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Our ageing population presents the NHS with its greatest challenge
In the latest of a series of blogs introducing a number of senior appointments within NHS England, the newly appointed National Clinical Director for Older People and Integrated Care looks at what he sees as his main challenges:
It is with a mixture of excitement and humility that I take over this month as NCD for Older People and Integrated Person Centred Care.
I was brought up in a close-knit rural community among a large and long-lived family. As an impressionable teenager I observed people dealing with a host of long-term medical conditions where the nearest hospital was miles away and largely inaccessible.
I was fascinated by the prospect of ageing and struck by the conundrum of how to best care for someone who had complex and quite probably incurable illnesses. For me it was not a difficult decision to commit to joining the medical profession and seeing what I could do to improve the lot of people who at the time seemed largely beyond the scope of modern medicine.
Much has changed in the NHS since then.
Following training in geriatric and general medicine in the North West and London I moved back to Manchester to take up my first job as a consultant geriatrician in 1999. I now practise and teach medicine in Central Manchester occupying dual, inextricably linked roles as a geriatrician and clinical leader.
I have been privileged to occupy senior leadership roles across Manchester in primary and secondary care, and worked in Greater Manchester on integrated and community based care during the early stages of the whole system health and social care reform program now widely known as DevoManc.
Alongside this my colleagues at the British Geriatrics Society have been hugely supportive of me as a national lead for end of life care which has enabled me to build wide reaching networks. My recent experience working on health outcomes indicators with NICE will prove invaluable in my new role. My career long interest and training in medical ethics and health care law will continue to serve me well and add value to my contributions as NCD.
The lessons in population ageing and the ‘demographic time bomb’, I first learned at Manchester Medical School in the 1980’s continue to ring loud and true, but with a sense of urgency as never before.
My immediate predecessor Professor John Young has done a magnificent job of raising the profile of frailty in older people as a long term condition, giving us hitherto elusive clarity in framing what probably amounts to one of the biggest challenges we have ever seen in the UK health and social care system. I look forward to continuing working with John and other colleagues across the system in taking his legacies forward.
When the NHS was founded nearly 70 years ago, one-in-two people died before they reached 65. Now this has dropped to about one-in-eight. By the time they reach 65 men can now expect to live on average for another 18 years and women for 20 years. People aged over 85 are the fastest growing part of the population. In the next fifteen years one fifth of the population will be over 65 and people reaching this age can realistically expect to live to 90 or beyond.
Population ageing, effective management of long-term conditions and improved life expectancy are of course success stories for the NHS. But they also present significant challenges to us all.
The average age of people admitted to hospital acutely is over 70 and people over 80 occupy a quarter of bed days in English hospitals. The vast majority of people staying in hospital over two weeks are over 65 and the cost of acute care rises with age. Older people are more likely to be readmitted to hospital and more likely to experience delay in transfer to other health or social care settings including their own homes. The number of people admitted to hospital from nursing homes is also rising.
While the NHS has up until now served us well, it now needs to rapidly adapt and change if it is to continue to care effectively and efficiently for a growing population of older people with complex conditions generating combined health and social care needs. NHS England has set a clear strategic direction to achieve this in the Five Year Forward View.
As the new NCD for Older People I intend to pursue all available opportunities for preventative, collaborative care offered by identification of pre- and moderate frailty.
I want to work with commissioners, providers and training organisations to cross and multi-skill the professional and voluntary sector workforces focused around trusted assessor and accountable decision making behaviours.
I want to support the development of new care models and incentives which reduce duplication, diagnostic pathway waste and unnecessary pathway prolongation for patients with complex conditions.
Finally, I want to explore how we can make better use of data sharing and so called ‘big data‘ to develop new ways of measurement which also support clinical decision making and improve health and experiences of care outcomes for older people living with frailty.
This is, after all, why I went into medicine and I am thrilled to be privileged with the opportunity help take our NHS forwards.