The ageing population in healthcare: a challenge to, and in, the workforce

Abstract

Welcome to the August edition of Clinical Medicine . I think it would be fair to say that since I wrote my last editorial much has changed in the healthcare landscape and, despite many people's misgivings about the recent general election, the outlook for patients and staff in the NHS may have unexpectedly been improved, with a government that is now mandated to listen, if it wishes to stay in power. We, the NHS, need them to listen, and more importantly to start responding, to our concerns.In addition to the changed political landscape, the combined tragedies of the Manchester, Westminster and London Bridge terror incidents and the subsequent Grenfell Tower disaster have required all emergency services, including medical staff, to respond in terrible and tragic circumstances. This response is rightly described as heroic in the lay press, but, as we must continue to point out to ministers and those who control our purse strings, this is how we aim to respond to all our patients, providing life-saving and supportive care every minute of every day, not just in the nation's darkest hours. Of course, we do this in the UK, for our own population, but as outlined in this journal, we also do so during international crises, such as the recent Ebola epidemic. 1 We all know that the NHS is under enormous strain, and will continue to be so for many years to come. A publicly funded NHS model will remain under critical pressure with a government committed to austerity, but at least extra taxation to underpin its future was committed to by both opposition parties and is now forming part of the national debate. What is missing, however, is discussion on the additive effect of the ageing population, not just of the patients, but also the workforce.In this issue, the excellent CME section focuses on the care of the older patient, highlighting the need to manage the complexity of this growing population with pragmatism, respect and dignity, focusing on frailty as the primary driver, rather than chronological age. Whether in the acute admission 2 or perioperative setting, 3 or on the ward, we must ensure the environment we provide this cohort is safe, both physically andThe ageing population in healthcare: a challenge to, and in, the workforce emotionally. As is highlighted, our decision making must be underpinned by the mantra 'no decision about me, without me', which is of utmost importance in this vulnerable population. The article by Khizar and Harwood 4 provides a useful handrail in this difficult area. Reducing falls 5 and being aware of the physiology of ageing 6 all support optimal care of the aged and frail patient on our medical wards.As I have highlighted in previous editorials, retaining generalist expertise in the era of sub-specialisation is a real challenge and I suspect for many of us that this applies particularly in the areas of acute neurology, cardiology and oncology. Access to neurology expertise is essential to provide optimal care in the acute setting; however, in many hospitals colleagues working in acute m...

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“…It is estimated that healthcare accounts for 17.0% of the nation’s 2020 GDP in the United States alone. Moreover, the GDP share is poised to rise in the near future due to the substantial increase in the aging population [ 1 ]. Unsurprisingly, the convoluted healthcare system takes a heavy toll on the environment as indicated by a study that showed that the healthcare sector contributes up to 8% of the total US greenhouse gas emissions [ 2 ].…”

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