The “it’s all about the ageing population” conundrum….where next……

The “it’s all about the ageing population” conundrum….where next……

This is a follow up to a previous blog:

Is the ageing population is accounting for escalating health costs

https://gregfellpublichealth.wordpress.com/2016/03/21/is-the-ageing-population-is-accounting-for-escalating-health-costs/

Some have said that we should find and case manage high cost patients.

I’m not overly convinced that active case management of high cost / high need will save megabucks. It will certainly pay for itself and may deliver a little net save, but I don’t believe mega save.

Happy to be proven wrong there

There’s also the cost / case vs number of cases angle
I’d blogged a little bit in this previously and the importance of prevention of ‘cases’ in cost control

Prevention as long term health care cost control 1

https://gregfellpublichealth.wordpress.com/2016/02/20/prevention-as-long-term-health-care-cost-control-13/
Prevention as long term health care cost control 2/3

https://gregfellpublichealth.wordpress.com/2016/02/20/prevention-as-long-term-health-care-cost-control-23/
Prevention as long term health care cost control 3/3

https://gregfellpublichealth.wordpress.com/2016/02/20/prevention-as-long-term-health-care-cost-control-33/
Value in pathways versus value in populations – Don’t forget population health in your efforts to improve “efficiency”. Its important but remarkably easy to forget

https://gregfellpublichealth.wordpress.com/2016/02/21/value-in-pathways-versus-value-in-populations-dont-forget-population-health-in-your-efforts-to-improve-efficiency-its-important-but-remarkably-easy-to-forget/

So ……what to do……
1)

Let’s build the narrative as part of STP and elsewhere for more investment in prevention as a long and short term investment strategy
2)

And build the narrative that healthy ageing is something to start in middle age

See here
Mitnitski paper is excellent on this.

The rate of aging: the rate of deficit accumulation does not change over the adult life span

ncbi.nlm.nih.gov/pubmed/25972341 

Updated a previous analysis

Same message: deficits accumulate mercilessly, like compound interest. To be fit at 80, be fit at 50
deficit accumulation will, on average, double twice between ages 50 and 80 highlights the importance of health in middle age on late life outcomes.

3)

And the narrative that the NHS has a critical role in macro economic terms, and needs to get this & engage with it…….

So as well as pouring money into  rescue treatments, often for limited gain and lots of cost……lets have a conversation about the role of the NHS in terms of the contribution to economic productivity.
See here – this blog is astounding: a broader view on healthy ageing 

https://flipchartfairytales.wordpress.com/2015/08/28/the-healthy-ageing-challenge/
Explores the distinctions between life expectancy and healthy life expectancy, and the absolutely fundamental importance of this in both health, health care and social policy.

The question is so much broader than just a “health care spending” issue, though health care productivity is a critically important variable from a macro economic perspective (NB – all those shiny toys that add lots of cost but little value to the system do little to nothing to improve productivity and may well degrade it significantly).
The old age dependency ratio is another critical variable in future planning – the doomsday scenario may not be as bad as many (including me) have suggested. There is also much that can (and should) be done with regard to both formal and (arguably more importantly) informal social care, neighbourhood capital and wider social economy considerations.

This was also picked up in the Walshe paper on Devo Manc

http://www.bmj.com/content/352/bmj.i1495

This is something we must pick up in the JSNA and the like.

I’m keen to take NHS policy thinking up a gear or two locally and nationally. 

And challenge the NHS to answer fundamental questions like – why do you exist……what’s the point of your £120bn

This is public sector reform, applied to the NHS.

I suspect I will keep adding to this blog as it’s such a fundamental question.

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