role is to raise profile of OT with Government in Scotland and to support others at COT to link in with Scotland policy etc. I see assisting members to influence as a big part of my role as there is only one of me and there are about 3,000 members in Scotland and I work closely with the COT Scottish Board, COT Specialist Sections, and members in general.
And now to statistics … or at least little charts… I expect that many of you will have seen this or at least have heard of the changing shape of the population …… you will know that much of Gov policy across the UK is driven by this projected population shift ….. Scotland’s population is constantly changing. This chart visually demonstrates the way Scotland’s population structure has changed over the last 100 years and how it is projected to change – from the pyramid of 1911, to a supertanker by 2031. The important issue for us is the way the population is projected to change over the next 10 years and beyond. I will demonstrate here why this has particular resonance for all of us involved in the delivery of health and social care; and why we need to put this firmly on our agenda now and not simply hope that everything will just turn out right by chance. The next statistics are the ones I found mind-blowing …..
A population aged over 65 that will rise by 21% between 2006 and 2016. And will be 62% bigger by 2031. For those aged 85 and older the population will rise by 38% by 2016; and by a staggering 144% by 2031. And we should not forget that supertanker shape implies a proportionately smaller younger – working – population. These projections represent a success story compared with previous generations – but the implications for the future of care need to be considered carefully. And that’s our business. I will illustrate the issues by showing you possible scenarios. None of these are certain or agreed by anyone but they hopefully help us to understand the challenge we face and help us to prepare for all eventualities.
This next chart shows the actual number of people, some 88000 recipients, who received these forms of care in 2007 - and how numbers would grow if we project the rates into the future, matching the growth in the older population. The horizontal line marks the 2007 level and illustrates how much we would have to expand services over time to simply try to meet a scenario of increasing service demand – assuming of course that we allowed services expansion to happen like this. By 2016 the need would be 26% higher than in 2007. This would mean services for some 23000 extra people. And in the longer term, by 2031 , under this scenario the implications are a near doubling of the volume of services that we are providing now – ie for an extra 83,000 people.
Projecting these costs on the basis of demographic change would see the costs rise by just over £1bn by 2016 (a 22% rise) and by £3.5bn by 2031 (a 74% rise). This translates as an average real increase in the total NHS budget of 1.2% per year, every year and of 2.7% per year, every year to Local Authority Social Work budgets for older people services, assuming current service models.
It may be instructive to look at the issue from a slightly different perspective. This piechart shows longer term care of people aged 65 and over, in terms of NHS Continuing Healthcare, Care Homes and Home Care. But what this piechart vividly shows is that the proportion of the 65+ population who are receiving these forms of care account only for about 10% of the overall 65+ population. The remaining nearly 90% (shown in blue ) are people living at home and generally receiving only the normal universal services to meet their needs. Our understanding of who does and does not get specialist services can be enhanced by looking at the same information presented by age group….
These piecharts reveal quite marked differences by age – whilst only 3% of people aged 65 to 74 receive these services now, some 40% of people aged 85+ are receiving them. Perhaps useful to bear this age gradient in mind when we refer to the over-65 population. Of course many of the younger over 65s are themselves likely to be carers, of a spouse, neighbour or even an older relative.
I have painted just a few scenarios. The challenges for all of us here are: What do we need to do now to prepare for the changing needs of Scotland’s population? What do we need to do now to shape the future of health and social care? We need to be realistic and not dwell on the unachievable. But in thinking what we need to do we have to be prepared to think beyond current models. No one agency can deal with these issues in isolation. There are many uncertainties in this analysis but the potential scale of the challenge is undeniable.
Kerr Report - Building a Health Service Fit for the Future - a National Framework for Service Change , Delivering for Health – previous Gov’s agenda based on Kerr Report Changing Lives- 5 yr prog to transfomr sw services 21 st Century Social Work Review
Although final Guidance not out work has been going on behind the scenes to prepare the supplementary items suggested during the consultation phase.
Occupation is essential for health and wellbeing. What we do in our everyday lives is individual to each of us and has personal meaning and significance for us. What we do gives us our sense of who we are in the world and defines us. OT is based on a social and not medical model e.g. we believe that it is the environment and not the impairment that disables someone. Being actively engaged in what we want or need to do is essential to our health and wellbeing. When occupation is compromised for some reason, e.g. illness, disability, a LTC, redundancy we often lose our sense of self. Facilitating occupation and activity is often a key goal of the service user and the longer they are occupationally deprived, the more risk of them developing poor physical and mental health as a result e.g. in the case of enforced redundancy. OT should be available whenever occupation is compromised to listen to what the person wants or needs to do and to carry out occupational analysis, to problem solve with the individual, offer rehabilitation or enablement programmes and enable them to grade activities until they can engage to the level they are happy with, or to adapt the environment or the activities e.g. with a piece of equipment. People often work there way through difficulties, problem solving making changes and adapting their lives but when the problems are complex or their resilience has been knocked, having an OT to help them when they need them is a necessity. I have heard from so many people that they struggle to access an OT and usually there is no-one who can work with them to help them to achieve their occupational goals .. As OTs we need to keep striving to build services that help people to get what they need from us ….
1. Positive Change Elizabeth MacDonald Scotland Policy Officer College of Occupational Therapists
2. Drivers for change <ul><li>Ageing population, </li></ul><ul><li>Growth in long-term conditions, </li></ul><ul><li>Growth in emergency hospital admissions </li></ul><ul><li>Health inequalities </li></ul><ul><li>Changes in capacity of the workforce </li></ul><ul><li>Developments in IT </li></ul><ul><li>Vulnerability of rural healthcare </li></ul>
3. The changing shape of Scotland’s population
4. Some headline projections <ul><li>Scotland’s 65+ population projected to rise by 21% between 2006 – 2016 </li></ul><ul><li>By 2031 it will have risen by 62% </li></ul><ul><li>For the 85+ age group specifically, a 38% rise is projected for 2016 </li></ul><ul><li>And for 2031, the increase is 144% </li></ul>
5. Demographic change for population aged 65+ Scotland Potential impact on specialist care services 2007-2031 1-9 hrs Home care 10+ hrs Home care Care Home Cont h/care (hosp) Projection 26% 94% P Knight Scottish Government
7. Current service provision by service type
8. Current service provision by age group 75-84 85+ 65-74 97% 88% 60%
9. How can we prepare for the changing needs of the population and to shape the future of health and social care?
10. The policy context <ul><li>Kerr Report - Building a Health Service Fit for the Future - a National Framework for Service Change </li></ul><ul><li>(Delivering for Health) now Better Health, Better Care – Action Plan </li></ul><ul><li>Changing Lives </li></ul>
11. Key themes <ul><li>Shift in balance of care </li></ul><ul><li>Management of LTC </li></ul><ul><li>Self management / personalisation / empowerment </li></ul><ul><li>Anticipatory care </li></ul><ul><li>People as partners </li></ul><ul><li>Building community capacity </li></ul><ul><li>Seamless transitions </li></ul><ul><li>Integrated teams </li></ul><ul><li>Prevention </li></ul><ul><li>Carers as partners </li></ul><ul><li>Proactive use of technology </li></ul>
12. Government strategies etc <ul><li>Coordinated, integrated and fit for purpose-A Delivery Framework for Adult Rehabilitation in Scotland - Rehab Framework </li></ul><ul><li>Guan Yersel! </li></ul><ul><li>Provision of Equipment and Adaptations </li></ul><ul><li>Reshape of Care for Older People </li></ul><ul><li>Dementia strategy </li></ul>
14. <ul><li>Changing Lives, Changing Practice: </li></ul><ul><li>Occupational therapy in social work, enabling independent living in Scotland </li></ul><ul><li>Dr Jill Riley </li></ul>
15. <ul><li>What can you do? </li></ul>
16. Be an active members of your professional body Promote Occupation and Occupational Therapy Enable and influence positive change
17. Get together with your colleagues <ul><li>learn, </li></ul><ul><li>share, </li></ul><ul><li>debate, </li></ul><ul><li>contribute, </li></ul><ul><li>Influence ... </li></ul>
18. Hot topics ... ? <ul><li>Integrated working across NHS and local authority </li></ul><ul><li>Making beset use of the OT resource </li></ul><ul><li>Skill mix </li></ul><ul><li>Loss of OT in your title - generic working – loss of OT skills </li></ul><ul><li>Access to HNC in OT Support </li></ul><ul><li>Implementing Guidance on equipment and adaptations </li></ul><ul><li>Community rehabilitation and re-enablement </li></ul><ul><li>Personalisation and self management </li></ul>
19. Something positive ... <ul><li>Form a </li></ul><ul><li>BAOT/COT </li></ul><ul><li>LOCAL GROUP </li></ul><ul><li>Speak to Anna, Lee, Chris-Elaine or me during the breaks for more information </li></ul>