This week the Herald Newspaper launched a campaign calling for a review of NHS beds capacity. Age Scotland Chief Executive Brian Sloan responded.
The Herald’s NHS: Time for Action campaign is a welcome contribution to the debate on how best to meet the health and care needs of our ageing population. With 90% of people seen and discharged within four hours it is clear that A&E is still working well in most cases. However, it is also evident that emergency health services are under pressure and the experience of some A&E service users is unacceptably poor. In the rush to ensure health and care services meet the challenges of changing demography, we must not be panicked into seeing an ageing population as a drain on public services.
Most older people are healthy: around two-thirds of those aged 60-74, and more than half of those aged 75 and older, report very good health, whereas for both age groups the proportion reporting very bad health is around one in 10. And while 3000 older people need 20 or more hours of care at home each week, 40,000 are providing the same level of care for their friends and family members.
The Herald is right to ask if more beds will be needed in the future, or whether steps can be taken to bear down on demand so that the NHS of the future will be able to cope within its current capacity. To a large extent the answers are already clear and there is a risk that a further beds review might shed little fresh light on the underlying issues.
The Scottish Government’s Public Bodies (Joint Working) Scotland Bill is laudable in its aim to tackle the disconnect between health and social care services that too often lead to unnecessary hospital admissions. But it should be underpinned by human rights principles, and the influence of Scotland’s third sector needs to be strengthened; voluntary groups and social enterprises know how to enable older people enjoy good quality of health and life in their own homes.
Furthermore, by shifting the long-term balance of resources into prevention, from encouragement and opportunities for active lifestyles that reduce the risk of falls, to community transport services that reduce social isolation, we can do far more to minimise the pressure on acute services in the first place.
The crunch question is how we can invest in these preventative services while maintaining acute and emergency care until there is clear evidence that demand has fallen. This is likely to involve increased spending now to reap the rewards later, something which will require political leadership and public buy-in.
The Herald rightly points out, people may want health services protected but are often unwilling to pay the price. A vigorous and candid debate is required to establish a consensus on how we will fund the move to more preventative health and care services and in what circumstances a reduction in beds, locally or nationally, may be the price to pay if we ourselves wish to remain out of hospital in future.