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Living Well with Long Term Conditions: Health & Social Care for LTCs

This summary provides information about the increasing prevalence of long term conditions (LTCs) in England and the need for appropriate health and social care services to support individuals with LTCs. It also highlights the challenges faced by carers and the impact of changing family structures on the care market. Furthermore, it discusses the state of healthcare funding and the growing deficit in NHS hospitals. The role of doctors, particularly GPs, in managing LTCs is also examined, along with the impact on older people and the increasing use of outpatient services. The summary concludes with the need to address delays in care, such as delayed discharges.

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Living Well with Long Term Conditions: Health & Social Care for LTCs

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  1. Age UK London - Working for You Health & Social Care 2017 Summary 2nd October 2017

  2. Long Term conditions (LTCs) • England 15 million+ people have an LTC • LTC = “a health problem that can’t be cured but can be controlled by medication/other therapies - includes high blood pressure, depression, dementia and arthritis” • In our 80’s – only 1 /7 will not have any LTCs • Aged 85, 80% of us will have at least 2 LTCs • Similar pattern care needs – in our late 80’s, over 1 in 3 of will have difficulties undertaking five or more tasks of daily living unaided

  3. Long Term conditions (LTCs) • Increasing, particularly those with 3+ LTCs • Affects many parts of life, ability to work and have relationships, housing, education opportunities. • Care of people with LTCs accounts for 70% of money spent on health/social care in England. We need right health/care to live as well as we can!

  4. Government Policy LTCs May 2015 • Most people have more than one LTC , and spend most of their time not in contact with health or social care services • Recurring concern about benefit contact with health service brings for people with LTCs. • “We want to think differently about living well – rather than ‘managing’ long term conditions – in a way that is meaningful to people and their families and the lives they want to lead”.

  5. Context Social Care • £160 million cut total spending real terms on older people’s social care in 2010 to 2015 • Nearly 1.2 million people 65+ don’t receive help they need with essential daily living. A 17.9% increase last year and a 48%increase since 2010 • Nearly 1 in 8 older people live with some unmet need • Age UK analysis - local government spending on social care will fall 8.3 % real terms between 2015/16 – 19/20 • % of older population receiving social care support fell 15.3% in 2005/06 to 9.2% in 2013/14

  6. Carers & Care Market • 2011 = 8.2 million carers - by 2015 = 9m+, helping loved ones with increasingly complex needs • 2m+ carers aged 65+, 417,000 of whom are 80 plus • 37%+ of carers 80+ providing 20 hours or more of care a week • 34% providing 35 hours or more. • Nearly two thirds of older carers have a health condition or disability • 72% report feeling pain or discomfort, rising to 76%for those providing 20+ hours of care a week

  7. Carers & Care Market • …alongside • Rapidly rising levels of unmet need • Impact of changing family structures • Greater geographic dispersal • Rising State Pension age • … suggests provision of informal care has not been able to fill gap left by declining care services • 2015/16 - 48 local authorities reported at least one home care provider ceased trading in their area

  8. State of Healthcare • NHS funding increased 2015/16, primarily due to £2 billion pledged 2014 Autumn Statement, but insufficient to plug NHS’s growing deficit • End 2013/14 deficit NHS hospitals = £109m - has accelerated rapidly to £2.5 billion end of 2015/16 • Despite funding increases, money coming into hospitals not keeping pace costs of services. Due to: • Treatments they deliver over recent year • Hospitals’ need to achieve ‘safer staffing levels’ in wake of the Mid-Staffordshire Inquiry • Many hospitals seeking to address shortfalls through increased recruitment and costly agency fees

  9. Doctors • Doctors - fastest growing group health care professional recent years • Whilst numbers of hospital and community health service doctors increased from 97,130 in 2010 to 104,498 in 2015, - numbers of GPs fell by 3.4 per cent from 35,243 to 34,055 • Demand in general practice growing steadily 20 yrs. • 1995 - 2008, longitudinal study concluded consultations had grown by 38.3% from 217 million consultations pa to 300 million pa

  10. GPs • 2010/11 and 2014/15 Analysis by Kings Fund found that: • Number of GP contacts with patients increased by 15.4 per cent between • Proportion of contacts with those aged 85+ increased by 16 per cent over the period, compared to just four per cent amongst those aged 18 to 64.

  11. Impact on Older People • No. older people reporting a good experience of getting a GP appointment in decline • Numbers older people attending A&E departments increased significantly last 5 years • Overall, number of hospital inpatient episodes has risen significantly in recent years • Older people account for 65% of these admissions and generally stay longer in hospital

  12. Outpatient Services • 2010/11 - 2014/15 number of outpatient appointments people aged 60+ increased by a third from 28.1 million a year to 36.1 million • Increase far exceeds increase in the overall numbers of people in this age group • Effective use of outpatient services essential in managing many long-term conditions and avoiding multiple and repeat visits across different specialties

  13. Delays • 2010 - 2016 - Delayed discharges – increased because of waits for home care • Waits for residential care - increased 40% • Since beginning 2014/15 • Number of days delayed waiting for a care package in your own home has more than doubled • Total number of people waiting has risen at a much slower rate (28.8 per cent), suggesting waiting times for each individual are getting longer rather than a rapid rise in the number of individuals waiting

  14. But…….it’s complex…. • Prevalence all major chronic and long-term conditions increase significantly with age • Older population is extremely diverse - ‘65+ generation’ as two generations • Increasingly common people in their 60s & even 70s to have living parents/older relatives • Huge diversity within those generations particularly in the likelihood of living with poor health and disability as we age.

  15. But…….it’s complex…. • On aggregate growing older population is driving greater demand for health/care services • Too simplistic an equation to say more older people inevitably equals a greater burden of disability and disease • It is a calculation that misses: • Possibility of improving health in later life • Fails to account for changing nature and complexity of some of our health needs as we age

  16. Good News! • Acquiring a health condition does not necessarily mean high levels dependency on health/care services • Most people 75+ have one or more health conditions, but almost 50 per cent of them do not consider themselves to be living with a ‘life limiting’ long-term condition, meaning that even if they have one or more health conditions this is not perceived to have a significant impact on their lives • Good newsthe onset of age-related conditions and disability can be prevented or delayed!

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