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Archive for the ‘Ageing’ Category

By Professor Azeem Majeed, Head of the Department of Primary Care and Public Health, Imperial College London

The departure of the UK from the European Union (EU) will have wide-ranging consequences for public health. The UK first became a member of the EU in 1973 and as a member of the EU for over 40 years, the UK has played a full part in European-wide public health initiatives. These have covered many areas, including food regulations, road safety, air pollution, tobacco control and chemical hazards.

Cross-national approaches to public health are essential when dealing with issues that do not stop at a country’s borders (eg. air pollution) and when dealing with large, multi-national corporations over which any single country will have only limited influence. Although EU public health initiatives have had important positive effects on health in the UK, there will be strong resistance from pro-Brexit politicians in participating in future programmes, as they generally view them as unnecessary interference in the UK’s internal affairs. The UK will also find that it is no longer able to lead such programmes or have much influence over their content, which will inevitably damage the leading role that the UK has played in public health globally.

The NHS will also find itself facing major challenges because of Brexit. With over one million employees and an annual spend of over £100 billion, the NHS is England’s largest employer. For many decades, the NHS has faced shortages in its clinical workforce and has relied heavily on overseas trained doctors, nurses and other health professionals to fill these gaps. This reliance on overseas-trained staff will not end in the foreseeable future. For example, although the Secretary of State for Health, Jeremy Hunt, has announced that the government will support the creation of an additional 1,500 medical student places in England’s medical schools, it will be more than 10 years before the first of these extra medical students complete their medical courses and their subsequent post-graduate medical training.

The recruitment of overseas-trained health professionals has been facilitated by EU-legislation on the mutual recognition of the training of health professionals. This means that health professionals trained in one EU country can work in another EU country without undergoing a period of additional training. For example a cardiologist or general practitioner trained in Germany would be eligible to take up a post in the NHS. Moving forward, it’s unclear that this cross-EU recognition of clinical training will continue. As inward migration to the UK looks to be the most politically contentious area in our post-Brexit future, we will need to take urgent action to ensure that the NHS has sufficient professional staff to provide health and social care for our increasingly ageing population.

The UK’s government will also have to address the issue of access to healthcare, both for EU nationals living in the UK and UK nationals living overseas in countries such as Spain. Currently, all these individuals are entitled to either free or low-cost healthcare. It’s unclear what will happen in the future, and this is particularly important for the UK nationals living overseas, many of whom are elderly and who will have a high level of need for healthcare. As the NHS has never been very effective in reclaiming the fees owed to it by overseas visitors to the UK, the UK may find itself substantially worse off financially when new arrangements for funding cross-national use of health services are put in place.

In conclusion, Brexit will have important impacts on public health and health services, with scope for wide-ranging adverse consequences for health in the UK. It’s therefore essential that public health professionals engage with government to ameliorate these risks and also gain public support in areas such as the benefits of participation in EU-wide public health programmes and the continued recruitment of health professionals from the EU.

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By Alan Maryon-Davis, honorary professor of public health at Kings College London and past president of the Faculty of Public Health

WE love our NHS, despite its failings. We trust it, we depend on it and we cherish its fundamental principles of fairness and universality – free to all at the point of use.

Born out of Beveridge, midwifed by Bevan, the safe arrival of the infant NHS in the aftermath of war was nothing less than a revolution – the sort of massive change that could never happen today. It was huge – so big it dwarfed outer space.

Now, as we all know, the NHS is under threat – weighed down by the ageing population and high-tech hypertrophy, harried by small-state politicians, encircled by drooling marketeers  and asset-strippers.

The NHS is accused of being too monolithic, lumbering and unsustainable. The Government’s response has been to claw back millions of pounds and fire an explosive harpoon into its belly. The 2012 Act has torn into the flesh of the NHS, damaged many of its vital organs and put it on the critical list.

But it’s not dead yet. They have underestimated the power of the people. The NHS is healthcare of the people, by the people, for the people, all for one and one for all. This is why so many of us feel so passionate about it – and why we delighted in seeing it celebrated in the Olympics opening ceremony.

I believe the NHS at 65 is still, fundamentally, in good shape – in spite of all the ‘efficiency savings’, all the sniping and Cassandras, all the barbs, rug-pulling and clattering of bedpans in the corridors of Whitehall. The NHS can be nursed back to full health and vigour. Of course this requires political will – but political will is driven by the power of the people. And people power can be shaped and energised by the advocacy of those of us who feel strongly about defending the NHS and its fundamental principles.

We must seize this 65th birthday celebration to let everyone know that we will fight to make sure the NHS – the real NHS, not just the logo – is here to stay.

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Morning parallel session, at the Faculty of Public Health annual conference, on Wednesday 7 July.

Chaired by Laura Donnelly (Health Correspondent at the Sunday Telegraph), and panel members Dame Carol Black (National Director, Health Work and Wellbeing), Andrew Harrop (Director of Policy and Public Affairs, Age UK) and Yvonne Coull (Consultant to, and former Director, Queen Mary University Centre for the Older Person’s Agenda).

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By Jessica Becker

How can one extend work life while meeting the needs of an ageing workforce? What can be done to promote age-friendly communities? And how is the recession impacting on the care for the elderly?

Dame Carol Black, the National Director of Health Work and Wellbeing, Andrew Harrop, Director of Policy and Public Affairs at Age UK, and Yvonne Coull, former director of Queen Margaret University Centre for the Older Person’s Pension Agenda,  discussed the future challenges of an ageing society at the FPH Annual Conference on Wednesday 7 July.

One of the big issues related to an ageing society is the question as to how to deal with an ageing workforce. Dame Carol Black said that while life expectancy is increasing, health expectancy has not kept up. She argued that in order to build a resilient workforce, support in education and an early, co-ordinated intervention is required. Andrew Harrop stressed that no society can afford to leave a high number of people from their mid-fifties relying on welfare because they are no longer fit for their jobs. Yvonne Coull therefore claimed for flexibility on the side of the employers to meet the demands and potential of older people.

An ageing population does not only impact on the work life, but also changes society. As the number of the elderly increase, communities need to adapt. One aspect of this change relates to the physical design of communities, for example when it comes to pavements, as Harrop explained: “When people feel safe, they are more confident to participate in the communities.” This participation has a positive impact, not least on the interaction between generations, Dame Carol pointed out, and should therefore be further encouraged.

Everyone agreed that the underlying issue affecting all of the discussed topics is the prospect of cutting funds. However, Yvonne Coull expressed the hope that the “older generation that is coming through is more active and more demanding than ever before,” and may therefore be able to lessen the effects of decreasing funding.

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