We are the oldest population in the north west by a long way and ageing at a faster rate,” says John Howarth, a former GP now charged with improving Cumbrian health services.

To be successful he faces an uphill battle as he tries to juggle the increasing demands of that elderly – or “super ageing” – population with an ever-shrinking pot of money.

One of the key concerns is the rising number of dementia cases and how an already overstretched system will cope.

Among health and social care leaders, and the county’s voluntary organisations, there is a widespread admission that Cumbria is facing its biggest challenge and against a backdrop of troubles – hospitals in special measures, health trusts in debt and councils constantly looking for new ways to slash costs.

There seems to be a strong consensus that the solution is to focus less on expensive hospital beds and care homes and more on community care.

But this has been tried before – there was the Closer to Home plan of 2007 – yet the deficit seems to have continued to spiral.

Voluntary organisations and the services they provide are also being hailed as part of the solution but they too are feeling the impact of austerity.

Although a national problem, Cumbria will feel it more than most due to its high proportion of elderly residents.

“The number of 85-year-olds will have doubled from 2010 to 2030,” said Dr Howarth. “Dementia cases will go up by about 80 per cent in that time.”

To put the figures into context, in Carlisle it means one new person is being diagnosed every week.

In towns the size of Penrith and Workington there will be a new case every fortnight.

In smaller communities it may be every three or four weeks but the upshot is most of us will soon know someone with dementia.

“It’s going to be a constant increase. That puts pressure on families, carers and communities,” said Dr Howarth. “One of the biggest challenges is that we are having to deal with all this in the face of reducing budgets.”

“With dementia there is an emotional impact but also a financial one. Nationally dementia costs the UK £26.3bn every year. Yet it is a time when budgets for social care are being radically reduced.”

When it comes to elderly care, it is widely acknowledged that most people want to stay at home for as long as possible.

But Dr Howarth said the current system isn’t set up for that.

“If you take an average person, most of the money that’s spent on their health is in the last year of life, often doing things that if we had a choice we wouldn’t do – such as admitting them to hospital or a care home,” he explained.

“We need to re-imagine the health service. The system we have now dates back to 1948. Today we need a more integrated system where specialist skills aren’t defined by the four walls of a hospital.”

He said this would benefit both elderly patients, who can go downhill fast in hospital and healthcare budgets.

“Two thirds of people with dementia live at home. If someone with dementia is admitted to hospital for any reason, even if it is a fairly minor illness, there is a 30 to 40 per cent chance of them ending up in a nursing home,” he said. “That’s because you stay a lot longer, you often get more confused, your nutrition might deteriorate and you may end up enable to go back home.

And Dr Howarth said ways to prevent someone with dementia going into hospital could include things as simple as checking their footwear.

“For example, if someone falls and breaks their hip they are in hospital for about a week on average. If that person has dementia, they stay about a month. It costs and £7,000 to £8,000 more and there is a 40 per cent chance of them going into a care home afterwards, at a cost of nearly £40,000 a year.

"If you look at what happened prior to the fall it may well have been triggered by something little like ill-fitting slippers. That is where we need to focus, on preventing the fall in the first place.”

He said a community focus is the answer, looking out for carers and families, ensuring people are living in a safe environment and getting the support they need.

To do this he said health and social care teams have to work closely with organisations such as Age UK, the Alzheimer’s Society and carers’ associations – but he acknowledges they have limited finances.

“If organisations such as the Alzheimer’s Society have to cut back services because of reduced funding this goes against the direction of travel which we need to be moving in. More and more we are going to need these organisations as partners. If you reduce the support they provide it ultimately means more people will be admitted – so we are back to square one,” he said.

“These groups are part of the answer and we need to be supporting them.”

He also believes that to really implement the changes needed, there has to be a shake-up of the way the NHS is funded across Cumbria.

“Closer to Home was in the right area as a plan, but the system beat it,” he admitted. “We are essentially paying for exactly the thing we are trying to avoid because the payment system encourages hospitalisation. That is the fundamental root cause of the problems.”

He hopes that the new Success Regime could hold the key.

Set up by the Government to tackle the long-standing problems in north Cumbria, it brings together all the health and care providers together with voluntary organisations and the wider community. Its remit is to find a solution and quickly.

“We’ve got a system that pays for hospital admissions; the more admissions, the more money we get. If you treat more people in the community there is no more funding. Unless we change that system we will continue to struggle. We need a system that rewards and pays for avoiding hospital admissions.

“We won’t solve the challenges we have in north Cumbria just by working harder. We have got to redesign the system.”