25/07/2011 Newsnight Scotland

We are joined from Capitol Hill by Tonight on Newsnight Scotland: The

baby boom was bigger in Scotland than the rest of the UK and as they

reach retirement, the cost of caring for them in old age will be

a greater challenge. In the first of a series of programmes on the

cost of care, we look at the pressures caused by a growing

elderly population. Good evening. The baby boomers have

been described as the luckiest generation in history. Healthier

and wealthier than those who went before. But as the first post-war

babies begin to draw their pensions, the care system has to prepare for

a large rise in the number of older people. So if we are to have any

chance of coping with the more to billion pounds needs ahead, what

has to change and how much can we as individuals reedy bruised our

chances of being fitter and healthier for longer? In the first

of a series of films, Ian Hamilton looks at the implications of a

growing elderly population being was supported by a shrinking number

Despite Scots having the worst health record in Europe, we have

never lived as long or been as healthy as we are today. We all

want to live a long and healthy life. But paradoxically, none of us

want to grow old. However, there is a very good chance we will

certainly grow old. These are the most affluent, long-lived and help

these times that human beings have ever known. It is surely a cause

for celebration rather than worried. It is these infants map were born

as part of the baby boom in the 1940s, 1950s and 1960s, that are

poised to enter the care system in the near future.

Here in Scotland, we have a bigger challenge. Because of a dwindling

workforce, we will have to find more cash for a growing elderly

population. One thing we noticed was in the baby boom Scotland had a

higher furtive to rate than the UK as a whole but since 1980,

fertility has been lower in Scotland than the United Kingdom.

In fact, lower than any other country. So what we had is higher

facility in the baby boom coupled by it lower fertility afterwards.

At a time when the population but looked like a triangle on a pyramid,

there was a big working population and a smaller ageing population.

When it looks like a rectangle, depending on where you draw the

line on the age of retirement, the ratio between the people working

and not working is becoming less and less favourable, just in

mathematical terms. REPORTER: What exacerbated the

problems since the Second World War was that more people have left

Scotland and come here, reducing the potential workforce further up.

Although we are living longer, we are not living healthier.

problem happens when we expand that time period. The time at which we

get ill health stays at the same time, so we stretch out that a

period. It will be much more expensive to look after a Scottish

or the person than in England because they will be less healthy

because this is reflected in the life-expectancy. The sad thing is,

all this is avoidable. We can just say bitter or longer. The ambulance

call-outs for over 60 year-olds has fallen but many people are not

taken into hospital. They are simply picked up and put back in a

chair. They have lost the ability to get up off the floor. If we can

improve that with exercise, we will have less ambulance call-outs. And

it means they will be able to use the bath, sit on the floor and play

with their grandchildren... So exercise can have a much wider role

Cluster housing association and Glasgow Live on running three

classes for older residents with the end of reducing care costs in

the future. You can move better. Use your hands better. I am

bothered with my hands so the exercise is good for them. Yes, I

am a bit better now. I can walk better. I have a stick but I can

walk better. I just feel it is very good for all my joints.

We know, for example, that we lay down the majority of our bone

density before the age of 15. So we are looking at a very early start

of being visit it axes -- active. You can take someone vote who is 90

and improve their strength and muscular power. Therefore there

will be able to get out more, socialise more, engage with the

community more. We are not talking about being elderly elite athletes,

here. It is about basic movement. As you get older, you use -- blues

power. Even just getting out of a chair, when you are young, you use

80% -- 40% to get out of a chair. Older people use 80% of their power

to get out of a chair. Soap meant gaining strength and fitness, these

are actual bits that will matter to us all as we get older. -- and

these are attributes. The conversation is not really being

had with the population. Government has been very short-

sighted for many years. If we start thinking about prevention and

stopping getting people into the hospital setting, we will make a

big difference to health care costs. Prevention is important that we are

not immortal. -- but we are not immortal. There are health issues

we cannot prevent, such as dementia. Because we are living longer, the

chance of developing dementia increases significantly. And that

will require more residential care homes like this one run by the

Church of Scotland in Polmont. to run St Margaret's costs over �1

million per annum because you have a fairly intensive need port staff.

So staffing costs quite a lot and we have a set amount from the local

authority. It kind of allows us to break even but only just. There are

currently 63,000 known cases of dementia in Scotland and that is

likely to increase to 110,000 over the next 20 years. So we will have

to find even more cash to support these people in residential care.

think as the years go on and the numbers of people with dementia

increase, one of the real challenges will be to provide high

quality care at a level of finance that people are able to resource

from a local authority level. And that is very, very difficult now

but I think we have to be able to say that we need to provide good

quality care and that that actually does cost quite a lot of money. You

can't actually provide good quality dementia care on the cheap and I

think one of the challenges will be for people to make a decision about

how they are going to be able to finance that care, either

personally themselves, through selling their houses or whatever,

which is quite controversial, all through local authority funding.

I was born in the 1960s at the end of the baby boom. Mike generation

probably enjoyed the best of the health service, which hopefully it

means I should live a long life. The demographic change people talk

about is not something in the future, it is here now. People born

in the 1940s are now retiring. Old age needn't be miserable. It could

be, though, if you do not plan properly.

I am joined now by Dr Dawn Skelton from Glasgow Caledonian University,

who whistle in the film, and the director of the Royal College of

Nursing in Scotland, Theresa Fyffe. Dawn, if we start with the big

picture, this is massive. Do you think that the penny has dropped

collectively yet? Nope. We have been talking about burden for far

too long. -- mare. We should be embracing older adults and their

knowledge. We spend our time are reacting to the increased in the

cost of hip fractures, for example, as opposed to preventing. We have

20% of our population over 65. Now is the time to be doing it. Do you

agree that we should be thinking about preventative medicine and if

that is the case, why don't we do it that way round? What often gets

lost in debate is the needs of the person in care. Instead of asking

if we can afford the service, we should ask what kind of service we

want for older people in our country. There is a debate to be

had. Spending on health care has become a currency. To find the

funding of that, which was the indication of the film, to find the

new funding it on preventive spending, we have to tackle that

question up front and discover where we might find it. Is it

always the case, if we take a pot some of the assumptions, is it

always the case that preventative care has to be more expensive? Or

does it actually deliver savings in the longer term even if you are

dealing with people with critical illnesses? There has been a number

of exercise programmes to prevent falls that has been looked at in

terms of cost effectiveness. It is cheaper to train the nursing staff

to deliver it, to follow up with people for a yet, than to leave

them and have the hip fracture. They have done that research and it

has been proved cost-effective. why are we still trapped in that

side of things? Her I wish I knew. It is not everywhere. Some parts of

the country are taking it up. Glasgow is one of them. A service

there has been preventing false and fractures for ten years now. But it

How much do nursing professionals or people who have to deliver the

service, how much say do they have in the kind of service that's

provided? Are they saying, look, we can do things differently, we would

like to do things in a more imaginative way or are they

constrained by cultures and budgets? Nursing has a significant

role to play in enable enabling older people to stay at home rather

than hospital. In highland, a district nursing team have set up a

new service where they have protected beds in a care home and

they enable people who couldn't go home straightaway to go to those

bids for a short-term and they've turned that around to actually

enable people not to have to be admitted to hospital and provide

care there. You can see the benefit to the patient and to the family.

But six months they demonstrated a loss of - saving by doing that.

Nurses do want to provide that care. I would agree with Stkaupb, it

takes us to be clear what we men by preventive spending, because

sometimes we talk about preventive spend, it's spending now that will

make a difference in the longer- term but in the meantime we have to

provide services for people who require healthcare at the moment.

So, that's what I meant by actually the funding gap. This particular

generation at this particular time are caught in a very specific... Is

that because of budget constraints, because of political short-termism,

what factors are feeding into us not being able to get over that

first hurdle? I don't think it's not always political short

sightedness, I think in terms of Government strategy they've been

putting into place for the last five years a lot of good documents

saying we need to prevent, it's cost-effective to do that. The

problem is when it gets to the local authorities and local budgets

often. An example of the recent Scottish fiscal activity charter,

this is worked out if we reduce inactive Scots by 1% each year for

the next five we will save 85 million in Scotland alone by 1%

change in activity levels in Scotland. But then you will come to

local authorities that have rid of the free swimming for older people,

got rid of subsidised gym memberships for older people, so

the strategy's there high up, it is when it gets to local funding level

it is seems to go wrong. Let's look at the effective exercise, because

so often we assume certain things will happen to us as we get older

and we are almost passive in all of this and from what Dawn was saying

earlier on exercise can be - play a significant part, not only in

improving quality of life whatever age you are, but in making

significant difference to your physical well-being, mental well-

being. Do you think that we are saying too often gosh, you know, I

am 80, I should expect this to come, I am not for the record 80! I

should expect my knee is not working or something, do we need to

be more up and at them do you think? My experience of older

people is they are up and at them as you put it. It's dependent upon

the services. If you take rehabilitation, it can happen out

in the community. It can happen by other organisations coming forward

and saying we have gyms, we have community hauls -- halls that we

can provide those services. It doesn't have to come from the local

service provider. There is a strategy clear about that, there is

a strategy that says let's get out there and find ways of providing

that and older people tend to go to those services. I don't see them as

hesitant in doing that. It just needs to be near them, it needs to

be local to them, accessible and then they are enthusiastic for it.

Do you have any concerns that if there are multiple providers that

you won't have a parity ofed kind of care you could expect or support

you could expect? Will different parts of Scotland be able to

provide different levels? We do have a problem with plurality, some

of the islands can't provide local exercise classes within two miles

of a person, it can't happen. We need to be looking at the very

forthright ideas now about internet provision so watching people or

taking part with exercise, watching the television or watching a

programme on the internet you can have literally a seeing eye from

further away, a physiotherapist can keep an eye on someone's progress.

The new IT provision might be a way of tackling some of that. The other

thing is that every health professional or indeed social care

worker coming in contact with older people have to be aware of the

benefits of being active and I think a lot aren't. So you have

that problem to overcome. You have to overcome problems of families

not understanding the needs to keep their older relatives active. We

all want to care for our older relatives but by caring if we

actually do everything for them we are taking away their ability to

remain active. There's a myth to be overcome there, for a start. I

think also we need to be tackling different ways of approaching

different people in different areas as you say, it's not going to be

the same in Glasgow as Shetland. as if the film we heard people are

hitting major health crisis in their life at the same age but

living for longer so having to deal with this, what do you think are

the most significant implications of that? It's a significant factor

that men, seven years at the end of the life and women nine years at

the end can have significant health problems and this comes back to

preventive spending again, it's what you put in place to - for

those of us in the middle ages to stop us reaching the point where

when we have long-term conditions that they're managed in a way that

we live a healthier life, that's what the film was showing that it's

further down the way we have to actually put the spending in and

make those changes. But as I said earlier, the challenge is we have

to provide the services for people at the other end at that time, as

we try to invest in preventive measures that will enable us to

look at a different older age. wonder if the baby boomer

generation will be more successful in flexing political muscle than

perhaps other generations that came came before once they got to that

elderly age group, do you think there's something about the baby

boomers that have have expectations and political know-how? With each

generation the older people are getting louder, wanting that are

rights and understanding more about the conditions, not just believing

what someone says to them as well, that's important. Again, one of the

things we need to change is the inherent culture within care that

we just do things for people, rather than engage. An example is

in nursing homes and in hospitals older people are spending 80-90% of

time sitting or lying down and we know long periods of that that

behaviour are worse than having the odd bout of activity in terms of

keeping you fit and healthy. If you spend more than two hours at a time

your metabolic rate slows down, you are more likely to get diabetes, a

higher risk of dementia. So it's really important that we constantly

break those. Of course, where we care for people in the hospital

setting in the care setting they spend most of their time sitting or

lying down. Part of that staffing, part of that isn't staffing, part

is culture, it's asking people to stand or to walk around their chair

and to get back into it again isn't going to take a huge amount of time

or extra staffing. A lot of it can be put into place by changing

thought patterns. But we also see from the exercise class you saw on

the film that the volume Torrey -- voluntary organisations, sheltered

associations, they've seen the light, they're starting to put on

great provision for older people, especially Age Scotland, they have

classes all over the place. We need to engage more people so it becomes

more regular. Thank you both very much indeed.

We have to leave it there. And a quick look at tomorrow's

The Scottish Daily Mail leads with the Smirk of the Maniac. The Times

has pictures of missing children presumed dead. That's all from me

for tonight. Gordon is here tomorrow, good night.

Hello. We have a mixture again tomorrow, varying amounts of

sunshine. It will start off cloudy I suspect, rain and drizzle here

and there, no great amounts. That will fade. Eastern areas of the UK

will stay cloudy. Further west we see sunshine. So much brighter for

north-west England. There will be cool weather down the eastern side

of England. A cooler day in the south-east of England than today

but dry by the afternoon. For the south-west it should be warmer,

more sunshine. Watch out for misty low cloud around some coasts of

Cornwall. For the West Country sunshine around here. More sunshine

in Wales, should be dry in the afternoon. Temperatures hitting 23C.

For Northern Ireland the south-west will be cloudy, the northeast will

be sunny. The west of Scotland does nicely in terms of sunshine.

Here is our city forecasts. A change on Wednesday is rain coming

into Northern Ireland during the afternoon. Elsewhere looking

further south into England and Wales, more cloud coming in to

London and Cardiff and Birmingham around the middle part of the week.

A cloudy picture on Wednesday, especially cloudy for eastern areas.