Older People - Public Health & Health Policy Issues

1. Older People - Public Health & Health Policy Issues Elizabeth Bream SpR in Public Health Lothian NHS Board

2. The Plan • Why you’re (we’re?) in the right job • Structure of the NHS & role of different health organisations • Recent NHS Scotland policy • (Recent DH policy) & (Recent NHS Lothian Older People’s strategic work) • Where Public Health meets Older People

3. “The most important policy issue facing European governments over the next 50 years is how to cope with ageing populations…For Scotland the future is now…its population is ageing faster and dying quicker than any other industrialised nation” The Scottish Report - Scotland the Grave? (2003)

4. Age structure of the Scottish populationSource: http://www.gro-scotland.gov.uk/files/ar05.pdf

5. The changing age structure of Scotland’s populationSource: http://www.gro-scotland.gov.uk/files/ar05.pdf

6. Projected change in the age structure of Scotland’s population, 2004-2031Source: http://www.gro-scotland.gov.uk/files/ar05.pdf

7. Structure of the NHS Isn’t it obvious?

8. NHS Scotland Structure Scottish Executive Health Department (Minister for Health & Community Care, Chief Medical Officer, NHS Chief Executive etc) Lothian Health Board (Chief Executive, Chair, Medical Director, Director of Public Health etc) University Hospitals DivisionCommunity Health Partnerships

9. NHS Lothian Board Structure Chief Executive Director of Healthcare Planning Director of Finance & Performance Management Nursing Director Medical Director Chief Operating Officer (LUHD) Director of Health & Social Care (Joint: Report Health NHS Lothian and Edinburgh City Council) Chief Operating Officer (Primary Care Organisation) Director of Public Health Medicine CHP General Manager (x3) Director of HR Director of WL CHCP

10. NHS Lothian University Hospitals Division Structure Chief Operating Officer Director of Operations WGH Site Responsibility Director of Operations St John’s Site Responsibility Director of Performance Management ERI Site Responsibility Director of Finance Associate Medical Director Associate Nurse Director Head of HR

11. Other Relevant Organisations • Quality Improvement Scotland/SIGN • Scottish Medicines Consortium • (NICE) • (NSFs) • Information Services • NHS Health Scotland • Health Protection Scotland • NES • And others...

12. Key national policy documents • White papers • Frameworks • Action Plans • HDLs • etc etc

13. Key national policy documents

14. Key national policy documents

15. Key national policy documents

16. Building a Health Service Fit for the Future (The Kerr Report) • Sustainable & safe local services • local communities not NHS • preventative not reactive • galvanise the whole system • become modern • new skills to support local services • develop options for change with people

17. Changing need for health care over the next 10 years • Growth in number of older people…relatively frail older people • Emergence of long-term conditions as main challenge facing NHS • Changing expectations from patients for more personalised care

18. Delivering for Health: The future... Source: Delivering for Health

19. The big priorities for investment and reform • As local as possible • Systematic support for people with LTCs • Reducing inequalities gap • Actively managing hospital admissions

20. Making Improvement Happen • “As local as possible” • Shifting the balance of care • Community Pharmacies • CHPs • Extending professional roles

21. Making Improvement Happen: Systematic support for people with Long Term Conditions

22. Making Improvement Happen • Systematic support for people with long term conditions • Population-wide prevention • Risk prediction • Intensive co-ordinated management • Improving self-management • Supporting unpaid carers

23. Making Improvement Happen • Reducing the inequalities gap…

24. Male Life Expectancy 1953-2001, most affluent 20% vs. least affluent 20% Source: Delivering for Health

25. CHD mortality (under 75s),most affluent vs. most deprived quintile Source: Delivering for Health

26. Reducing the inequalities gap • Community Regeneration Fund • Central Heating Programme • ‘Warm Deal’ programme • Targeting & enhancing primary care services

27. Making Improvement Happen • Actively managing hospital admissions • Treat day surgery as the norm for planned procedures • Improve referral & diagnostic pathways (central referrals, referrals to services, diagnostics to specialists direct, WL mgt, new roles etc etc)

28. Making Improvement Happen • Actively managing hospital admissions • Actively manage discharge & length of stay (who discharges patients/when) • Actively manage follow-up (DNAs for follow-up etc etc)

29. An integrated NHS for the whole of Scotland... • Redesign of unscheduled care • National tariff • Independent sector • Diagnostic services • MCNs • Transport • Further waiting times targets

30. An integrated NHS for the whole of Scotland... • Unscheduled care: 4 hour A&E target • Planned care: • 18/52 from GP to OP • 18/52 to start of Rx for IPs, DCs • 24 hrs from adm to t/f for hip fracture • 16/52 from GP ref to cardiac intervention • Reduced emergency IP bed days for >65s by 10% by 2008

31. An integrated NHS for the whole of Scotland... • Hospital services: as specialised as necessary… • Neurosurgery & Neuroscience

33. Improving Health in Scotland, The Challenge, 2003 “Poverty in the broader sense is a central feature of the problem”

35. The Challenge • Indicators of inequality: • All cause mortality >75 years • Cancer mortality >75 years • CHD mortality >75 years • Inequalities targets for those <75 years • Reduce mortality rates from: • CVA (50%) CHD (20%) Cancer (20%) • Other targets also important http://www.scotland.gov.uk/Publications/2003/03/16747/19933

36. Progress: CHD mortality in under 75sSource: http://news.bbc.co.uk/1/shared/bsp/hi/pdfs/02_12_06_healthreport.pdf

37. Recent DH Policy • Choosing Health • Informed choice • Personalisation • Working together http://www.dh.gov.uk/assetRoot/04/09/47/51/04094751.pdf • Our health, our care, our say • New direction for community services

38. DH - hot topics • Mending Hearts and Brains http://www.dh.gov.uk/assetRoot/04/14/10/17/04141017.pdf • Reconfiguring Emergency Care Services http://www.dh.gov.uk/assetRoot/04/14/10/18/04141018.pdf

39. NHS Lothian • Large and small scale… • Pan-Lothian reviews • Jarvie Report • Medicine of the Elderly ward surveys • Carer’s Strategy • Protecting Vulnerable Adults • etc etc

41. Where Public Health meets Older People • Health Protection • Health Improvement • Improving Services

42. Health Protection & Older People I • All relevant… • Specific issues: • HAI: MRSA, Norovirus, UTIs, RTIs • (Pandemic) Flu, Flu-like illness

43. Health Protection & Older People II • Surveillance: local, national, international • Management of incidents/outbreaks • HB priority areas (“everyone’s business”) • Impact on service provision http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/17914/21447 http://www.hps.scot.nhs.uk/haiic/index.aspx http://www.dh.gov.uk/PandemicFlu/fs/en

44. Current WHO phase of pandemic alertSource:http://www.who.int/csr/disease/avian_influenza/phase/en/index.html

45. Health Improvement & Older People • All relevant… • Specific issues: • Fuel Poverty • Food Poverty • Welfare/benefits • Mental Health • Carers…

46. Improving Services & Public Health • Quality Standards – QIS, (NICE) • Service redesign – small or large scale • Managed Clinical Networks (e.g. CVA) • Majority of healthcare not delivered anywhere near a hospital…

47. Death rates from selected causes, by sex, Scotland, 1980-2005Source: http://www.gro-scotland.gov.uk/files/ar05.pdf

48. What we’ve done... • Structure of the NHS • Overview of recent NHS Scotland policy • (DH) • (Lothian) • Public Health & Older People

49. Final thoughts • Big issues for the older people of the future: • Obesity? • Alcohol? • Pandemic Influenza? • Climate change?

50. elizabeth.bream@lhb.scot.nhs.uk