On March 22nd the University of Winchester and Southern Policy Centre co-hosted a seminar to explore the impact on the Central South of England of the changing make-up of our society. The event was chaired by Professor John Denham, Director of the Southern Policy Centre, and heard presentations from Lord Geoffrey Filkin of the Centre for Ageing Better, Alex Whitfield from the Hampshire Hospitals Foundation Trust and Graham Allen from Hampshire County Council. The audience of nearly 200 took part in a discussion after the presentations.
The growth of the Central South’s older population was outlined in a background briefing paper prepared by the Southern Policy Centre for the seminar. That quantified the increasing proportion of our population who will be over 65, together with the anticipated increase in age related health conditions and the social challenges posed by an ageing population.
All present recognised that these demographic changes presented opportunities for individuals and communities: the challenge was to ensure older people could enjoy a good quality of life and continue to contribute to society. That depended on older people continuing to enjoy good health and social care, having stable finances, feeling part of their community and having a sense of purpose.
Our discussion focused on the first of those challenges, ensuring our health and social care services were ready to meet the challenge of an ageing society. The context is a growing national appreciation of the funding challenges facing the NHS and local government, and a projected £20bn funding gap for these services by 2025.
There was a consensus that, whilst national politicians needed to grasp the nettle of funding and give a clear direction on future fiscal policy, the solution lay in local leadership. It was for society as a whole, and not just the NHS, to ensure that the local challenge was properly understood and collective responses found. Whilst the health service and local councils both faced immediate crises, it was essential they were not deflected from finding longer term solutions.
Five broad, and inter-related themes emerged from presentations and discussion:
- Solutions must be driven by reliable data on local circumstances. Understanding local trends and healthcare priorities allows us to understand what we need to change and where our efforts are best directed. The picture for the Central South will differ from that for London, Manchester or Norfolk. Local initiatives have made better use of data to forecast demand and provide a good start.
- Enabling digital or technology-driven solutions, which were both more efficient for service users and cost effective for providers. They also facilitate service integration, which has both operational and financial benefits. There are good examples locally of how the NHS and local councils are using technology to provide more immediate, personalised support to older people. Technology can also be a key support to more co-ordinated, integrated care, enabling collaboration and leading to better outcomes.
- Collaboration across the health, local government, voluntary and private sectors to integrate services and explore new models of delivery. Managing people’s health and care needs is a seamless process and the organisational response needs to be seamless. There is also a significant role for community-based organisations and volunteers.
Presenters gave good examples of local initiatives which brought together providers, the challenge is to ensure the shift in organisational culture which allows us to overcome institutional barriers and jealousies. There is a challenge to national politicians to move away from a compartmentalised view of public services.
- Shaping care and support around patient needs and wishes rather than medical or service interventions. A more patient-centred approach is at the heart of several local initiatives by health and care providers. They are designed to give better outcomes for individuals, but can also promote a better use of resources.
- Early intervention to encourage healthier lifestyles and behaviours. Addressing current problems of poor diet, lack of physical activity, alcohol consumption and smoking, and, linked to all of those, poverty at earlier stages in life could have a profound effect on the health and wellbeing, and so care needs, of older people. This in turn raised questions about spending and investment priorities both locally and nationally, for example whether the current split between spending on acute services (49% of budget) and primary care services (11% of budget) in a local Commissioner’s budget struck the right balance.
Resources were a thread running through all our discussions; the consequences of limited and overstretched budgets, the ability or willingness of organisations to pool resources or where investment is best targeted. Our discussions also raised questions about how we allocate funding, and whether the current compartmentalised approach constrains innovation.
There were many good examples of collaboration, but a recognition we need to move beyond this to integrate and transform services. There is a shared understanding that if we are to meet future challenges in an environment where funding is likely to remain constrained, then health and social care providers need to look beyond one-off partnerships or initiatives to tackle discrete problems and find ways of transforming services, with new methods of delivery driven by data and based around individual’s needs.
This more sophisticated, cross-sector and community-based approach encourages an holistic perspective, and brings together partners beyond the traditional health and care sector, to include community organisations, the voluntary sector and individuals acting as carers.
The seminar and presentations from across the health and care sector stimulated a discussion about how we can build on a range of initiatives to provide a better future for older people across the Central South. It is vital that discussion continues to support some of our most important service providers as they struggle to find the resources they need to meet demand and expectation.
To maintain the momentum and continue to encourage informed debate SPC, working with the University of Winchester and others, propose to develop a programme of work based on five inter-linked themes, beginning with a better understanding of need and expectation:
- Forecasting the health and care needs of our population as we face significant demographic changes. That will draw on demographic, health and related data for the Central South, and can help us understand where intervention can have the greatest impact. As a start it would be useful to map those at risk of poor health in older age against the provision of services to understand where resources may be best directed.
- Understanding the aspirations and expectations of our communities for future health and care services, and their views on financing those services. We would like to hear the views of the current older users of services and those who will in future require health or social care. A better appreciation of individuals’ expectations and the choices they are willing to make underpins the re-shaping of future provision.
We also want to explore solutions:
- How to re-shape service delivery. Building on an understanding of local needs and community expectations, we want to examine how all parties – public and private health and social care providers, the voluntary and community sector, as well as our carers – can work together to re-design how they deliver health and social care. It is clear that the voluntary sector, as well as individual carers, has a significant role to play in community-based provision, and there are models elsewhere to learn from. We’ll also consider how localisation of funding and decision-making could help re-shape services, and what role technology can play.
- Investing in prevention to improve the physical and mental health and wellbeing of people as they age. We will consider how different organisations, including voluntary sector bodies, can agree shared priorities and investment to help improve the health of people as they age, whether through new services or by encouraging behavioural change. This is not just about health interventions, factors such as employment, good quality housing and solid community support also have a role in maintaining physical and mental health as people age.
Finally, we plan to address how change and improvement can be funded:
- New models for financing of health and social care. We aim to explore models which draw on individual assets, as well as those based on local or national taxation. We will consider how the funding regime may help or hinder re-shaping of services, and how funding options fit with people’s wishes and expectations for health and social care in future.
The Government Plan to publish a Social Care Green Paper later this year, which it promises will consider solutions to the current ‘care crisis’. By understanding what will work best for the Central South our communities will be better placed to respond to whatever new framework the Government sets for the provision of health and social care.
Presentations from the event can now be viewed at: https://southernpolicycentre.co.uk/wp-content/uploads/2018/03/Health-and-Social-Care-Seminar-Powerpoint-presentation.pdf