'Tough decisions needed to head off elderly care crisis' in Wrexham and Flintshire

Mr White says he can detect the time bomb ticking on the horizon if the country doesn’t get to grips with caring for its elderly.

Wrexham Maelor’s geriatric medical expert knows only too well the demands an ageing population poses.

Advances in medical treatments have meant he and his team are keeping more and more frail and elderly people alive beyond their hospital stays. Often when they return home intensive and costly care packages are needed to keep them going.

The Professor of geriatric medicine is convinced more needs to be done to link care in hospital to what is on offer back home from social services. Ignore the future at your own peril could be the message. Otherwise all of us, young, middle-aged and soon-to-be retired, could be storing up some very grim final years for our dotage.

Tony says big decisions need to be taken now about how we fund elderly health care, particularly with numbers affected by conditions like Parkinson’s and dementia soaring. It is a picture hardly envisaged by the founders of the NHS back in 1948 when the life expectancy for men was around 65 and women, 71.

Now a man, on average, can expect to reach his 80th birthday, while for women life expectancy is around 83.

“Then a man would typically retire at 65 and would have a relatively short life expectancy afterwards. Most of the chronic conditions were untreatable,” recalls Tony.

“As medics we are quite good at what we do and now a lot of elderly people who would not have survived in the past are being treated successfully and are returning to the community. A lot of what we do is to try to keep them out of hospital.”

Tony outlines the variety of geriatric care in the Wrexham area, which includes acute care, rehabilitation and outpatient care. A stroke unit run by two physicians with specialist training and services for those affected by Parkinson’s Disease as well as a new service for frailty - one of Tony’s specialisms - are among the excellent services on offer.

Many families are familiar with the downward spiral as they desperately try to put in place support when elderly parents reach an age when they can no longer live safely in their own homes. Illness and hospital admission often highlights their plight as the more able parent finds it difficult to care for his partner as frailty increases.

Tony points out: “We need to look at integrating our work more closely with social services. We had a joint project some years ago and we looked at elderly patients and helping them get home and making sure they had social support.

“Some precarious arrangement may keep things going at home then some sort of crisis happens. It is very challenging, some of it comes down to resources and money and everyone is very stretched. Social services are struggling to do what they can. For example, we do have got a number of care homes who do take who they can, but they are often quite full so we are reliant on carers in the community who go into homes and get people up, washed and dressed.”

A spectre haunting health care is the rise in those diagnosed with dementia. The Alzheimer’s Society says there are 850,000 with the condition in the UK and that figure will rise to one million by 2025. One person in six over the age of 80 has dementia and Tony says while changes have been made in elderly wards at Wrexham Maelor to accommodate them resources are stretched to manage their complex needs.

“It is an epidemic now and pushes additional stresses on the individual, their carers and their families. We need skilled nursing and knowledgeable care, but we have limited facilities. People with dementia get easily distressed if they are taken out of their normal environment. It’s a nightmare situation, but we are getting better at dealing with it and there is expertise in Wrexham, particularly from our colleagues in old age psychiatry at the Heddfan Unit.”

Joined-up care, where NHS staff work with social care professionals from councils, is the way forward says the medic.

“Quite often dementia patients come into us as medical admissions because they have got specific physical illnesses. So you need expertise from people who can deal with that and those used to dealing with dementia, but getting those skills in the same place at the same time is not easy.

“Hospitalisation can leave people with dementia acutely confused, so ideally we would like to return them to a familiar environment as soon as possible.

“Changes have been made in the wards here to allow increased space. They need a calm environment with space to walk and constant reassurance. Because of the numbers involved it is difficult to cater for what is a particularly challenging group.”

With council budgets squeezed care in the community is a controversial topic, but the Wrexham consultant isn’t afraid to question the unrealistic pronouncements of politicians.

“The country has to decide how much it wants to spend on care for the elderly because it will affect all of us one way or the other. If we are saying we are going to charge for health care it is anathema really, people are so use the NHS being free at the point of access,” declares the Professor, who at the age of 67 briefly became a pensioner himself when he retired for a month but thought better of it and returned to the Maelor where he has worked since 1991.

“Nobody is keen to stand up and say “actually we can’t afford this any more, or if you want it you will have to pay for it with increased taxation”.

“Someone proposed NI payments were replaced with a health-type tax. Something is going to have to be done because the pressures are unsustainable.”

Meanwhile, in the present Tony, who lives at Bwlchgwyn, and his team have been coping with the demands of “the busiest winter he can ever recall” as the wards at the Maelor have been inundated with unwell and frail old people, but he adds: “Those of us who do elderly care feel this is an important challenge and there is a real need for the skills we provide.”