I’m 55 years old and have just acquired a long-term health condition. It might be a quite a few years before I acquire another health condition, still longer before I die. Life expectancy for men and women continues to increase but so has the proportion of life spent living with a disability, according to the Office for National Statistics. It is quite possible that I might be affected any number of long-term health conditions such as dementia – a point brought out in the recent Oxford Martin Report. Whatever happens, my own healthcare needs, like many people of my comparatively young age, are already starting to get quite expensive.
The good news is that quite a few people, such as David Clark from the University of Glasgow, are putting their minds to thinking through the problem of what happens when more and more people enter what I’d call “the care gap”. His idea of the Crichton Care Campus addresses the period in our lives when most of us will acquire some form of long-term health condition and might expect to live with it for a considerable time before we die.
There is growing disquiet, including concerns about the impact of increasing numbers of people who are leaving the working population, reducing the tax base for services but also the number of people available to provide services. Perhaps this is apparent in the recruitment and retention crisis concerning GPs, who are often at the frontline of care for older people.
Moving away from hospitals and homes
Simply building more care and nursing homes or expecting our still gainfully employed 40 or 50-year-old children to look after us at home is not necessarily practical. We can’t automatically expect them to leave the working population to look after us, can we? It is also quite likely that our mum or dad don’t live near enough to us.
So does this mean that living longer, or ageing, is the problem? Not really. It means that the way we structure our communities and services is problematic. In thinking through what we mean by integrating health and social care services in either England or Scotland we need to construct alternatives to existing forms of care. Following a theme in the report of the Christie Commission, we need to create sustainable communities that puts healthcare at their heart. Christie cited increasing demand on public services but currently little appetite for raising tax revenue to pay for anticipated demand.
For many years governments have attempted to withdraw from capital and resource-intensive operations such as hospitals in favour of care and health in the community. “The community” seems a better, more natural and unplanned alternative environment to the planned and organised life of institutions. But unless we plan to innovate care in communities we are unlikely to sustain healthcare without crises.
Ideas such as the care campus aim to offer new models of sustainable living and adapting existing community life to the exigencies of ageing societies. In the 19th century, a number of industrialists created model villages such as Port Sunlight and New Lanark which exhibited thoughtful, high-quality design compared to slum life. However influential these villages were for urban planning, they tended to be “self-contained”. Crichton would not be self-contained, it would benefit its residents but would also provide care solutions for any community, in Scotland, or further afield.
The care campus is not intended to be a utopian or gated community for older people. It would be a real community composed of different generations, the majority of whom would be affected by a long-term health condition. It would be a centre of innovation. It would put healthcare at the heart of the community. It would experiment with technology, for example human-computer interface systems but also with housing design. It would experiment with new forms of professional and work culture in healthcare, following Christie’s notion on empowering individuals and communities, and would seek solutions at the level of the individual, the social and the cultural.
True for them, true for us
The problem that governments in the UK face is shared in many other countries although it plays out in different ways. At the sharpest end are countries such as Germany and Japan, where – according to the European Environment Agency – 50% of the populations will be aged 50 or above within the next 15 years.
Gunter Baaske, then government minister for labour and social affairs for Brandenburg, in Germany, described its demography to me in 2012 as “unsettling”:
A small federal state like Brandenburg currently has 90,000 people in need of care; in 2030 it will be 160,000 people. We currently have 27,000 people working in the nursing industry. In 2030 we will need 54,000 people. This means [that] because we have more people in need of care, we would have to hire 2,000 people in the nursing industry each year. We will have a birth rate in 2030 of only 10,000 [a year], [and currently] we have 15,000 school leavers [each year]. The demographics won’t allow us to carry on as usual.
Baaske said that it wasn’t possible to recruit 2,000 school leavers just for the care of the elderly. “This is illusory,” he said. “We need completely new concepts that integrate everything from family to volunteers and all possible other resources.”
What is true for Germany is true for us. We need to create sustainable communities with healthcare at their heart. Thinking ahead to when my existing long-term health condition is complicated by something else, I want to look forward to living in a community with the expectation of a good quality of life. Perhaps governed by ideas and innovation generated by the Crichton Care Campus.