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Published online by Cambridge University Press: 27 December 2024
Aim
This chapter discusses the impact of some of challenges that health and wellbeing commissioners and their partners face today, and those that are arising in the near future. This includes two ambitions from the NHS Long Term Plan (NHS England, 2019c), related to the ageing population and the advancement of technology. Also, the impact and learning from the COVID- 19 pandemic is covered, as this has been influential in shaping health and care delivery in agile and adaptive ways and has offered a unique opportunity to accelerate change for the better. And finally, the climate change crisis is discussed, as this will have increasing impact on both demand and delivery of health and care services. Understanding these challenges helps commissioners plan for today and the future effectively.
The ageing population
What defines ‘old’ or ‘ageing’? This is a contentious question. Generally, we refer to the older population as those aged over 65 but, as many of us will know, there can be people who are very fit at 75 years old but others at the age of 60 who are showing signs of biological older age. Instead, it is simpler to refer to the older population in terms of frailty. Frailty is the progressive loss of physical and cognitive resilience, and it is a better indicator of specialist need in older age. People who are frail are at greater risk from falls, admission to hospital, and episodes of ill health. People from some groups can be at higher risk of frailty at a younger age. This is particularly true of people in deprived areas (Stow et al, 2022). Commissioners must remain mindful of their population needs when considering ‘ageing’ or ‘frail’ populations.
Although an ageing population is seen as a problem in terms of demand, it is also a marker of success of health and social care, and the wider welfare state. In the next 25 years, the number of people aged 85 and over will double to 2.6 million (Raymond et al, 2021). We can make the obvious assumption that the ageing population will require more services to meet the growing need – and this is supported by the fact that the proportion of people aged over 75 with one or more long- term condition has risen.
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