Summary of the Need for Change. In Caithness the combined impacts of an ageing population, demographic changes, and clear implications for the workforce with increasing costs and demands mean that the current model of health and social care delivery is not sustainable. The model of five sites providing 24/7 care is continually under pressure and leads to unplanned closure of services and disjointed multi-contact service delivery. While such pressures are being experienced across the country and beyond, they are more severe for NHS Highland in general, particularly in the more remote and rural areas like Caithness. These pressures have been evident and growing for several years, yet the pace of change has been slow. This is in part due to resistance to change, including a belief by some that the solution is to have more money or to be more innovative around recruitment. Arguably while more money and innovation will certainly assist, it will not address the fundamental challenge of addressing issues of sustainability (workforce) and the associated need to transform some services and rationalise the current estate. Health and social care needs to adapt and extend beyond the classical settings of hospitals, care homes, GP practices, and hospices. Improved multi-disciplinary and multi-agency working would help to reach more people, with communities becoming more resilient, gearing up for better use of technology. This has in part been facilitated through integration of health and social care which has been ongoing in Highland since 2012. The lead agency model has created several opportunities to develop more flexible care models that had previously not been thought of or implemented. These challenges are not unique to Caithness, Highland, Scotland, or the United Kingdom. In fact, it is an international challenge and is faced across the public sector where many professions, such as education, are also facing significant recruitment and financial pressures. However, although not unique to Caithness, the challenges here are greater than in most other areas largely due to the rural and remote nature of the area. Rural depopulation plays a significant role in these challenges. A summary of the need for change and the resulting impact on the organisation is provided in table SC16. Table SC16 – Summary of the need for change What is the cause of the Need for Change What effect is it having, or likely to have, on the organisation? Why action now: More people living longer with complex needs, less peo...
Summary of the Need for Change. The need for change is influenced by many factors: Demographic change – the growth in population and more importantly the significant increase in the proportion of people aged over 65 People are working longer – with a rising retirement age, to 67 and beyond, which means that there are increasing numbers of people aged over 70 who continue to remain in employment. Application of the current growth rate for elective procedures to these population and age profile projections indicates that further activity increases should be anticipated Increased demand – the demand for surgical procedures has been steadily increasing in recent years due to demographics, epidemiology and advancing technology which enable more conditions to be surgically treated. National, regional and local trends reflect an increasing demand over the previous 10 years for common elective procedures, including in Orthopaedics, General Surgery and Urology. These changes have resulted in significant and growing service pressures for elective surgery, particularly for primary hip and knee arthroplasty; foot and ankle surgery; hernia repairs and laparoscopic cholecystectomies. As a result waiting times in Orthopaedics, General Surgery and Urology have risen in NHS Tayside during the last year, making it difficult to deliver NHS Scotland waiting time targets.
Summary of the Need for Change. The need for change is influenced by many factors: The rising retirement age, to 67 and beyond and the increased number of people aged over 70 living more active lives, resulting in rising rates of intervention Demographic change – the growth in population and more importantly the significant increase in the proportion of people aged over 60 These changes have resulted in significant and growing service pressures in orthopaedics and other surgical specialties. As a result waiting lists in orthopaedics have risen significantly in the West of Scotland during the last year, making it difficult for many NHS Boards to deliver NHS Scotland waiting time targets. Actual Demographic Change Between 2005 and 2015, the WoS Population increased by 2.8% from 2,553,860 to 2,627,290, the number of people aged over 60 increased by 24% - (from 551,195 to 684,601). The ageing population within the WOS has significantly increased the demand for orthopaedic and other surgical specialities over the last 10 years. Forecast Demographic Change Between 2015 and 2035 the WoS population is forecast to grow by 1.6%, a population increase of 42,011. However more significantly: The number of people aged 60 plus is predicted to increase by 34.8%, an increase of 218,670 people aged over 60 by 2035 The number of people aged 70 plus is predicted to increase by 56%, an increase of 183,959 people aged over 70 by 2035 It is important to note that that age at time of intervention will be a key factor in forecasting the potential additional demand for surgical procedures, for example: 84% of patients undergoing primary knee replacement are aged over 60 years old at the time of intervention 80% of patients undergoing primary hip replacement are aged over 60 at the time of intervention approx 40-50% of urology patients are aged over 60 years old at the time of intervention approx 30-40% of general surgery patients are aged over 60 at the time of intervention. To ensure the demand modelling is accurate age at time of intervention has been factored into the demand modelling methodology. See section 4.2 for further explanation. Current Waiting Time Pressures There are significant waiting times pressures within Orthopaedics across the West of Scotland, improvements in productivity cannot possibly meet all of the predicted additional demand (see section
