More Years, Better Lives and End of Life Care

JSNA LogoOne positive consequence of wider improvements in health and well-being achieved over recent decades has been that more people are living longer. However living longer poses challenges for health and wellbeing services.

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Marmot recommendations: D - "Ensure a healthy standard of living for all" ; E - "Create and develop healthy sustainable places and communities"

The United Nations Population Fund (2012) describes the ageing population as both a celebration and a challenge; stating that ‘ageing is a triumph of development. Increasing longevity is one of humanity’s greatest achievements.’

In Southampton, as nationally, average life expectancy is increasing and as a consequence more people are living longer. The fastest growing sector of the population is that aged 65 years and over. Forecasts made using known residential development plans predict the over 65s will rise by 11% between 2011 and 2018 whilst the number of people over 85 years is forecast to grow from 5,300 to 6,000, an increase of 13%. Longer term projections, based on past trends, predict a 42% increase in over 65’s in Southampton between 2010 and 2035 with the number of res idents in the city aged over 85 reaching 10,000 by 2035.

The increasing proportion of older people creates challenges for individuals and policy makers alike. On the one hand we can expect to live longer than ever before but the number of years with a limiting illness or disability has also been increasing. This is creating pressures on social care resources and other public services. Medical advances are meaning people who previously might have died at a young age are living longer, often into adulthood, but frequently with long-term conditions and needs which require support to help them live as independently as possible. Like wise, with old age being extended, demands for social care and support are increasing.

However, we must be clear that ageing is not a burden and it does not necessarily decrease a person’s ability to contribute to society especially if an asset-based approach is adopted. In Southampton ‘opportunities for good health need to be optimised so that older people can take an active part in society and enjoy an independent and high quality life’ [1].

Each year about 460,000 people die in England and around 1,790 residents in Southampton (3 year average). End of life care is about enabling people to live their life to the end with dignity and having their choices respected. Not all people will be able to plan for their death, but for a majority of people planned end of life care has enabled them to expe rience a peaceful and dignified death.


Other References:
Association of Directors of Adult Social Services (2005) Safeguarding Adults: A National Framework of Standards for good practice and outcomes in adult protection work
Association of Directors of Adult Social Services (2009) Common Resource Allocation Framework
Audit Commission (2010) Improving Value for Money in Adult Social Care
Cabinet Office (2009) A guide to social return on investment
Campbell, F. (2011) The social determinants of health and the role of local government. Improvement and Development Agency.
Cicely Saunders Institute (2011) Local preferences and place of death in regions within England 2010.
Department of Health (2008) A dialogue of equals: The pacesetters programme community engagement guide. Department of Health.
Department of Health (2008) End of Life Care Strategy Promoting high quality care of all adults at the end of life.  
Department of Health (2009) End of life Care Strategy: quality markers and measures for end of life care. DH. London.
Department of Health (2010) Impact assessment of the revision to the Fair Access to Care Services (FACS) guidance
Department of Health (2010) Prioritising need in the context of Putting People First: A whole system approach to eligibility for social care, Guidance on Eligibility Criteria for Adult Social Care, England 2010
Department of Health (2011) The Adult Social Care Outcomes Framework – Handbook of Definitions. Department of Health 
Field, F. (2010) The Foundation Years: preventing poor children becoming poor parents. Cabinet Office.
Gold Standards Framework. Available from: (Accessed 7 September 2011)
National Institute for Health Research (2011) The Quality and Outcomes Framework (QOF): does it reduce health inequalities?
NHS South Central SHA (2010) Unified Do Not Attempt Cardiopulmonary Resuscitation Adult Policy (DNACPR). Available from:
NHS Southampton & Southampton City Council (2010) A Bright Future in Later Years, Southampton’s Vision for 2014
Office for National Statistics 2010-based Subnational Population Projections
Schizophrenia Commission (2012) The Abandoned Illness
Shepperd, S., Wee, B,, and Straus, S.E. (2011) Hospital at home: home-based end of life care. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD009231.
United Nations Population Fund and HelpAge International (2012) Ageing in the 21st Century: A Celebration and a Challenge.