Thank you Michelle [Mitchell, Charity Director General]. I want to talk today about a great challenge facing our society. A challenge even…
Thank you Michelle [Mitchell, Charity Director General].
I want to talk today about a great challenge facing our society.
A challenge even more serious than the economic crisis, or the debt crisis facing young people. Potentially even as serious as global warming.
I am talking, of course, about our ageing population.
Once, living to see your 100th birthday got you a slot on the evening news. Today, about a tenth of my generation will reach that milestone, while a third of people born this year, including my own daughter born this March, are likely to reach their centenary.
Already, there are more people over the age of 65 than there are under the age of 16. The number of people over 85 is set to double by 2030.
And with age come the inevitable health problems. Already, people over the age of 65 account for more than half of NHS spending. One quarter of hospitals beds are occupied by people over 80. An aging population will place growing strain on the NHS and its limited resources.
But this is a challenge with real opportunities too. Living to a ripe old age is a wonderful mark of progress. Living roughly twice as long as our great grandparents means we have so much more time to savour, to enjoy, to spend with our families and our loved ones. Living longer is a nice challenge to deal with, but it’s a challenge nonetheless.
And it’s one we can’t afford to ignore. And unless we face up to it, unless we prepare for it, unless we meet this challenge, then we run the risk of being the first generation for a long, long time whose children will not be able to look forward to a life better than their parents.
Before I talk about the radical change we need to deal with this, I want to thank you for the tireless work you do at Age UK to highlight the need for action and to get politicians to engage with the many issues facing older people.
Last weekend, we remembered those who fell in wars past and present. Age UK itself, in a previous guise, rose from the need to support older people after the dislocation and chaos of the Second World War.
Ever since, you have fought for older people to receive equal rights, to have enough money to live a secure and decent life, to have the health and social care they need, to live in safe, comfortable homes and to lead rich, fulfilling, active lives.
For all of your work - and that of your many volunteers - thank you.
Long term conditions
My grandmother was one of the few among her generation that did live til 100. While she never complained, for most of her last 20 years she suffered with arthritis.
What I didn’t understand at the time was just how many older people - how many people - have long term conditions. Indeed fully a third of the population today have a long term condition. That’s 15 million people. Together they are responsible for more than half [52%] of GP appointments and over two thirds [69%] of the money we spend on the NHS.
So at heart of our approach must be a revolution in the way we deal with long term conditions.
Yesterday, I announced a world’s first - the NHS mandate. It sets out clearly my priorities for the health service as Secretary of State.
One of those priorities is to focus specifically on long term conditions and to do so in two ways:
• first, helping people to understand and take control of their own conditions by supporting them to self care,
• and second, to bring to bear the massive potential benefits offered by information technology.
As you will be aware, this week is national Self Care Week. For a decade now, self management courses, such as the Expert Patient Programme, have been helping people to understand their conditions and to give them the confidence to manage them themselves.
People like Susan Rodgers, a woman from Morecambe in Lancashire who has diabetes.
• It gave her the confidence to ask questions if she was unsure of something, rather than just going home and worrying.
• It helped her to accurately work out how much insulin she needed instead of hazarding a guess.
• And it got her walking every week with a local Active Health Walking Scheme - keeping her weight and her blood sugar levels down and giving her a valuable social outlet, with people who understand what she’s going though.
Now, rather than constant visits to her GP, she sees a specialist diabetes nurse just a few times a year.
She feels in control.
Today we reach a milestone. 100,000 places on the Expert Patient Programme. 100,000 chances for other people to benefit like Sue. But 100,000 compared to the 15 million with a long term condition is just a drop in the ocean. It’s now time to ramp it up and go much further, much faster.
Why shouldn’t every patient with a long term condition have the support they need to become an expert in their own health?
That is why I have challenged the NHS Commissioning Board to ensure that, by 2015, far more people have the knowledge, skills and confidence to manage their own health.
And when good self management saves the NHS £3 for every £1 spent, this quickly becomes an irresistible step forward.
We also have to be far smarter in the way we use huge potential of technology. Telehealth and telecare have proven themselves able to transform the quality of people’s lives.
The results from the Whole System Demonstrator programme were nothing short of astonishing:
• 20% fewer emergency admissions
• 15% fall in visits to A&E
• A similar drop in elective admissions [14&]
• And, most astonishing of all, a 45% fall in mortality when compared to a control group. That is around 60 people alive today who wouldn’t otherwise be.
These are the human stories, stories of lives improved and tragedy prevented. People like Carol Hodges from Newham in east London who uses a set-top box connected to her TV to send in her daily blood sugar readings for her diabetes.
She said, “One morning I called the nursing team and said I was not feeling very well. They looked at my readings and … before I knew it an ambulance was here at my house. A few more minutes could have been fatal.”
The Whole System Demonstrator programme was the biggest study of its kind in the world. But it only covered 6,000 people.
Work is underway now to see a further 100,000 people benefit from telehealth during 2013. This demonstrates our ongoing commitment to the 3 million lives initiative and will bring a sixteen-fold increase in use, making England the largest telehealth market in the world after the USA.
Technology - broader ambition
But there’s so much more to achieve, and we must not be complacent.
By 2015, everyone will be able to book a GP appointment, get repeat prescriptions and have access to their GP records online, and we’ll be well on our way to having a single digital record across all of NHS and social care service, down to the paramedics at the scene of an emergency.
When we achieve that, that will be a true revolution.
My other three priorities also have improved care for older people at their heart.
The next one is about care, making quality of care every bit as important as quality of treatment throughout the NHS and social care system.
We’re introducing a ‘friends and family’ test, asking people if they would recommend the care they received to their loved ones as a way of gauging its quality. What more valuable feedback is there for clinicians than from their patients?
And, not only that, we’re championing transparency, making the NHS the most open system in the world. People must be able to see just how good their local services are, how well they join up and how well they compare to those in the rest of the country.
Another priority is to see a step change in the way we deal with dementia. Making our hospitals and our communities dementia friendly, massively improving diagnosis rates and making the very best treatments available to everyone. Those with dementia should be supported to live fulfilled lives, not merely survive from day to day.
The final priority is reducing the number of people who die every year from the big killers - stroke, cancer, heart, liver and respiratory disease. If mortality rates in England were the same as the best in Europe, we could save as many as 20,000 lives every year. That’s 20,000 tragedies averted, many of them older people, who have a golden retirement cruelly snatched away from them at present.
But doesn’t focusing so much on older people mean neglecting other users of the NHS? No. And for two very important reasons.
First, because these changes will benefit everyone. They will benefit everyone with a long term condition, everyone with a serious illness, everyone in need of high quality care and not just older people.
But we do have to recognise that older people are the heaviest users of the NHS. So they will see the most immediate change and feel the most immediate benefits.
But, more importantly, unless we make these changes, the NHS will not be sustainable. Improving the care, the treatment, the quality of life for the people who use the NHS the most, will do more than anything else to put the NHS on a firm footing, fit for the future.
If we get it right for older people, we get it right for everyone.
The American philosopher, Rabbi Abraham J. Heschel, once said, “A test of a people is how it behaves toward the old… . the affection and care for the old, the incurable, the helpless are the true gold mines of a culture.”
This is the test we have to pass.
Sunday was Armistice Day. A reminder, if ever one was needed, of the greatness of our nation and of the incredible debt we owe to older generations.
Let’s not let them down.