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Tagged In:  NHS

With the life expectancy of the average UK citizen increasing by an amazing five hours a day, there are major concerns about the NHS's ability to cope with future demand. 


When the NHS was founded in 1948, 48% of the UK population died before the age of 65. In 2011 that figure had fallen to 14%. Over 65s already outnumber under 16s and it's predicted that, by 2035, a staggering 23% of UK residents will be over 65. What's more, the fastest population increases in recent years have been in what the Office for National Statistics calls the 'oldest old', with the number of people aged 85 or over almost doubling between 1985 and 2010 and predicted to increase by a further 250% over the next two decades.

On the one hand it's a healthcare success story. On the other it's a huge challenge for health policy planners. While many people are healthy and independent well into old age, many more will be living with long-term chronic conditions and complex disabilities. That means not just more stress on resources, but also on staff across the NHS spectrum, from frontline doctors and nurses to allied health professionals such as physiotherapists and occupational therapists, not to mention diagnostic and therapeutic radiographers.

The 'time bomb' warnings


Health professionals, politicians and statisticians are all warning of an ageing population 'time bomb' which is set to have a huge impact on NHS resources in years to come. "If the NHS continues to function as it does now, it's going to really struggle to cope because the model of delivery and service that we have at the moment is not fit for the future." That was the stark message from National Medical Director of NHS England Professor Sir Bruce Keogh in a recent interview with The Guardian.

The highly respected think tank The King's Fund agrees. "Health and care services have failed to keep up with this dramatic demographic shift," says their 2014 report Making our health and care systems fit for an ageing population. As a major part of the solution, they propose that the NHS moves from 'high-cost, reactive and bed-based care to care that is preventive, proactive and based closer to people's homes, focusing as much on wellness as on responding to illness'.

This strategy, driven mainly by fears about the impact of the ageing population, is one of the key features of the 2012 Health and Social Care Act, which introduced substantial changes to the way the NHS in England is organised, such as giving clinical commissioning groups budgets to buy care on behalf of their local communities.

A different perspective


However, not everyone is convinced that an ageing population is the major threat many perceive it to be. In the 2012 report Active Ageing: Live Longer and Prosper, researchers at the UCL School of Pharmacy claim that the benefits of people living longer will outweigh the additional health and social care costs. Report co-author Dr Jennifer Gill argues that the participation of older people in formal and informal work could increase national productivity by up 10%, offsetting or even outweighing the additional healthcare costs.

A similar standpoint is taken by the lobby group Campaign for the NHS Reinstatement Bill 2015, chaired by the University of London's Professor Allyson Pollock. In their paper The Myth of the 'Demographic Time Bomb' they question the veracity of the claim that, because people are living longer, the NHS is 'unaffordable'. Instead they assert that older people have accounted for a relatively small proportion of the increase in spending on healthcare in the UK. They also put forward a similar economic argument to UCL: "It is estimated that, taking together the tax payments, spending power, caring responsibilities and volunteering effort of people aged 65-plus, older people contribute more to the UK economy annually than they receive in state pensions, welfare and health services."

Even the King's Fund, while warning of the dangers posed to health services of an ageing population, also acknowledge the economic benefits. If you accept these arguments, the issue seems to be more about the government providing adequate funding to the NHS, rather than simply blaming the ageing population for increased pressures on staff and resources.

Seeing opportunities


Some professional bodies also take a 'glass half full' approach, seeing the ageing population as an opportunity for their members. With working lives being extended well into old age, allied health professionals such as physiotherapists and occupational therapists could have a vital role to play in the future of healthcare. "It's really clear that there is a business and financial case for occupational health services and a really clear return of investment," said Sue Browning, Chartered Society of Physiotherapy (CSP) Deputy Chief Executive, speaking at the 2013 annual conference of the Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE).

The College of Occupational Therapists (COT) claims that its members can provide 'cost effective solutions for older people's care' and can support them with 'reablement, preventing falls, remaining safe and independent at home'. They cite 2007 research which showed that a fall which leads to a hip fracture could cost the NHS around £28,000, almost five times the cost of a major housing adaptation and over 100 times the cost of fitting hand and grab rails.

As for the Society of Radiographers (SOR), their policy and guidance document Team working in clinical imaging says it is 'impossible to ignore the rapidly increasing pressures on the NHS caused by demographic change', going on to highlight the 'growing appreciation and understanding that the key to attaining good healthcare outcomes is getting the correct diagnosis in a timely manner'. It also refers to a Royal College of Radiologists (RCR) workforce census which shows that, while there has been a small increase in radiologist capacity in the UK, one in 13 posts remain unfilled.

Whether you see the UK's ageing population as a threat, a challenge or an opportunity, there's no denying its potential impact on healthcare and the need to take action. As the King's Fund so aptly puts it, "If people can stay healthy, they will remain engaged members of society."

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