Zolfo Cooper 1 Advisory & Restructuring Zolfo Cooper Healthcare: The Care Conundrum 8 May 2014

Zolfo Cooper 2 Advisory & Restructuring Dr Mark Jackson Zolfo Cooper

3 In 1947, The National Health Service was formed on two premises: In 1947 the main challenge was communicable disease – those challenges have been met But, healthcare needs and the services needed to fulfil them have changed - the system has not How did we get here? Healthcare is provided free at the point of need if: With time, healthcare needs will decrease as health improves then:

Zolfo Cooper 4 Demographic change Life expectancy at retirement age 65 was less than three years Life expectancy age 65 is more than 20 years As a result: Over 85 population will rise from 1.1 million to 2.7 million by to 84 year olds will increase by 4 million by

Zolfo Cooper 5 Social care At the birth of the Welfare State – care of the elderly was not a major issue There were fewer elderly, social mobility was low, extended families provided much of the care needed The resource does not match the need Attempts to ‘stretch’ resource has resulted in a race to the bottom in pursuit of lower cost care Poor quality, inadequate care is the inevitable risk

Zolfo Cooper 6 Is structured to deal with illness ‘events’ eg infectious disease or traumas using Primary Care as a ‘filter’ to select those needing secondary or hospital care Now Primary Care ‘filter’ removed eg out of hours care contracted out The only ‘safety net’ is the hospital or an ambulance and most of those admitted have chronic as well as acute illness? There has been no willingness to either lead change, by the politicians, nor tolerate change, by the system Beyond 2015, the NHS must achieve savings or cut services The National Health Service

Zolfo Cooper 7 Western economies still struggling to accept that Government spending overshot available resource and needs to be reduced permanently At the current rate of investment in the NHS the gap between NHS Care Provision and population need will be: —2020: £30 billion pa —2025: £60 billion pa This is effectively a new, private-pay, health care market in the UK The financial crisis

Zolfo Cooper 8 Far greater proportion of disposable income will be spent on ‘care’ of all sorts A ‘mixed’ health economy is inevitable We should be planning for this now but this would require politicians to lead a real debate about the future of healthcare In the meantime, those with assets will have more freedom of choice The future So what is the solution?

Zolfo Cooper 9 We need: Integrated care – what does it mean? Coordinated care – what does it mean? Chronic disease management pathways A true focus an outcomes Led by? (not NHS!) We need more: Care homes – dementia is a symptom Domiciliary health care - ‘hospital-at-home’ Specialist accommodation – eg retirement villages, close care apartments The way forward

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