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Tuesday, 20 January 2009


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Report by the Oxfordshire Joint Health Overview and Scrutiny Committee and the Social and Community Services Scrutiny Committee



1          Introduction


1.1             Oxfordshire, like the rest of the UK is going through a period of profound demographic change. The population of the County is growing, and it is also growing older. In twenty years time there will be more people living in the County, the proportion of those people who are aged over sixty-five will be considerably larger than it is now and that there will be a particularly large increase in those aged over eighty-five.


1.2             This is good news: people are living longer, and many can now look forward to a considerable number of years of active life beyond the current age of retirement. Moreover, as friends, neighbours, carers, active citizens, and simply as individuals in their own right, older people make a tremendous contribution to society; an increase in their number is to be welcomed.


1.3             But this also presents challenges; a higher proportion of older people in the population, particularly people who can be numbered amongst the ‘oldest old,’ will put a strain on those services that are most frequently used by older people – most notably those statutory health and care services provided or commissioned by Oxfordshire County Council and Oxfordshire Primary Care Trust. It also means that the ratio between those of retirement age, and those of working-age, will be different from what it is now.


1.4             It is appropriate then to think about the impact of demographic change on the various services provided in the county – including the impact on community and volunteering initiatives – and to start to plan, collectively, for this change. The challenge is by no means insurmountable, but it does demand that all stakeholders engage in a serious dialogue about demographic change; consideration of how well prepared the County is to deal with the challenges that change presents; to think about what can be done to anticipate it, and to start planning now for what is needed to be done to meet the challenge of demographic change effectively.


2          Background


2.1             The population of Oxfordshire is growing; on current trends, the population of the county could increase by 20% by 2031, from 685,600 to 758,000 people. 


2.2             The population of the county is also ageing. On present trends, there will be 154,200 people aged over 65 in 2031 (66% more than in 2006); numbers of the very elderly (85 years plus) are projected to increase by almost 40% by 2016, and by 143% by 2031. This means that the proportion of older people in the population will increase from just under 15% in 2006 to just over 20% in 2031, while a decrease is projected in the proportion of the population of working age, from 54% in 2006 to 48% in 2031.


2.3             Demographic change will have a significant impact on services for older people and on service-provision in general: in 2005/06, for example, just under 50% of Oxfordshire’s total personal social services expenditure was spent on older people, which amounted to just under £1,000 per head of population aged 65 and over.  


2.4             It should be noted in passing, however, that this is not the only change afoot; up to 2017, Central Government expects positive net migration to account for half of UK population growth, and expects this trend to remain positive in the longer term. Migrants are overwhelmingly of working-age, and this should be taken as a corrective to viewing the phenomenon of population ageing outside of the broader demographic context.


3          Emerging Themes


3.1             In general, the panel of members examining this issue found that there was, throughout the various relevant agencies and their partners, a significant degree of awareness of the issues around demographic change, and it was clear that much work is already being done to account and plan for it.

3.2             The single biggest theme to emerge from the review process was the importance of partnership-working in, and joining-up of, services for older people; where it existed, the benefits of partnership working were consistently lauded by review participants, although there were suggestions that partnership could be emphasised more at a grassroots level. Members also saw a need to join up strategies in a way that is not always intuitive – for example, harnessing the Local Transport Plan (LTP) to the Oxfordshire Primary Care Trust (PCT) Strategy.


3.3             The need to promote and support independence and choice among older people by, for example, moving to deliver various services in, or close to, the home was the second theme to consistently emerge. The ethic of home-delivery cuts across services provided by health and social care, but should also be borne in mind as an element of housing and planning strategy.


3.4             The importance of prevention was the third recurring theme. As the number of older people grows, costs to various services can be reduced by taking steps to decrease morbidity – for instance, by taking simple preventative measures in health, and also by trying to attend to moderate, as well as critical, need in care service provision.


3.5             The fourth theme to emerge consistently was inclusion; older people are not a homogenous group, and there are different sectors of older people who will either have different or greater needs, who will be harder to reach for service-providers, or who do not always avail themselves of the services available to them – be they older people living in rural areas, older members of black and minority ethnic communities, or older people living with a physical or learning disability.


4          Caveats


4.1             With all of this said, it should be noted that the situation is subject to re-appraisal; future-proofing is an inexact science, and future ageing will not occur without other changes, such as significant technological or medical developments, or a change in cultural or social practices. Therefore, this review should be conceived of as a ‘living process,’ or one incident in an ongoing process that would need reviewing on a regular basis.


4.2             Furthermore, the panel strove to retain focus on the bigger picture of demographic change insofar as this was possible, and thereby to create a review that was self-consciously strategic in outlook. In producing this report therefore the Panel was striving to use the wealth of data obtained to identify and deepen awareness of areas and issues that require detailed examination, and not to seek to fully engage in that examination itself.


4.3             Hence, what follows should be seen as a series of ‘red flags’ that are intended to raise awareness of the major issues identified by the review rather than a series of specific recommendations.


4.4             However there is one specific recommendation and that is to undertake a conference in Oxfordshire, in the spring of 2009. The conference would take the major themes of this review as its point of departure, and would be an opportunity for all relevant agencies and bodies – both statutory and voluntary – to come together to hear influential speakers, to discuss the issues in greater detail and to begin to further develop begin the serious work of planning for the future. 


5          Red Flags


5.1       As pointed out above, the following are intended to raise awareness of major issues of importance recognised by the panel that will need attention if the response to the demographic challenge is to continue to be positive and effective.


5.2       The Contribution of Older People


5.2.1   Efforts should be made to ensure that all communities are aware of the services that are available to older people and the importance of understanding the needs of older people and, perhaps more importantly, the contribution that they can make to society.


5.3       The Contribution of Informal Carers


5.3.1   Informal carers make a tremendous contribution to the wellbeing of their families, friends, neighbourhoods and communities and in fact this is the main level of care for most people. There are a variety of forms of informal care and it will be important to encourage, support and develop all of them– whether it be family caring, simple neighbourliness, or a more structured idea of volunteering. Support from the statutory authorities working together is vital to maintaining this level of informal support.


5.4       Maintaining Independent Living


5.4.1   In order to help people to continue to live for as long as possible in their own homes both social care and the local NHS should give particular attention to:

o       Continuing to develop the preventative agenda by promoting positive lifestyle change and reviewing the barriers to older people’s activity 

o       Attending to critical needs in social care, but also attending to those needs that are less obviously acute

o       Continuing, and spreading more widely, investment in specific preventative services – including, but not limited to, the falls prevention service

o       Developing, and  increasing, the use of assistive technology


5.4.2   Independence, choice and dignity of older people should be promoted and maintained by taking steps to increase the take-up of direct payments and personal budgets, with the appropriate support and advice. 


5.4.3   The move towards lifetime homes and neighbourhoods will have a significant part to play in enabling people to continue living at home and careful thought should be given towards how this could best be developed in Oxfordshire.


5.4.4   Extra care housing is part of the support which is available to more frail older people to enable them to continue living independently for as long as possible and, as such, the development and implementation of the extra care housing strategy should be pursued.


5.4.5   Deteriorating mental health is often a barrier to people managing to live independently, particularly in old age. A significant increase in dementia and depression should be anticipated, although this could be ameliorated by the promotion of good mental health and by working against social isolation.

5.4.6   A model of choice and independent living for older people with learning and physical disabilities needs to be promoted and sustained.


5.5       Partnership Working


5.5.1   Partnership working between health and social care, and between other agencies (statutory and voluntary), has developed well and is ahead of many other parts of the country. However it will be important to ensure that effective partnership working takes place between all agencies at the level of frontline services as well as at the institutional level.


5.5.2   Joined-up planning will be vital to the development of strategies for responding to the demographic challenge. This is particularly relevant  to housing and to transport; for example, housing plans could and should be linked with relevant plans from other agencies – such as the PCT Health Strategy, the Local Transport Plan, District Council Community Plans and others.


5.5.3   Consideration should also be given to broader modes of partnership and linking-in; for example, the County Council could conceivably forge links with organisations such as the SPARC (Strategic Promotion of Ageing Research Capacity) initiative, a showcase for, and a funder of, ‘the latest research findings from design, engineering and biology to all stakeholders in older people’s issues.’


5.6       Access to Services


5.6.1   Access to services is obviously limited if people do not know about them; unmet need could be addressed to a major degree by ensuring that older people are made aware of, and have access to, all of the services and benefits that are available to them.


5.6.2   Specialist advice and advocacy services for older people would be of great benefit in helping older people to access services, and to claim those benefits to which they are entitled. Imaginative provision of such services, for example by using GP surgeries as sites or signposts, could bring them to the attention of a wider group of people.


5.6.3   With regard to access, particular note must be made of older people living in rural areas, and older members of Black and Minority Ethnic (BME) communities.


5.7       Continuing the Work – A Conference on the Demographic Challenge


5.7.1   To carry the spirit of this document forward, it is proposed that a conference take place, on this topic, in Oxfordshire, in the spring of 2009. The conference would take the major themes of this review as its point of departure, and would be an opportunity for all relevant agencies and bodies – both statutory and voluntary – to come together to hear influential speakers, to discuss the issues in greater detail and to begin to further develop begin the serious work of planning for the future. 




The Cabinet is RECOMMENDED to:


(1) endorse the proposal to hold a Demographics Conference on the 19th March 2009;


(2) accept the report as a whole and in doing so, endorse the “red flags” as the main areas for work and development in the future;


(3) agree that the red flags should be used as the main underlying themes for the conference in order to lead to agreed actions as appropriate and necessary in the future.





Senior Policy Manager



Background papers:             Full Review report on web site and in Members Resource Centre


Contact Officers:       Roger Edwards, Scrutiny Review Officer - Health Specialist


                                    Tel: 01865 810824


January 2008


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