Round about the year 2000 – whether or not associated with the turn of the millennium – the New Zealand Government produced a swathe of policy documents, depicted as “strategies”. They included the New Zealand Positive Ageing Strategy (2001), the Health of Older People Strategy (2002), the Disability Strategy (2001), the Transport Strategy (2002), followed by the Housing Strategy (2005). Notice that the first two of these concerned older people.
This reflected increasing attention on population ageing in the international arena. In the late 1990s the OECD published a series of reports on the topic – Maintaining Prosperity in an Ageing Society (1998); Reforms for an Ageing Society (2000). I don’t intent here to review progress since this time or to examine where the Positive Ageing Strategy has taken us (although both might be the subject of blogs to come). Instead, I want to draw your attention to a review of the second item on my list above – the Health of Older People Strategy (HOPS).
The original HOPS was intended to cover the period 2002-2010. The revised version will cover 2016–2025, shaping a direction for future services to meet the health and disability support needs of older people. It will fit under the New Zealand Health Strategy (also being revised and coming out ahead of the new HOPS), which takes a wider view of health for everyone.
What has changed since 2002 and what are the emerging challenges?
* Population ageing, with growth in numbers aged 85 plus – the age group with the highest health expenditure. ‘Healthy life expectancy’ – the average number of years in which people can be expected to remain in good or fairly good health – is also increasing, but not keeping pace with life expectancy. This means that people are living longer, but also spending more years with some disabilities.
* More people are living with one or more long term conditions, such as diabetes, cardiovascular disease, asthma, and arthritis.
* An increasing number of people will be affected by dementia.
* Greater ethnic diversity in the older population, requiring a different mix of services and methods of service delivery in the future.
* There is greater recognition of the social factors which influence health and the need for preventive action; key factors include nutrition and physical activity.
* The health workforce is also ageing, giving concerns about the future supply of health professionals and support staff.
* Consumer expectations of health care and access to treatment and medication have risen.
* There are concerns about the financial sustainability of health services, linked to higher demand, but also to the increasing complexity of care, arising out of the above factors.
* There is greater recognition of the social factors which influence health and the need for preventive action; key factors include nutrition and physical activity.
Developing a new Health of Older People Strategy
The new HOP Strategy will build on the objectives and vision of the 2002 Strategy, which still have validity. Its vision was:
“Older people participate to their fullest ability in decisions about their health and wellbeing and in family, whānau and community life. They are supported in this by coordinated and responsive health and disability support programmes.”
A review of HOPS concluded that its implementation had resulted in some significant improvements in health services for older people and considerable advances in the aged care system, medical treatments, and supporting technology.
A new HOPS needs to respond the new challenges, with a stronger focus on wellness and early intervention; social wellbeing and person-centred approaches. It needs new approaches to addressing inequities, especially ethnic inequalities in health outcomes and access to services. There is currently a much greater need be aware of overall cost and ensure value for money. The 2002 Strategy did not cover affordability. The Ministry of Health proposes that the review will look at what’s working well, where the gaps are, and where there is room for improvement. The process has begun with consultation with sector experts and stakeholders. Meetings with groups of older people are occurring at present.
What do you think are the new issues and challenges? What are your thoughts and suggestions? At the moment there is a call for comment on the draft of the new overall Health Strategy, which will come out before the revised HOPS. There is a consultation document available at health.govt.nz.
After this there will be an opportunity for anyone to provide their input on HOPS.
On Research 