Health services face meltdown as public ages

Stark figures revealed in an independent review of services published yesterday underline the huge increase in demand for care in the county in coming years as the elderly population rises.

Numbers of over-65s will increase by 40 per cent to nearly 200,000 by 2020, almost a quarter of the county’s population.

Even more significantly, numbers of over 85s, who have high health needs, will increase by 60 per cent to more than 30,000 by 2020. In the decade and a half to 2025, a 68 per cent rise in dementia cases is forecast.

Already the increased costs of an ageing population are putting extra pressure on health budgets. Over 75s were 10 per cent of the population in 2009 but accounted for 20 per cent of hospital admissions and 30 per cent of expenditure.

Despite record funding, which has seen the NHS budget double in North Yorkshire to £1.2bn since 2003, it has needed tens of millions in emergency funding in the past two years alone and has implemented a series of short-term cuts.

But the report ordered by health chiefs warns the current rate of expenditure is no longer an option for the county which is “ill-prepared” to make £230m in efficiency savings to be reinvested in care by 2015.

It says immediate plans for treating the elderly should be developed to cover the prevention of ill health, delayed discharges from hospital, provision of alternatives to hospital care, services to enable people to return home and, crucially, better co-ordination of care between hospitals, GPs and social services.

“All too frequently, people are treated at too high a level of care for their needs, with consequences for the cost and quality of care. Patients must be cared for in community services or with support at home where this is safe and appropriate,” says the report.

One survey last year found an incredible five in six patients at Selby War Memorial Hospital should not have been there, falling to one in four at St Monica’s Hospital in Easingwold. In some cases patients get an advantage over access to community hospitals depending on which GP practice they are registered with.

The report says community hospitals, which enjoy a high level of public support, should be given a much greater role carrying out simple diagnostic tests, holding consultant outpatient clinics and in out-of-hours care.

A key part of keeping people out of hospital will involve reversing a big increase in unplanned admissions. The report calls for a review to draw up specific plans focusing on those at risk to create better organised and integrated community care.

GPs will have a key role both in deciding how money is spent and in providing care. The report says general practice needs to be more responsive so that those needing urgent care are seen on the day.

In a radical move, the report suggests a code of practice for GPs so patients know the minimum services they can expect to receive, when they will be available and where.

It is hoped this will tackle “unwarranted” variations between GPs in service quality, as well as big differences in behaviour which drives NHS spending ranging from hospital referrals to drug prescribing.

“By reducing this variation immediately, a more coherent, consistent and better organised service for patients can be created,” it says.

The report also found there were no less than 260 buildings owned or funded by the county’s primary care trust, even before GP premises are taken into account. It urges a review of both NHS and local authority estate as well as of other public sector buildings to examine co-location of services. It was “essential” that this was addressed immediately and “with imagination”.