1. Joint Strategic Needs Assessment Lynn Waight Lead Commissioner Adult Social Care Pat Owen Public Health Consultant

2. Purpose To define achievable improvements in health and well being to inform the commissioning cycle and LAA Determine priorities across organisations in Cornwall Identifies issues which can only be tackled in partnership

3. Background Informed by many strategies Health Inequalities Strategy Health & Well Being Strategy The issues paper which inform the Sustainable Community Strategy for Cornwall The Prospectus Joint Commissioning Strategies (Older People, Mental Health, People with Learning Disabilities, Carers, and Drug and Alcohol) Children and Young People’s Plan, particularly the needs assessment Both quantitative and qualitative Follows guidance from DoH Commissioning framework for health and well being e.g. minimum dataset

4. How will the planning come together? The Joint Strategic Needs Assessment will Feed the Sustainable Community Strategy which Determines the priorities of the new Local Area Agreement also Links with the Prospectus and the Local Delivery Plan of the PCT Joint planning allows services to be better tailored to the needs of the population of Cornwall & isles of Scilly.

5. Issues identified – Demographics Increasing population – 4.9% increase Increasingly ageing population

6. What Are the Changes Within Cornwall over the next 22 years, the population of people aged 65 and older will increase from 103,200 to 177,400 (a 60% increase). Whereas there were 13,200 people aged over 85 in 2003, by 2028 there will be 28,600 (a 117% increase – or an average of over 600 people per annum). Whereas in 2003 older people accounted for 20% of the population, by 2028 older people will account for 28.6% of the population (one of the highest proportions in England). There will be more ‘last time movers’ than first time buyers

7. Good News Much of this is good news; people are living longer but For many with an illness that limits their life So It is not good unless we plan ahead for the health and social care needs of the population

8. Life Expectancy and Long Standing Limiting Illness Life expectancy is higher in Cornwall & Isles of Scilly (m 77.8, f 81.9) than England and Wales (m76.9, f 81.1)) but differences of 8 years between wards in Cornwall Higher percentage of the population consider they have a Longstanding Limiting illness in Cornwall & Isles of Scilly (20.5% compared to 17.6%)

9. Social and Environmental Context Deprivation – hotspots, IMD 2007 1 in 5 children live in benefit-dependent households Fuel Poverty – 45,000 households, higher than average no. of people aged over 65 living in house with no central heating Rurality – access to services Income – gross weekly earnings are 80% of national average Seasonal increases in population

10. Current Known Health Status of the Population 21% of population have LLTI – higher than national average Chronic illness rate higher even when age structure taken into account – Kerrier and Penwith Smoking – 28.5% Obesity – lower % of people who eat healthily Childhood Obesity similar to national – Year 6 17% obese and 14% overweight

11. Current Met Needs of the Population – Social Care Nationally 70% of those receiving services as part of a package of care were aged 65 and over, 57% were for those aged 75 and over In Cornwall 15,000 – 20,000 people with moderate or mild learning disability 3000 – 3,500 with severe learning disability No. of people with learning disability is growing 56,000 people give unpaid care to family/friends with illness/disability No. of people with dementia and needing care increasing

12. Learning Disabilities More surviving at birth and from childhood to adulthood People with learning difficulties have greater health needs, so good access to primary care is very important including screening for cancer Dementia is higher and as more live to older ages the numbers of people will increase Information to support good health has not been widely taken up or sufficiently targeted

13. Who do Carers Care for? In Cornwall carers stated the main disability of the person being cared for as Mental health 16% Physical disability/Long-term health problems 37% Learning disability 3% Frailty/old age 27% Sight and hearing loss 17%

14. Age of Carers Carers are most likely to be 45-64 years of age - of working age. By 2028 28.6% of the population in Cornwall will be over 65 years of age One in five people over 80 years of age will have dementia. This implies that the need the for carers is likely to increase But there will be less people in the County of working age, the caring role may fall more significantly on agencies and organisations.

15. What other pressures are there? There is increasing prevalence of people with complex, severe or profound disability due to higher survival rates of disabled children, and longevity of adults with learning disability is increasing. This means a higher number of young people moving from children’s services to adult services each year. There are over 500 older individuals (65+) living at home with parents – up to a 100 of these where the parents are in their 80’s. This is creating dual cost pressures where by there are increasing numbers of new cases, whilst existing cases are living longer.

16. Current Met Needs of the Population – Primary and Secondary care Disease Prevalence from QMAS clinical register – GP commissioning groups CHD prevalence highest in West Cornwall 4.5% compared with 3.5% Hospital admissions – Health Reference Group descriptions Heart disease is the most costly

17. Example Two of the most costly conditions cared for in Cornwall & Isles of Scilly are to related to heart disease and knee replacement The need for both can be reduced by reducing obesity It may reduce life expectancy but there will be demands on services for younger age groups It causes strain on carers paid and unpaid when lifting is needed

18. Mental Health About one in ten people in South West has a mental health problem at any given time; most of these are people experiencing a “common” problem such as depression or anxiety. About one in 100 has a ‘severe mental health condition’ such as schizophrenia or bipolar disorder. As the Social Exclusion Unit’s 2004 work indicated nearly a third of GP consultations are related to mental health problems. Social exclusion results from mental ill health Mental ill health is reported by one in ten men who are carers and one in five women

19. Examples Dementia is known to be increasing nationally as the numbers of people in the oldest age groups increase Estimates vary but for Cornwall & Isles of Scilly the numbers suggest that means around 6,000 to 8,000 people

20. Prevention The planning is needed now as the proportion of the population over 65 years of age will increase even more as those born in 1950s become elderly This means that it is important that LA and PCT work together with Community and Voluntary sector supplying some of the essential services

21. Issues in Cornwall Tourism Access to Services Skin Cancer higher mortality than the England average Skin Cancer Hip fracture Mental health rate of people claiming sickness benefit because of mental health problems is higher than the England average Mental health Long Term Conditions End of Life Care Alcohol Rate of admission to hospital for alcohol specific conditions is higher than the England average Alcohol Infant mortality