Overview and key messages

The population of West Wales has a higher proportion of older people than the Welsh average, and that already high proportion is predicted to increase significantly in the coming years, as average life expectancy in the region follows the national upwards trend (Office for National Statistics, 2011).

The change in the profile of the population will undoubtedly have an impact on health, as older people are statistically more likely to have a life limiting health condition (Office for National Statistics, 2011) These changes will significantly impact on the health and social care services provided, as demand for hospital and community services by those aged 75 and over is in general more than three times that from those aged between 30 and 40 (Parliamentary Select Committee on Public Service and Demographic Change, 2013).

A number of ‘accelerating factors’ add to the challenge of providing effective services to older people in West Wales, from pockets of significant deprivation to large areas of rurality and high levels of migration of older people to certain areas (Henry, 2012).

In 2013-14 an estimated £91 million was spent in West Wales on services specifically for older people including Tier 1 – Community, Universal and Prevention Services, Tier 2 - Early Intervention and Reablement and Tier 3 - Specialist and Long Term Services. Across the UK public expenditure related to older people is expected to rise from 20.1% of GDP in 2007-08 to 26.7% in 2057 (Mid and West Wales Health and Social Care Collaborative, 2015).

 

 

 

 

“public finances are likely to come under pressure, primarily as a result of an ageing population”

The Office for Budget Responsibility (2011)

 

 

Demographics and trends

There are increasing numbers of older people across Carmarthenshire, Ceredigion and Pembrokeshire. Current projections suggest that the population of people aged over 65 living in West Wales will rise 34% in Pembrokeshire, 31% in Carmarthenshire and 27% in Ceredigion by 2039.

Demographics and trends

Over the same period there is expected to be a marked decline in the working age population. By 2033 the proportion of the population between 0-14 years in West Wales will reduce to 15% and 15 –24 year olds will also reduce to 11%. Older people in this region currently represent a higher percentage of the population with 21.3% of the area being 65 or over compared with 18.6% in Wales a whole. This raises into question capacity and resources to care and support the older age group. (Nuffield Trust, 2014).

With large parts of Carmarthenshire, Ceredigion and Pembrokeshire being both rural and coastal, the region attracts high levels of inward migration of people over 65. People from elsewhere in the UK already account for almost 22% of the population of Wales, with the vast majority of the new arrivals retiring from England (Bingham, 2014) The highest levels are found in Pembrokeshire with a 31% migration rate with 87% of these being over 65. Ceredigion has the largest percentage of residents with a second home in the whole of the UK. Whilst this may be explained in part by the large student population, census data shows that 325 people over 65 in Ceredigion have second addresses outside the county. Of equal importance; data indicates that 1,182 pensioners have second homes in Ceredigion; these individuals have not moved permanently into the area but still spend a significant amount of time there, during which periods they might access health and social care services.

Demographics and trends

Older adults in the West Wales area have increasingly complex needs. Above the age of 65 the risk of developing dementia doubles roughly every 5 years, with estimates that dementia affects 1 in 14 people over 65 and 1 in 6 over 80. Recent projections show a rapid increase in dementia across all LA areas with some of the more rural areas, including North Carmarthenshire and Pembrokeshire, seeing the highest rises of up to 44% by 2035.

Current and future care and support needs

All partners in the region are moving towards a consistent model of care for older people based on the principles of well-being and prevention encapsulated in the SSWB Act and informed locally by a range of plans and strategies including Ageing Well plans, the Health Board’s Integrated Medium Term Plan, Carmarthenshire County Council’s ‘Vision for Sustainable Social Services for Older People 2015-25 and the regional Statement of Intent for the Integration of Services for Older People with Complex Needs in West Wales (2014).

Delivery across the region varies in detail but in each county area it is based around three levels of service described as ‘offers’ to individuals according to their need and circumstance and are as follows:

  • Offer 1: Help to help yourself
  • Offer 2: Help when you need it
  • Offer 3: Ongoing support

Gaps and Areas for Improvement

A number of areas need further development if the requirements of the Act, including well-being outcomes for older people and the aspirations of existing strategies are to be fully addressed:
 
  • Developing appropriate access to a range of information, advice and assistance including Dewis and advocacy services relevant to health and social care needs at relevant stages for health and social care
  • Improving anticipatory care across the health, social care and other sectors to avoid escalation of need
  • Reducing the reliance on residential and nursing care in favour of lower level, preventative and well-being services
  • Developing community-based, user-led, co-produced services that prevent isolation; promote community connectivity, well-being and resilience and support people to remain independent for longer in their own communities
  • Enhancing assessment and care planning processes to ensure older people and their carers are involved in decisions about them, including discharge planning
  • Ensuring that older people and their families are able to access services through their language of choice and that the offer through the medium of Welsh is available
  • Achieving a consistent, integrated approach to frailty across the region that aligns with regional frailty and dementia strategies and pathway
  • Developing consistent, integrated commissioning and procurement processes based on co-production principles, which involve older people, user-led community-based groups and fora in the design and delivery of services, to achieve market sustainability
  • Improving and standardising levels of telehealth and telecare across the region
  • Addressing the lack of transport links within very rural regions, which add to the difficulty of accessible service delivery and recruitment challenges
  • Growing an integrated approach to quality assurance and contract monitoring of care homes to identify and address emerging concerns and prevent placement breakdown