:00:12. > :00:17.We are joined from Capitol Hill by Tonight on Newsnight Scotland: The
:00:17. > :00:21.baby boom was bigger in Scotland than the rest of the UK and as they
:00:21. > :00:25.reach retirement, the cost of caring for them in old age will be
:00:25. > :00:29.a greater challenge. In the first of a series of programmes on the
:00:29. > :00:34.cost of care, we look at the pressures caused by a growing
:00:34. > :00:37.elderly population. Good evening. The baby boomers have
:00:37. > :00:42.been described as the luckiest generation in history. Healthier
:00:42. > :00:46.and wealthier than those who went before. But as the first post-war
:00:46. > :00:50.babies begin to draw their pensions, the care system has to prepare for
:00:50. > :00:55.a large rise in the number of older people. So if we are to have any
:00:55. > :00:59.chance of coping with the more to billion pounds needs ahead, what
:00:59. > :01:05.has to change and how much can we as individuals reedy bruised our
:01:05. > :01:09.chances of being fitter and healthier for longer? In the first
:01:09. > :01:13.of a series of films, Ian Hamilton looks at the implications of a
:01:13. > :01:23.growing elderly population being was supported by a shrinking number
:01:23. > :01:44.
:01:44. > :01:53.Despite Scots having the worst health record in Europe, we have
:01:53. > :02:00.never lived as long or been as healthy as we are today. We all
:02:00. > :02:06.want to live a long and healthy life. But paradoxically, none of us
:02:06. > :02:13.want to grow old. However, there is a very good chance we will
:02:13. > :02:17.certainly grow old. These are the most affluent, long-lived and help
:02:17. > :02:25.these times that human beings have ever known. It is surely a cause
:02:25. > :02:30.for celebration rather than worried. It is these infants map were born
:02:30. > :02:34.as part of the baby boom in the 1940s, 1950s and 1960s, that are
:02:34. > :02:40.poised to enter the care system in the near future.
:02:40. > :02:44.Here in Scotland, we have a bigger challenge. Because of a dwindling
:02:44. > :02:49.workforce, we will have to find more cash for a growing elderly
:02:49. > :02:54.population. One thing we noticed was in the baby boom Scotland had a
:02:54. > :02:57.higher furtive to rate than the UK as a whole but since 1980,
:02:57. > :03:05.fertility has been lower in Scotland than the United Kingdom.
:03:05. > :03:09.In fact, lower than any other country. So what we had is higher
:03:09. > :03:14.facility in the baby boom coupled by it lower fertility afterwards.
:03:14. > :03:21.At a time when the population but looked like a triangle on a pyramid,
:03:21. > :03:25.there was a big working population and a smaller ageing population.
:03:26. > :03:29.When it looks like a rectangle, depending on where you draw the
:03:29. > :03:34.line on the age of retirement, the ratio between the people working
:03:34. > :03:38.and not working is becoming less and less favourable, just in
:03:38. > :03:42.mathematical terms. REPORTER: What exacerbated the
:03:43. > :03:48.problems since the Second World War was that more people have left
:03:48. > :03:53.Scotland and come here, reducing the potential workforce further up.
:03:53. > :04:03.Although we are living longer, we are not living healthier.
:04:03. > :04:03.
:04:03. > :04:07.problem happens when we expand that time period. The time at which we
:04:07. > :04:16.get ill health stays at the same time, so we stretch out that a
:04:16. > :04:20.period. It will be much more expensive to look after a Scottish
:04:20. > :04:24.or the person than in England because they will be less healthy
:04:24. > :04:32.because this is reflected in the life-expectancy. The sad thing is,
:04:32. > :04:38.all this is avoidable. We can just say bitter or longer. The ambulance
:04:38. > :04:41.call-outs for over 60 year-olds has fallen but many people are not
:04:41. > :04:45.taken into hospital. They are simply picked up and put back in a
:04:45. > :04:50.chair. They have lost the ability to get up off the floor. If we can
:04:50. > :04:54.improve that with exercise, we will have less ambulance call-outs. And
:04:54. > :04:59.it means they will be able to use the bath, sit on the floor and play
:04:59. > :05:09.with their grandchildren... So exercise can have a much wider role
:05:09. > :05:17.
:05:17. > :05:21.Cluster housing association and Glasgow Live on running three
:05:21. > :05:29.classes for older residents with the end of reducing care costs in
:05:29. > :05:35.the future. You can move better. Use your hands better. I am
:05:35. > :05:42.bothered with my hands so the exercise is good for them. Yes, I
:05:42. > :05:52.am a bit better now. I can walk better. I have a stick but I can
:05:52. > :05:54.
:05:54. > :05:59.walk better. I just feel it is very good for all my joints.
:05:59. > :06:05.We know, for example, that we lay down the majority of our bone
:06:05. > :06:11.density before the age of 15. So we are looking at a very early start
:06:11. > :06:14.of being visit it axes -- active. You can take someone vote who is 90
:06:14. > :06:19.and improve their strength and muscular power. Therefore there
:06:19. > :06:26.will be able to get out more, socialise more, engage with the
:06:26. > :06:33.community more. We are not talking about being elderly elite athletes,
:06:33. > :06:39.here. It is about basic movement. As you get older, you use -- blues
:06:39. > :06:45.power. Even just getting out of a chair, when you are young, you use
:06:45. > :06:50.80% -- 40% to get out of a chair. Older people use 80% of their power
:06:50. > :06:57.to get out of a chair. Soap meant gaining strength and fitness, these
:06:57. > :07:04.are actual bits that will matter to us all as we get older. -- and
:07:04. > :07:08.these are attributes. The conversation is not really being
:07:08. > :07:13.had with the population. Government has been very short-
:07:13. > :07:16.sighted for many years. If we start thinking about prevention and
:07:16. > :07:20.stopping getting people into the hospital setting, we will make a
:07:20. > :07:27.big difference to health care costs. Prevention is important that we are
:07:27. > :07:32.not immortal. -- but we are not immortal. There are health issues
:07:32. > :07:38.we cannot prevent, such as dementia. Because we are living longer, the
:07:38. > :07:42.chance of developing dementia increases significantly. And that
:07:42. > :07:49.will require more residential care homes like this one run by the
:07:49. > :07:55.Church of Scotland in Polmont. to run St Margaret's costs over �1
:07:55. > :08:01.million per annum because you have a fairly intensive need port staff.
:08:01. > :08:08.So staffing costs quite a lot and we have a set amount from the local
:08:08. > :08:11.authority. It kind of allows us to break even but only just. There are
:08:11. > :08:16.currently 63,000 known cases of dementia in Scotland and that is
:08:16. > :08:22.likely to increase to 110,000 over the next 20 years. So we will have
:08:22. > :08:27.to find even more cash to support these people in residential care.
:08:27. > :08:30.think as the years go on and the numbers of people with dementia
:08:30. > :08:35.increase, one of the real challenges will be to provide high
:08:35. > :08:41.quality care at a level of finance that people are able to resource
:08:41. > :08:45.from a local authority level. And that is very, very difficult now
:08:45. > :08:51.but I think we have to be able to say that we need to provide good
:08:51. > :08:56.quality care and that that actually does cost quite a lot of money. You
:08:56. > :09:00.can't actually provide good quality dementia care on the cheap and I
:09:00. > :09:04.think one of the challenges will be for people to make a decision about
:09:04. > :09:08.how they are going to be able to finance that care, either
:09:08. > :09:17.personally themselves, through selling their houses or whatever,
:09:18. > :09:24.which is quite controversial, all through local authority funding.
:09:24. > :09:29.I was born in the 1960s at the end of the baby boom. Mike generation
:09:29. > :09:34.probably enjoyed the best of the health service, which hopefully it
:09:34. > :09:39.means I should live a long life. The demographic change people talk
:09:39. > :09:46.about is not something in the future, it is here now. People born
:09:46. > :09:50.in the 1940s are now retiring. Old age needn't be miserable. It could
:09:50. > :09:55.be, though, if you do not plan properly.
:09:55. > :10:01.I am joined now by Dr Dawn Skelton from Glasgow Caledonian University,
:10:01. > :10:07.who whistle in the film, and the director of the Royal College of
:10:07. > :10:11.Nursing in Scotland, Theresa Fyffe. Dawn, if we start with the big
:10:11. > :10:16.picture, this is massive. Do you think that the penny has dropped
:10:16. > :10:22.collectively yet? Nope. We have been talking about burden for far
:10:22. > :10:27.too long. -- mare. We should be embracing older adults and their
:10:27. > :10:32.knowledge. We spend our time are reacting to the increased in the
:10:33. > :10:39.cost of hip fractures, for example, as opposed to preventing. We have
:10:39. > :10:44.20% of our population over 65. Now is the time to be doing it. Do you
:10:44. > :10:49.agree that we should be thinking about preventative medicine and if
:10:49. > :10:53.that is the case, why don't we do it that way round? What often gets
:10:53. > :10:57.lost in debate is the needs of the person in care. Instead of asking
:10:57. > :11:01.if we can afford the service, we should ask what kind of service we
:11:01. > :11:11.want for older people in our country. There is a debate to be
:11:11. > :11:14.had. Spending on health care has become a currency. To find the
:11:15. > :11:19.funding of that, which was the indication of the film, to find the
:11:19. > :11:23.new funding it on preventive spending, we have to tackle that
:11:23. > :11:27.question up front and discover where we might find it. Is it
:11:27. > :11:32.always the case, if we take a pot some of the assumptions, is it
:11:32. > :11:36.always the case that preventative care has to be more expensive? Or
:11:36. > :11:42.does it actually deliver savings in the longer term even if you are
:11:42. > :11:46.dealing with people with critical illnesses? There has been a number
:11:46. > :11:51.of exercise programmes to prevent falls that has been looked at in
:11:51. > :11:56.terms of cost effectiveness. It is cheaper to train the nursing staff
:11:56. > :11:59.to deliver it, to follow up with people for a yet, than to leave
:11:59. > :12:03.them and have the hip fracture. They have done that research and it
:12:03. > :12:08.has been proved cost-effective. why are we still trapped in that
:12:08. > :12:13.side of things? Her I wish I knew. It is not everywhere. Some parts of
:12:13. > :12:18.the country are taking it up. Glasgow is one of them. A service
:12:18. > :12:26.there has been preventing false and fractures for ten years now. But it
:12:26. > :12:30.How much do nursing professionals or people who have to deliver the
:12:30. > :12:33.service, how much say do they have in the kind of service that's
:12:33. > :12:38.provided? Are they saying, look, we can do things differently, we would
:12:38. > :12:41.like to do things in a more imaginative way or are they
:12:41. > :12:46.constrained by cultures and budgets? Nursing has a significant
:12:46. > :12:49.role to play in enable enabling older people to stay at home rather
:12:49. > :12:52.than hospital. In highland, a district nursing team have set up a
:12:52. > :12:55.new service where they have protected beds in a care home and
:12:55. > :12:59.they enable people who couldn't go home straightaway to go to those
:12:59. > :13:02.bids for a short-term and they've turned that around to actually
:13:02. > :13:05.enable people not to have to be admitted to hospital and provide
:13:05. > :13:14.care there. You can see the benefit to the patient and to the family.
:13:14. > :13:18.But six months they demonstrated a loss of - saving by doing that.
:13:18. > :13:23.Nurses do want to provide that care. I would agree with Stkaupb, it
:13:23. > :13:26.takes us to be clear what we men by preventive spending, because
:13:26. > :13:30.sometimes we talk about preventive spend, it's spending now that will
:13:30. > :13:33.make a difference in the longer- term but in the meantime we have to
:13:33. > :13:39.provide services for people who require healthcare at the moment.
:13:39. > :13:45.So, that's what I meant by actually the funding gap. This particular
:13:45. > :13:50.generation at this particular time are caught in a very specific... Is
:13:50. > :13:53.that because of budget constraints, because of political short-termism,
:13:53. > :13:58.what factors are feeding into us not being able to get over that
:13:58. > :14:01.first hurdle? I don't think it's not always political short
:14:01. > :14:04.sightedness, I think in terms of Government strategy they've been
:14:04. > :14:09.putting into place for the last five years a lot of good documents
:14:09. > :14:14.saying we need to prevent, it's cost-effective to do that. The
:14:14. > :14:19.problem is when it gets to the local authorities and local budgets
:14:19. > :14:25.often. An example of the recent Scottish fiscal activity charter,
:14:25. > :14:30.this is worked out if we reduce inactive Scots by 1% each year for
:14:30. > :14:33.the next five we will save 85 million in Scotland alone by 1%
:14:33. > :14:38.change in activity levels in Scotland. But then you will come to
:14:38. > :14:44.local authorities that have rid of the free swimming for older people,
:14:44. > :14:48.got rid of subsidised gym memberships for older people, so
:14:48. > :14:52.the strategy's there high up, it is when it gets to local funding level
:14:52. > :14:55.it is seems to go wrong. Let's look at the effective exercise, because
:14:55. > :14:59.so often we assume certain things will happen to us as we get older
:14:59. > :15:03.and we are almost passive in all of this and from what Dawn was saying
:15:03. > :15:08.earlier on exercise can be - play a significant part, not only in
:15:08. > :15:11.improving quality of life whatever age you are, but in making
:15:11. > :15:16.significant difference to your physical well-being, mental well-
:15:16. > :15:22.being. Do you think that we are saying too often gosh, you know, I
:15:22. > :15:26.am 80, I should expect this to come, I am not for the record 80! I
:15:26. > :15:30.should expect my knee is not working or something, do we need to
:15:30. > :15:38.be more up and at them do you think? My experience of older
:15:38. > :15:42.people is they are up and at them as you put it. It's dependent upon
:15:42. > :15:45.the services. If you take rehabilitation, it can happen out
:15:45. > :15:51.in the community. It can happen by other organisations coming forward
:15:51. > :15:55.and saying we have gyms, we have community hauls -- halls that we
:15:55. > :15:58.can provide those services. It doesn't have to come from the local
:15:59. > :16:02.service provider. There is a strategy clear about that, there is
:16:03. > :16:07.a strategy that says let's get out there and find ways of providing
:16:08. > :16:10.that and older people tend to go to those services. I don't see them as
:16:10. > :16:15.hesitant in doing that. It just needs to be near them, it needs to
:16:15. > :16:18.be local to them, accessible and then they are enthusiastic for it.
:16:18. > :16:22.Do you have any concerns that if there are multiple providers that
:16:22. > :16:26.you won't have a parity ofed kind of care you could expect or support
:16:26. > :16:31.you could expect? Will different parts of Scotland be able to
:16:31. > :16:35.provide different levels? We do have a problem with plurality, some
:16:35. > :16:40.of the islands can't provide local exercise classes within two miles
:16:40. > :16:43.of a person, it can't happen. We need to be looking at the very
:16:43. > :16:47.forthright ideas now about internet provision so watching people or
:16:47. > :16:51.taking part with exercise, watching the television or watching a
:16:51. > :16:57.programme on the internet you can have literally a seeing eye from
:16:57. > :17:00.further away, a physiotherapist can keep an eye on someone's progress.
:17:00. > :17:04.The new IT provision might be a way of tackling some of that. The other
:17:04. > :17:07.thing is that every health professional or indeed social care
:17:07. > :17:11.worker coming in contact with older people have to be aware of the
:17:11. > :17:15.benefits of being active and I think a lot aren't. So you have
:17:15. > :17:18.that problem to overcome. You have to overcome problems of families
:17:18. > :17:23.not understanding the needs to keep their older relatives active. We
:17:23. > :17:26.all want to care for our older relatives but by caring if we
:17:26. > :17:30.actually do everything for them we are taking away their ability to
:17:30. > :17:34.remain active. There's a myth to be overcome there, for a start. I
:17:34. > :17:37.think also we need to be tackling different ways of approaching
:17:37. > :17:45.different people in different areas as you say, it's not going to be
:17:45. > :17:49.the same in Glasgow as Shetland. as if the film we heard people are
:17:49. > :17:52.hitting major health crisis in their life at the same age but
:17:52. > :17:56.living for longer so having to deal with this, what do you think are
:17:56. > :18:00.the most significant implications of that? It's a significant factor
:18:00. > :18:03.that men, seven years at the end of the life and women nine years at
:18:03. > :18:07.the end can have significant health problems and this comes back to
:18:07. > :18:11.preventive spending again, it's what you put in place to - for
:18:11. > :18:14.those of us in the middle ages to stop us reaching the point where
:18:14. > :18:19.when we have long-term conditions that they're managed in a way that
:18:19. > :18:22.we live a healthier life, that's what the film was showing that it's
:18:22. > :18:25.further down the way we have to actually put the spending in and
:18:25. > :18:29.make those changes. But as I said earlier, the challenge is we have
:18:29. > :18:32.to provide the services for people at the other end at that time, as
:18:32. > :18:37.we try to invest in preventive measures that will enable us to
:18:37. > :18:42.look at a different older age. wonder if the baby boomer
:18:42. > :18:46.generation will be more successful in flexing political muscle than
:18:46. > :18:48.perhaps other generations that came came before once they got to that
:18:48. > :18:54.elderly age group, do you think there's something about the baby
:18:54. > :18:59.boomers that have have expectations and political know-how? With each
:18:59. > :19:02.generation the older people are getting louder, wanting that are
:19:02. > :19:06.rights and understanding more about the conditions, not just believing
:19:06. > :19:12.what someone says to them as well, that's important. Again, one of the
:19:12. > :19:16.things we need to change is the inherent culture within care that
:19:16. > :19:21.we just do things for people, rather than engage. An example is
:19:21. > :19:26.in nursing homes and in hospitals older people are spending 80-90% of
:19:26. > :19:29.time sitting or lying down and we know long periods of that that
:19:29. > :19:34.behaviour are worse than having the odd bout of activity in terms of
:19:34. > :19:38.keeping you fit and healthy. If you spend more than two hours at a time
:19:38. > :19:44.your metabolic rate slows down, you are more likely to get diabetes, a
:19:44. > :19:48.higher risk of dementia. So it's really important that we constantly
:19:48. > :19:54.break those. Of course, where we care for people in the hospital
:19:54. > :19:58.setting in the care setting they spend most of their time sitting or
:19:58. > :20:02.lying down. Part of that staffing, part of that isn't staffing, part
:20:02. > :20:07.is culture, it's asking people to stand or to walk around their chair
:20:07. > :20:11.and to get back into it again isn't going to take a huge amount of time
:20:11. > :20:15.or extra staffing. A lot of it can be put into place by changing
:20:15. > :20:23.thought patterns. But we also see from the exercise class you saw on
:20:23. > :20:26.the film that the volume Torrey -- voluntary organisations, sheltered
:20:26. > :20:30.associations, they've seen the light, they're starting to put on
:20:30. > :20:33.great provision for older people, especially Age Scotland, they have
:20:33. > :20:36.classes all over the place. We need to engage more people so it becomes
:20:36. > :20:41.more regular. Thank you both very much indeed.
:20:41. > :20:51.We have to leave it there. And a quick look at tomorrow's
:20:51. > :20:57.
:20:57. > :21:02.The Scottish Daily Mail leads with the Smirk of the Maniac. The Times
:21:02. > :21:11.has pictures of missing children presumed dead. That's all from me
:21:11. > :21:15.for tonight. Gordon is here tomorrow, good night.
:21:15. > :21:18.Hello. We have a mixture again tomorrow, varying amounts of
:21:18. > :21:21.sunshine. It will start off cloudy I suspect, rain and drizzle here
:21:21. > :21:28.and there, no great amounts. That will fade. Eastern areas of the UK
:21:28. > :21:31.will stay cloudy. Further west we see sunshine. So much brighter for
:21:31. > :21:34.north-west England. There will be cool weather down the eastern side
:21:34. > :21:39.of England. A cooler day in the south-east of England than today
:21:39. > :21:43.but dry by the afternoon. For the south-west it should be warmer,
:21:43. > :21:47.more sunshine. Watch out for misty low cloud around some coasts of
:21:47. > :21:52.Cornwall. For the West Country sunshine around here. More sunshine
:21:52. > :21:56.in Wales, should be dry in the afternoon. Temperatures hitting 23C.
:21:56. > :22:06.For Northern Ireland the south-west will be cloudy, the northeast will
:22:06. > :22:07.
:22:07. > :22:12.be sunny. The west of Scotland does nicely in terms of sunshine.
:22:12. > :22:15.Here is our city forecasts. A change on Wednesday is rain coming
:22:15. > :22:19.into Northern Ireland during the afternoon. Elsewhere looking
:22:19. > :22:23.further south into England and Wales, more cloud coming in to
:22:23. > :22:31.London and Cardiff and Birmingham around the middle part of the week.
:22:31. > :22:34.A cloudy picture on Wednesday, especially cloudy for eastern areas.