Population

 Residents aged between 18 and 64

 Population forecasts indicate that there will be a small reduction in the number of people aged 18-64 with support needs in Knowsley between 2022-2032.

However, it is anticipated that there will be a proportion of people with learning disabilities that will live longer lives, in part due to the success of medical interventions. Support for this group is a key area of transformational activity, with a focus on increasing independent living options such as Extra Care and Supported Living services, which focus on meeting the needs and desired outcomes of individuals.

 Residents aged 65 and over

 There will be a significant increase in the number of people aged 65 and over living in Knowsley. There were around 26,419 older people across the Borough in 2022 and this is expected to increase to 32,980 in 2032 (which is an increase of 6561 people). The overall growth within the 65+ age group is projected to be steady, reaching a peak in 2026/27 after which the growth continues but at a slower rate.

In contrast to the 18-64 population, the prevalence of mental health problems, learning disabilities and physical disabilities amongst older people in Knowsley is expected to increase between now and 2028.

This increase in the prevalence of mental health problems, learning disabilities and physical disabilities amongst older people will have a significant impact on demand for services, with projections suggesting an additional 125 clients requiring support by 2026 and an additional 235 people by 2030.

Prior to 2014, dementia prevalence was higher in Knowsley than in England, but has generally been below the national rate since then. This is probably due to a reduction in the overall population of older people. Between 2019 and 2021 there was a major decline in dementia prevalence in Knowsley and in England, which is likely to be due to the increase in elderly deaths during the COVID-19 pandemic, and reduced diagnosis rates due to strain on the NHS. This decline appears to plateau in 2021/22.

Adult Social Care typically meets the additional needs of people in the city who are over the age of 18 and have care and/or support needs, this includes their carers. The rising cost of social care is driven by two main factors: increasing demand for services and increasing costs of providing them. The number of people who need social care has risen over recent years. Demand for social care is driven by an ageing population, and also an increased prevalence of disability amongst working age adults over recent years, which has increased by 3% over the past ten years.

In addition to increasing demand for Adult Social Care, we face specific challenges in Liverpool concerned with health inequalities between our most affluent and deprived neighbourhoods, rising levels of homelessness, and a lack of appropriate accommodation for working age and older people.

Over the next 10 years, the overall population of Liverpool is predicted to grow by 5.72%, equating to an additional 28,771 people in the city. The largest increase is in the 65+ population, who make up over 50% of this increase; it is expected that 8,200 more people will be over the age of 75.

Full population information for Liverpool can be found at: https://liverpool.gov.uk/council/key-statistics-and-data/

Our Joint Strategic Needs Assessment (JSNA https://www.sefton.gov.uk/ your-council/plans-policies/business-intelligence,-insight,-performance/ joint-strategic-needs-assessment-(jsna).aspx) contains a wealth of data and
intelligence and is used to help understand place and to inform resourcing our priorities, how we commission and work with others to improve the health and wellbeing of local people and reduce the health inequalities that exist in the borough.
Core Areas of Concern
based on the current relative comparison of national performance across all available health and wellbeing metrics the following issues have been identified where Sefton is performing most poorly compared to the national, North West, or Liverpool City Region averages:
■ Mental & behavioural disorders relating to alcohol are high as is severe mental illness and issues such as increasing levels of self-harm. In contrast alcohol and drug treatment success is low.
■ Cardiac issue prevalence is high in all areas, as is the prevalence of stroke and kidney disease.
■ Issues relating to older age are concerning including high predicted rates for hearing and sight loss, dementia prevalence, falls, and high rates of admissions to care homes.
■ Some operational health practice areas are low including health assessments for dementia and Alzheimer’s, and NHS health checks for those aged over 40.

Obesity and the implications for long-term population health
■ Mental health, particularly in association with substance use
■ Impact of social isolation on health and wellbeing
One of the starkest statistics for Sefton is the disparity in healthy life expectancy in our borough, for example health male life expectancy in Bootle is 49.8 years and in Formby 68.3. We will aspire to have an impact on this and that commissioning activity and market response it delivered on a locality basis. Working with the newly emerging Primary Care Networks to outline how Health and Care will be commissioned to meet locality-based need.
Primary Care Networks (PCNs) with wraparound Integrated Community Teams are the foundation for neighborhood (locality) working and are the building block for integrated care. PCNs are groups of GP practices who have agreed to work together, though a formal agreement to support the development and sustainability of general practice services, work with other partners in their community to improve the health and wellbeing of local people. Whilst focusing on the needs of their local populations, PCNs have also agreed to deliver the requirements of a national PCN contract. National policy states PCNs purpose to be:
■ Stability: support for and sustainability of GP services
■ Better health and care: be the hub for NHS community services in Sefton to meet health and wellbeing needs
■ Integration: an essential building block for integrated working, based on populations of around 30-50k
■ Investment: joint investment and delivery vehicle
■ Additional specified roles to be developed over 5 years
■ Community leadership: Clinical Director role – strategic and clinical leadership
PCNs are a core component of Health Transformation and are central to Sefton2gether – the NHS local five-year plan They enable stronger collective voice and engagement of general practice with other partners to improve health and wellbeing. There are seven PCNs established across our eight “health” localities in Sefton. One PCN covers two of our localities – Crosby and Maghull. PCNs will be budget holding and will make decisions about spending locally. This represents further opportunity for integrated control on spend to ensure local needs are met.

In 2018 the JSNA was refreshed and highlights the following areas we need to impact on;
■ Prevention and early diagnosis of long-term conditions, particularly cardiovascular disease

According to national population estimates the total population in Sefton aged 18-64 predicted to have a learning disability will reduce from 3,799 in 2019
to 3,594 by 2030. Of these, the total predicted to have a moderate to severe learning disability (and hence likely to be in receipt of services) will change from 861 in 2019 to 824 by 2030.
Internal predictions indicate that Sefton will continue to have an above average age of LD clients 55+ as well as younger people in transition and by 2025 we will see 350 extra clients aged 18-64 with a Learning Disability r Mental health Concern.
Sefton Council currently spends £28 Million supporting people with Learning Disability (where this is recorded as their primary support need). This number will increase as young people move to adulthood and as people require independent accommodation with support as parent unpaid carers grow older (We know we have a significant number of Older Parents Caring for this
population, please see the unpaid carers section for further information). There are also challenges in relation to the growing number of people over the age of 65 who have a learning disability and associated frailty and an increasing number of people with complex and challenging needs.
We also want to promote and increase access to employment and training opportunities we currently see low numbers in employment, 2% Learning Disabled Clients are in ‘Paid Employment’ the National Top Quartile is 9% This is a key area of growth for us.
We know Mental Health needs are increasing in Sefton, the 2018 JSNA reflects that 10% of our population have diagnosed depression and 1.2% have a Severe Mental Illness. We have an excess rate of under 75 mortalities in our Adults with serious Mental Illness. We have a lower than national average rate of people with a Mental Health Condition in paid employment (at 2.5%). From October 2018 to October 2019 we provided long term service to 752 people with Mental Health as a primary support need.

Sefton faces significant challenges over the coming years because of the structure of its population. We have a much higher than average proportion of older people and we expect over the next few years to have increasing numbers of:
■ People living alone with an increasing risk of social isolation, loneliness and depression.
■ People with dementia, by 2025 11% of our 64 plus age group will have Dementia.
■ People with multiple and complex long-term needs. ■ Unpaid Unpaid Carers, many of whom will be older people with their own care needs.
At present we support and admit many more clients in Care Homes for all ages than the national average suggesting a structural issue with over provision or insufficient levels of preventative or diversionary activity and a lack or underuse of alternatives. We currently see 753 per 100k rate of Permanent Admissions of 65+ to Care Homes, the national top quartile is 458, and for 18 – 64 year olds, we see 29 per 100k of Permanent Admissions to Care Homes, the national top quartile is 9. In 2017/18 when compared to other Councils with Adult Social Care responsibility we were the 150th highest long term Residential & Nursing Unit Costs out of 152.
Given Sefton’s high proportion of older people and an aging population dynamic it is unsurprising that there is and is likely to remain a need for nursing and complex support around memory and cognition (dementia) we need the market to be ready to meet these needs. However, there is also an increasing number of people who are currently placed directly into residential level care who might be better suited to alternative provision such as ‘Extra Care’ housing.

Sefton supports approximately 520 clients in long-term nursing and 1,040 clients in long-term residential on any one day. There are 131 Care Homes in Sefton with approximately 3,750 beds 43% of which are utilised by the Local Council.
We currently spend some £53.4m on Care Home provision, 20% of which is spend on clients under 65 years of age.
Average unit costs vary widely from £390 per week for clients aged 65+ with primarily physical disabilities in a residential home to £930 per week for clients aged 18-64 with primarily learning disabilities in a nursing home.

Sefton has the 6th Highest national % of 65+ living alone.