Ageing population must be considered by health review
In the next decade the number of people aged over 75 in Northern Ireland will rise by 32%.
That is one of the challenges that a major review of Northern Ireland's health service will have to consider.
NI's ageing population will require more services in their own homes, and the move to more community care will have major consequences for health service resources.
The review is due to be completed later this month.
BBC Health Correspondent Marie-Louise Connolly has been looking at how the health service can fund a system that promotes independent and healthy living for our older generation.
In the next decade the number of people living until 75 and above will rise by almost half - that's a tribute to modern medicine's ability to extend lifespans, but it is also a big challenge.
How can the executive pay for a care service which allows the growing number of older people to continue living at home for as long as possible?
Resources are not going to grow significantly, so effort will have to be shifted away from hospitals and into the community instead.
It could mean a seismic shift, both physically and in mindset.
More services will have to become available to people in their own homes.
The flipside of that is that hospitals, which eat up most of the health care budget, will have to be organised in a way that saves money.
At a day care centre in east Belfast, a group of pensioners told the BBC they want to stay in their own homes for as long as possible.
The 15 men and women who were there said they all enjoy being independent.
Some admit however, they do need a little help.
Ethel, who is 78, said she is too young for a nursing home.
"My health is generally good, it's just my back and my legs that are sometimes sore," she said.
"What I need is a chair lift which will help me up the stairs. I don't need to go into a home just for that."
At the moment an older person, who requires assistance at home, is assessed by their local health trust.
Depending on that assessment, a system will be put in place that could provide a home help, even meals delivered to the home daily - what is known as a domiciliary care package.
But according to Age NI's chief executive, Anne O'Reilly, that system is under pressure and failing too many people.
"Our social care system is broken and needs fixed. A new revised system is long overdue," she said.
"The current one is no longer sustainable or capable of meeting the needs of people."
From his home in County Down, John Murtagh, 91, is the human face of that system under strain.
He said the withdrawal of meals to his home by his health trust, will probably mean he will eventually have to move out of his house.
"After my wife died the trust took away the service, she needed it more than me. But I am 91, a bit forgetful and by the time I shop and cook the day is over," he said.
"I'm old, I need a little help, it's also good to have a little company during the day, though because they are so busy, the man who delivers the meals never has time to stay - even for just 10 minutes."
Deirdre Heenan is one of five experts employed by the Department of Health to lend her expertise about how social care could be developed.
"What we have to ask ourselves - is the system as good as it could be, especially for older people?" she said.
"We've been asking how can we do things differently.
"People want to remain at home, we need to see how the service can be delivered to their front door. But it must be affordable and it has to be effective."
One area being explored is what are known as direct payments or social impact bonds.
Each person who is entitled to financial help would be allocated a payment, for instance £100 a week.
From that payment the person and their family can choose how they want to spend it.
Choices would include meals on wheels, home help, the delivery of drugs by a pharmacy, even chiropody treatment.
Making greater use of that system would bring Northern Ireland into line with England, Scotland and Wales.
The chief executive of Northern Ireland Council for Voluntary Action, Seamus McAleavey, said personalising care is what communities want.
"I think communities and voluntary organisations can work with families as an advocate," he said.
"They can advise them how to make the right choices and to manage the money.
"The service would be evaluated by independents to ensure money is being handled properly and that families are getting good value."
But Anne O'Reilly from Age NI is concerned that the political will is not there to make it happen.
"Our biggest worry is that without the political will and public debate that we need, the system will revert to type. It will be a matter of just re-arranging the deck chairs," she said.
"Enough is enough. We've got to set the stage for the future - if we need access to care, for you, for me, for future generations."
A number of community associations in Belfast told the BBC they want to play a better role caring for the elderly.
Catherine Apsley is co-coordinator with the Belfast Central Mission.
Currently it supplies services to 60 people, but the demand is greater.
"People here in east Belfast like their neighbours, the streets where they raised their families, they want to end their days here," Ms Apsley said.
"At the moment we have handymen going into houses to fit locks on doors, rails on showers, stairs, etc, but we want to do more.
"With extra funding we could also do meals on wheels, people calling to help with collecting medication, podiatry services, there is a whole range of things which prevents accidents from happening and older men and women having to be hospitalized. It's cheaper in the long run."
In order for this aspect of the review to be tackled effectively, politicians must accept the scale of the challenge and the need for urgent action.
This is not the first time we have had such a review.
But what has changed this time is that the political choreography is different and we have a health minister who has said he is not afraid to make decisions.
That combination could create the chance to fix the care system so future generations are free from the fear of ageing.
- With a major review of Northern Ireland's health service due to be published later this month, BBC Health Correspondent Marie Louise Connolly will be looking at the big issues it will tackle each night this week on BBC Newsline at 18:30 GMT on BBC One.