'The Old Are Not So Old Anymore.'

Thank you for the opportunity to speak to you today.  Congratulations on putting together an outstanding programme for your annual conference.

I'd like to acknowledge, NZACA Board Members and your CEO Martin Taylor. And I'd also like to acknowledge you for your care of our older New Zealanders and your commitment to them.

A report published last week in Science magazine argues that rising life expectancy and improved health means the population is ageing more slowly. And this in turn means that the so-called burden of an ageing population may not be as dramatic as feared.

The American and Austrian authors say that the current methods of predicting the impact of an ageing population are wrong because they are based on chronological age... and consider people as being "old" when they are 65.

The authors say people are living longer healthier lives and, basically, "the old are not so old anymore".

People are fitter, healthier and more active. As a cyclist I can vouch for the speed of some of the more senior members of the cycling fraternity!

What the Science report is saying is people can look forward to fewer years of ill-health, much later in life and possibly for a shorter period.

[This is not an argument about the age of entitlement for superannuation. The Government's policy and commitment is clear about no change in this area. It is, however, making a comment about our expectations of future health costs].

Another recent report published by the American Heart Association found that even moderate increases in fitness in the elderly increases their life expectancy.  

Researchers exercise tested 5,000 men over 65 for 8 years and found that increased fitness reduced mortality risk by up to 61%.

But as you know, for many people a longer lifespan will increase the number of years these people live with a disability or chronic disease, and increases health spending over their lifetime.

Which ever of these trends prevails - and it will probably be a combination of both! - our health service must plan for the future and recognise the increasing prevalence of chronic diseases.

And that's what's happened with the Aged Residential Care review report released last week.

For the past couple of years at your annual conference I have talked about how New Zealand needs to better anticipate the future demand for aged residential care.

And then develop long term plans to progressively lift the number of beds and services available; making sure they are in the right place at the right time to meet the changing expectations of older people in New Zealand.

You as providers, DHBs and the Ministry of Health have worked collaboratively to review aged residential care services, in what is the most significant and comprehensive report of its kind in the Southern Hemisphere.

This report will greatly help our future decision making.

It provides robust information on demand and supply, workforce projections, and suggestions as to how models of care may evolve. 

It gives us the potential number of older people requiring aged residential care.

It tells us when extra care workers and beds will be required.

It provides the operating costs of current providers and the potential costs of new facilities.

And it provides an overview of the different types of support required.

The messages are clear: we have a window of opportunity to plan and to get ready, as demand remains relatively stable over the next few years. We need to invest more in hospital level and dementia care.

The process from here is that you and the DHBs and the Ministry will work to identify what needs to be done to meet our obligations to provide quality care for future older New Zealanders.

Our ability to do that depends on two things - how prosperous we are as a country, and how well we use our resources.

We know we will have to invest more to signal greater investment is needed in hospital-level and dementia care.

That will cost money. But if we do this right, then we can move resources from say fewer hospitalisations to pay for this.

In 2009, the Ministerial Review Group report on the public health service made it clear that New Zealand needs - now and into the future - better integrated community and hospital based care in order to provide better, more personalised services closer to home.

That's what older people want delivered - wherever their ‘homes' happen to be.

The ARC Review discovered that in 2008, over 26% of rest home residents presented at an emergency department during that year, many more than once.

The review also shows that hospitalisation and pharmacy costs of aged-care residents have been increasing, but using more integrated care and multi-disciplinary approaches could reduce this by over a quarter.

A major finding that needs further research is the indication that people in higher level home support have much higher levels of hospitalisation compared to people in rest homes.

Your report supports the international evidence which suggests that greater clinical services in the community - across home-support and rest home - reduce costly hospitalisations.

And that is how we can help pay for this additional investment in improved aged-care services.

By resourcing rest homes to have much greater clinical and social work capacity, older New Zealanders can live longer, in more comfort and dignity.

In many communities, some of the best expertise for supporting older people and helping them maintain independence and freedom is working in the local rest home.

A more integrated approach would see that clinical expertise improving the quality of care across the community.

And some DHBs are responding as part of the Government's new direction in primary care:

MidCentral DHB, for example, has established a specialist older person's team as part of their primary care changes and is providing interdisciplinary gerontological team clinics.

In Tararua and Horowhenua, they are also reporting increased access for residents to GP services in residential care facilities.

And in the Wairarapa, they are about to roll out a plan as part of their Primary Care Business Case for consistent GP coverage of Aged Residential Care facilities - including after hours access.

This should reduce the numbers of elderly Wairarapa people presenting at EDs from rest homes, who could instead be seeing a GP.   Arrangements are already in place for 24 hour on call for aged care facilities and for palliative care.

The ARC Review proposes a number of options for meeting the challenges of the future, and the integrated services approach sits very comfortably with the Government's direction.

This Government has taken the deliberate decision to take a long term view of our country's economic challenges.  

We are living in difficult economic times - which are likely to continue for some time yet. 

The Government has many competing demands and pressures across a range of services such as health, education and social services; and the Government is committed to delivering better, smarter public services.

Given the tightness of fiscal and competing demands these need to be prioritised - and it is critical that these services need to be those that the public deems of highest value.

The Government is investing more of the country's resources in health than ever before.

Last year Vote: Health got half of all new government spending.

In Budget 2010, $2.1 billion was allocated to Vote: Health for investment in health priorities over the next four years - including an extra $512 million of new spending in 2010/11.

That means Vote: Health has kept pace with inflation and population change.

The public health service will, however, need to ensure a strong and ongoing focus on value for money.

Resources need to be moving from administrative overhead and low priority spending into more important frontline services.

And this applies equally to services whether they are being delivered in the hospital, at home or in residential care. 

Increasing productivity - and the effectiveness of the system as a whole - will be key for decisions on health interventions and ensuring value from our investments.   

I wish you well for the rest of your conference. 

I look forward to hearing more from you about the challenges you are facing and the opportunities you are taking for working in new ways in your sector, improving the lives of the older people in your care.

Thank you again for inviting me to be part of it.