Chris Skidmore is the Member of Parliament for Kingswood and a Member of the Health Select Committee. Follow Chris on Twitter.
We have long known that Britain is an ageing country where the amount spent on care is projected to rise continuously over the next decades. The Personal Social Services Research Unit’s modelling of future expenditure for the Dilnot Commission predicted that by 2030, the total annual spending on long-term care for people will have risen from £20.6 billion to £44.8 billion, of which £26.3 billion is state funding. This would constitute a rise in spending in services as a % of GDP from 1.63% to 2.31%. Population projections also suggest that between 2011 and 2016 the number of people aged 65 and over will rise by 1.4 million, and by 2.4 million by 2021.
It is not just the costs of care that we must be concerned with: in particular, an elderly society will present new challenges, particularly around the rise in dementia. With an ageing population, it is expected that the number of people with dementia will increase considerably, to over 1 million by 2021. Estimates put the cost of dementia at £23 billion a year, while the pressure placed on NHS services presents an increasing challenge: in England at any given time, one quarter of hospital beds are occupied by people over 65 with dementia. It is clear that reducing the number of occupied hospital beds is a question of better prevention, not rationing. The American healthcare provider Kaiser Permanente operates on the principle that ‘unplanned hospital admissions are a sign of system failure’, something that is gradually beginning to percolate into the NHS. However, the NHS still uses 3 ½ times the number of bed days for those aged 65 and over, compared with Kaiser Permanente. If we can reduce the demand for hospital beds by just 10%, this could potentially free up £1 billion that could be redirected into community based care services.
As with so many conditions, early diagnosis is key: a recent report by the Social Market Foundation, A Future State of Mind, has highlighted our poor record on early diagnosis and treatment of dementia when compared to our European counterparts, citing one alarming study which claimed that 14% of people diagnosed with dementia did not subsequently make an appointment with a doctor, compared with 0-2% In Germany, Spain, France and Italy. Moreover, it is thought that there are 400,000 people living with Alzheimer’s in Britain, whose condition remains undiagnosed.
Tackling what David Cameron has described as a ‘national crisis’ must focus on a culture change in how we view dementia, removing the stigma surrounding the disease and ensuring that it is detected early enough. Home visits from trained specialists could be transformative in achieving this, and we can look to our Scandinavian neighbours for how best to proceed. In Denmark, since 1996, all municipalities have been obliged to offer preventive home visits to all over 75s, at least once a year. The aim is to provide health information, anticipate future need, and to support older people in retaining their independence for as long as possible. These are organised according to need, and remain entirely optional.
These visits are performed by a district nurse, and allow older people to discuss their daily life, health and housing and be informed of what assistance might be available to them. In an hour long visit it is possible to cover a great deal of ground, and importantly allows the health visitor to build up a strong picture of their social situation as well as their health, in addition to being able to detect early symptoms of dementia.
Similar programs exist in Norway and in Sweden, where local authorities are responsible for health care. A 2008 study on a controlled trial in a Swedish municipality showed that preventive health visits offered net savings, being considered a cost-effective intervention. The virtue of preventive home visits is not just that they help elderly people live longer, but that they also help them live better, with greater independence and in better health. With the number of over 85 year olds expected to double by 2030, it is time that we thought seriously about prioritising health visits in order to tackle head on the challenges presented by an ageing population and dementia.