3.3 Adults and Older People
At the other end of the scale, in the adult population we are faced with a growing ageing population over the next 5-20 years as life expectancy increases and people from the post-war ‘baby boom’ reach old age. The likelihood of being disabled and receiving care increases with age. The assumption based on these projections is that there will be more people requiring care but we are faced with providers reporting a reducing potential workforce to meet their needs. This increasingly puts pressure on both providers as well as commissioners, to come up with new and innovative ways of meeting these needs within not just available resources but within the available labour market.
Although South Gloucestershire has a lower population of elderly people than the UK average, people aged 65 years and over are still the fastest growing age group.
Longer term ONS projections suggest that there will be an extra 29,200 people aged over 65 years in South Gloucestershire by 2035 compared to 2010 figures ie an increase of 66%. The greatest concentrations of older people live on the fringes of Bristol in the Kingswood, Downend and Filton areas. Thornbury and the more rural areas of South Gloucestershire also have a significant proportion of over 65s.
The number of people aged over 85 and over, who are the most likely age group to have a disability or acquired disability and need to receive care, is expected to nearly triple over the next 25 years, from 5, 378 at 2010 to over 15,300 in 2035.
In terms of acquired disability in an ageing population, the increasing prevalence of dementia and the need to develop appropriate levels and types of services to meet the needs and expectations of our citizens, is an increasing challenge for the care sector. It is estimated that 3,450 South Gloucestershire residents have dementia yet there are currently only approximately 1,500 people on the dementia register. A growth in the elderly population is predicted to increase the number with dementia in South Gloucestershire to 5,200 by 2025 and 7,000 by 2035 – almost doubling current estimates.
It is estimated that in South Gloucestershire 1,607 children have a serious level and 2,893 children have some level of disability, compared with the adult population where 3,851 people aged between18 – 64 have a serious physical impairment and 13,034 have a moderate physical impairment. In terms of older people, it is estimated that 9,067 people over 65 are unable to manage at least one mobility activity on their own.
In the UK, at least one in four people will experience a mental health problem at some point in their life; at any one time, one in ten children aged five to sixteen and one in six adults has a mental health problem. People with severe mental illnesses will die on average 20 years earlier than the general population. Mental ill health is very expensive. The cost of mental health problems in the UK is estimated at £105 billion annually; these costs are expected to double in the next 20 years.
Similar to the national picture, there is increasing demand for community and inpatient mental health services in South Gloucestershire. Evidence for this is provided by local data which show increased caseload to AWP community mental health services, increased emergency admissions to AWP services (particularly from Priority Neighbourhoods), high bed occupancy rates for inpatient services with high out of locality placements, high out of trust placements and a high percentage of delayed transfers of care in excess of the national target. There was a 6.3% increase in caseload to the Avon and Wiltshire Mental Health Partnership (AWP) Community Mental Health Services from 2009/2010 to 2013/2014.
Difficulties in accessing services and problems with the consistency and continuity of care have been highlighted by service users. Service users and other groups including regulators have expressed concerns about engagement, access and quality of care.
The highest rate of mental health admissions to hospital were from GP practices located in Priority Neighbourhoods. With the exception of eating disorders, the prevalence of mental health conditions was higher in people from the most deprived socioeconomic groups and those from Priority Neighbourhoods. Local data were not available on the prevalence of personality disorders.
There is an increasing trend in the reporting of dual diagnoses of mental illness and substance misuse in South Gloucestershire, possibly due to better integration of drug and alcohol services with mental health services, better data recording or increased confidence of service users in reporting.
Proportionally, there has been low investment in mental health in South Gloucestershire compared with the rest of England. Data from the Community Mental health Profile show that the allocated average spend per head for mental health in South Gloucestershire in 2011/2012 was £147 compared to the English average of £183.This was estimated as the worst spend in England. Using newer 2014 data the mental health spend in South Gloucestershire was £153 per head, compared with a national spend of £210 per head.
There is increasing demand for the Improving Access to Psychological Therapies (IAPT) programme in South Gloucestershire. However, there are problems with access to these services and the provision of long term support post IAPT is poor.
There is a lack of community based support for people with sub threshold mental health conditions and there is increasing demand for community and inpatient mental health services. People with autism face long delays before they can access diagnostic assessment (see separate section on Autism below).
There is a lack of support for people suffering from minority mental illness conditions such as Huntington’s Disease which has a national prevalence in people between 51 and 60 years old of 15.8 people per 100,000 which would equate to 41 people of that age group having the condition in South Gloucestershire.
Although the acute response to mental health crises is good, there is less support for longer term care.
Autism is a developmental disorder. It is known as a spectrum condition, both because of the range of difficulties that affect adults with autism, and the way that these present in different people. Autism occurs early in a person’s development. Asperger syndrome is a form of autism. People with autism are much more likely to experience social isolation, mental health issues and difficulties in accessing employment. More than 1 in 100 people have autism; that is equivalent to approximately 2,700 adults and children in South Gloucestershire.
In children’s services, statistically autism is almost 5 times more common among boys than among girls. The ratio of male to females who use NAS adult services is approximately 4:1, and in those that use NAS schools it is approximately 5:1. [The National Autistic Society website]
In South Gloucestershire there were 50 adult referrals from GP practices to the Bristol Autism Spectrum Service from April 2014 to March 2015. Due to the existing waiting list 64 diagnostic assessments were completed (49 in males, 15 in females) with the largest numbers being in the 20-29 and 30 – 39 age groups (both 18 in number.) All referrals were of White British or unknown ethnicity. As of the 31st August 2015, there were 15 individuals waiting for diagnostic assessment on the South Gloucestershire waiting list.
The numbers of people with learning difficulties living in South Gloucestershire are estimated as follows:
- Out of 1000 children approximately 140 would have a Special Educational Need and 20 would have a Statement or EHC plan, most probably with a primary need on the autistic spectrum.
- A total adult learning difficulties population of 5,028 of which 4,101 are estimated to be aged between 18-64 years;
- 1,048 people aged 18 and over predicted to have a moderate or severe learning disability
- 246 people aged 18-64 predicted to have a severe learning disability
- 929 people known to statutory agencies
- 327 people in care homes, of which 20 are in care homes with nursing.
(Source: Projecting Older People Population Information / Projecting Adult Needs and
Service Information 2011 and JSNA refresh 2016).
The term sensory impairment encompasses visual loss, including blindness and partial sight, hearing loss, including the whole range and multi-sensory impairment, which means having a diagnosed visual and hearing impairment with at least a mild loss in each modality, known as Deafblindness. 70 people in every 100,000 over the age of 60 are Deafblind. For older people, particular those with other impairments, adapting to sight and/ or hearing loss can be a difficult process. This can impact on people’s confidence and aspirations in many areas of life. Older people with sight loss or hearing loss are at greater risk of social isolation than the general population. People with learning disabilities are ten times more likely to be blind or partially sighted than the general population.
People with sight loss of working age are more likely than those in the general population to live in a household with an income of less than £300 a week (RNIB) Only one in three registered blind and partially sighted people of working age is in paid employment. They are nearly five times more likely than the general population to have had no paid work for five years.
Hearing loss affects one in six of the population, or ten million people in the UK. By 2031 it is estimated that there will be 14.5 million people with a hearing loss in the UK. Hearing loss has high personal and social costs and can lead to social isolation and consequent mental ill health. Communication is the principle challenge for people with hearing loss. The Deaf community is a linguistic and cultural minority with specific access needs. It is estimated that around one per cent of the population has tinnitus that affects their daily life.