or healthier lifestyles.

In April this year, the Social Services and Wellbeing Act (Wales) 2014 came into force. Several years in development, it is one of the most wide-ranging pieces of legislation passed in Wales.

As well as focusing heavily on protection and regulation issues, the Act will give people a greater say over the support they need, and will give carers an equal right to be assessed for support.

Welsh Local Government Association chief executive Steve Thomas hailed it as “a new vision for social care services in Wales” but acknowledged that, within a continuing difficult financial climate, “meeting the cost of these new duties will be challenging.”

“Local government welcomes this Act for its clear focus on preventative public services and the need to integrate health and social care budgets in Wales. This is vital if we are to meet the challenges that our care services will face now and in the future.”

With the Act just four months in, it remains to be seen whether the integration of health and social care budgets helps provide a stronger care sector.

If it does, that can only help the NHS, which is experiencing ever increasing demand, much of it fuelled by the ageing population.

Hospital emergency departments are seeing big increases in the number of older patients with more complex problems coming through the doors, and health boards like Aneurin Bevan University Health Board are investing in services designed to make sure these patients can be seen and, as soon as possible and where appropriate, be provided with the support they require to be discharged home.

The issue of manpower also has to be addressed when looking at how the health and care needs of increasing numbers of older people are to be met.

The NHS in Wales, indeed across much of the UK, is facing recruitment problems, notably for nurses and doctors, and the care sector has similar issues.

Staff from overseas have played and continue to play a major role in the NHS and the care sector. Gwent’s health board, in common with others in Wales and beyond, has been recruiting nurses from Europe and beyond in recent months.

Quite where the recent Brexit vote, in which the issue of immigration played a major role, leaves the health and care sectors with regard to recruitment remains to be seen – but a clear plan in relation to staffing the likely increases in demand from an ageing population is needed sooner rather than later, in Wales and beyond.

There are challenges for everyone – individuals, the NHS, councils and the care sector – in preparing for and dealing with an ageing population, says Gwent’s director of public health.

Dr Gill Richardson, director of public health with Aneurin Bevan University Health Board, said a higher proportion of 65-84 year-olds and those aged 85 and over will be ill, and a higher proportion from the latter category will become increasingly frail.

“Age interferes with the body’s ability to repair. As you get older, your tissues take a lot longer to mend,” she said.

“For 65-84 year-olds, it depends if they are well or ill, and a lot of that will depend on their lifestyle when younger.

“For those aged 85 and over, because the body has loses its ability to repair, we are looking at three areas of decline – cognitive, physical and social.

“With cognition, mental processes do tend to slow with age. That might not mean dementia, Alzheimer’s, but an increasing proportion will have problems in this area.

“Physical problems might affect joints, eyes, organs – we might see more diseases of the heart, kidneys, blood. The longer lives get, the more cancers we will see.

“The social issues are around an increasing need for support, for people to remain in their own homes.

“For instance, you might have two people caring for each other. Together they can look after each other a little bit. If one becomes ill however, the other might not be able to cope on their own.”

Dr Richardson said there is not as much capacity in the care sector as an increasing ageing population is going to need.

“The home care sector is facing difficulties at the moment with austerity, councils have less funds to spend yet the overheads – the cost of consumables, the minimum wage – are increasing,” she said.

“The funding needed to deliver care has gone up and there is a shortfall in recruitment and retention because it is not an obvious choice for school leavers to go into caring.

“There is a lack of sheltered housing and residential accommodation, and for those more unwell there is a lack of nursing home capacity for those with the consequences of ageing on cognition.”

“If we are going to look after our population when they get older, we need a sustainable care sector with career progression for its staff.

“We need to be creating training centres of excellence for home care, and clear pathways into nursing, making these careers attractive.”

Living healthily, or adopting healthier lifestyles earlier, will give people the best possible chance of remaining healthier for longer, said Dr Stephenson.

“If people do live well, there is no reason why they should not live a healthy and long life,” she said.

“For instance, people in Sardinia and rural Japan seem to live well for longer, as well as living longer.

“They tend to have high levels of physical activity and have lower amount of animal fat in their diet, which tends to be low in processed food and red meat, high in vegetables, fruit, fish and white meats, and vitamin D. Smoking and alcohol consumption is lower too.

“It is not all down to lifestyle, some people will get diseases like cancer and diabetes, and other problems, through no fault of their own.

“But we can give ourselves the best possible chance by adopting a healthier lifestyle earlier.”

l Last January, Care Forum Wales chairman Mario Kreft sounded a stark warning on the future of a social care sector he said was facing a “perfect storm” around the issue of funding.

He spoke of a combination of years of inadequate funding and the requirement for care homes and domiciliary care companies to fund the – albeit justified – National Living Wage without any idea where the money was coming from, as threatening the viability of many providers.

Care Forum Wales was set up more than 20 years ago, to give health and social care providers a collective voice in the debate about how to provide the best outcomes for those who need social care.

A little over six months on from his warning – and with the new Social Services and Wellbeing (Wales) Act 2014 enacted in the meantime, and Labour once again in power in Cardiff Bay following Assembly elections – its chairman remains pessimistic.

An ageing population means that in 2036, even if the majority of us are living healthier lives and can remain independent for longer, there is likely to be continued and increased demand for residential and nursing homes places.

But Mr Kreft believes social care is at a tipping point in 2016, and the new Welsh Government needs to act.

“Labour’s manifesto (for the recent Assembly elections) very clearly stated that they saw social care as a sector of national importance. To me, the suggestion there is that it is as important as say, road and rail,” he said.

“We need a sustainable NHS that people can flow through, and this is where the care sector comes in.

“But the pressure on the NHS today in Wales is directly affected, negatively, by a lack of foresight and planning in social care policy in Wales.”

He claims that too often, the NHS – in the form of health boards – and councils do not talk, let alone work together on delivering social care, that the current system is “dysfunctional” and that the aforementioned manifesto statement is not being delivered.

“The reality is that fewer care beds are opening and more are closing,” said Mr Kreft, who warned that the result is pressure being put back on the NHS.

“The flow back is into the NHS and until we can make health boards work with councils and providers, and get regulators on board, that will continue.”