Long-term conditions are conditions that, at present, cannot be cured but can be managed through treatment and behaviour. These include conditions such as heart disease, diabetes and mental health problems. People with long term conditions are the most frequent users of healthcare services. People with long-term conditions account for around 29% of the population, but use around 50% of all GP appointments and 70% of all inpatient bed days. Long-term conditions fall more heavily on the poorest in society: compared to social class I, people in social class V have 60% higher prevalence of long-term conditions and 60% higher severity of conditions. Half of people aged over 60 in England have a long-term condition. With an ageing population and the growth of health harming behaviours such as physical inactivity, harmful alcohol consumption and smoking, we would expect the prevalence of long-term conditions to rise unless checked. The number of people with co-morbidities (more than one morbidity) is expected to rise by a third in the next ten years.
As our population ages, we expect the number of frail people, people with physical mobility, weakness, weight loss, slowness and or low physical activity to increase, specifically in our older age groups. The number of people with dementia is also expected to increase over the coming years. Estimates for the counts of frail people and also those with dementia are presented in figure 4 and figure 5.
People with poor physical health are at higher risk of experiencing common mental health problems, and those people with mental health problems are more likely to experience poor physical health.
Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Those more vulnerable are more likely to experience levels of mental ill health. One-in-four adults and one-in-ten children experience mental illness during their lifetime.
Across Torbay, there are measures that suggest high levels of mental health needs within the population. Prevalence of depression in primary care, emergency hospital admissions for self-harm, suicides and the proportion of support benefits due to mental and behavioural conditions tend to be higher in Torbay compared to the wider England average.
Other issues affecting levels of need are prevalence of learning disabilities. A learning disability affects the way a person understands information and how they communicate. A learning disability can be mild, moderate or severe. Some people with a mild learning disability can talk easily and look after themselves, but just take a bit longer than usual to learn new skills. Others may not be able to communicate at all, and have more than one disability. There has been a general rise in the number of patients with a learning disability known to their GP. The rate of patients known to have an LD per 10,000 registered patients is higher across Torbay compared to England. This could suggest higher levels of recognition within primary care. However, there are still estimated to be a noticeable number of people with an LD not known to primary care.
Another issue for people which adds to the complexity of meeting their needs is the experience of homelessness and rough sleeping. Rough sleeper count: Between 2013 and 2014, the Torbay estimate increased from 5 to 17 rough sleepers, an increase of 240% compared to 14% across England as a whole. In 2015 Torbay carried out a street count which recorded 21 rough sleepers, a further increase on 2014 (Street counts and estimates of rough sleeping in England, GOV.UK).
The issue of homelessness is, of course, wider than rough sleeping. Torbay Council has a statutory duty to house people who are eligible for public funds, with a local connection to the area, are unintentionally homeless and in priority need. In 2015, the council accepted a duty to house 60 households, compared to 61 households in 2014. In England there was a 6% increase in the number of acceptances between 2014 and 2015. In both years in Torbay these acceptances were 12% of the total decisions made, whereas in England acceptances were 46% and 48% of the decisions made in 2014 and 2015 respectively (Source Statutory homelessness, P1E returns, Department for Communities and Local Government GOV.UK).
This issue is being addressed through delivery of the Homelessness strategy, which is part of Torbay’s Housing Strategy.
Torbay has one of the highest incidents of reported domestic abuse in Devon and Cornwall, and is estimated to cost Torbay £34m a year. Domestic abuse is widespread and has no cultural or geographical boundaries. It can affect anyone regardless of sex, age, culture, ethnic or religious group, gender identity, sexual orientation, disability, marital or partnership status, income or lifestyle. Despite local investment in domestic abuse support services, there continues to be a high prevalence of domestic abuse in Torbay - see figure 6.