Wiltshire Independent Living Strategy 2022 to 2027
Forecasting demand
Wiltshire is a mostly rural county in the South West of England. It borders the Council areas of Gloucestershire, Swindon, West Berkshire, Hampshire, Dorset, Somerset, B&NES and South Gloucestershire. The county is relatively affluent. However, there are substantial pockets of deprivation.
Census data
New Census data released in 2022 shows that 510,400 people live in Wiltshire. This makes Wiltshire the ninth-largest local authority in England by population size, but the eleventh lowest by population density. Wiltshire's population has increased by 8.4% since the last Census - a higher rate of increase than the overall rate of increase in England (6.6%). Wiltshire has an ageing population - whilst 22.1% of residents are aged 0 to 19, 21.8% are aged 65 or older. Overall, in England, there has been an increase of 20.1% in people aged 65 years and over between 2011 and 2021; by contract, in Wiltshire there has been an increase of 30.5% in people aged 65 and over. Wiltshire is one of only three local authorities in the South West whose 65+ population has increased by more than 30%. People are generally living longer and healthier than ever before. However, our Joint Strategic Needs Assessment1 shows that these gains are not enjoyed equally across the population, and we have a number of long-term health challenges. In particular, we know that adults with long-term mental health problems and/or learning disabilities have much lower life expectancy.
Forecasting adults with learning disabilities
The national Projecting Adult Needs and Service Information System (PANSI2) and Projecting Older People Population Information System (POPPI3) databases forecast how many adults with learning disabilities, autism spectrum conditions and mental health conditions live in Wiltshire now, and how this will change over the next 20 years. They show that the overall numbers of working-age adults with these needs will stay much the same over this period, but the numbers of older people with LD and/or autism - whilst small in comparison with working-age adults - will increase significantly.
Our view locally is that these forecasts should be treated with caution, as they have historically not been accurate indicators of our population. (NB: most of these residents will not have Care Act-eligible needs; figures for people with personality disorder or psychosis aged 65+ are not available on POPPI).
Forecast year | 16-64 years old | 65-84 years old | Over 85 |
---|---|---|---|
2020 | 7057 | 2006 | 293 |
2025 | 7077 | 2207 | 337 |
2030 | 7053 | 2454 | 409 |
2035 | 7007 | 2641 | 522 |
2040 | 6991 | 2786 | 570 |
Forecast year | 16-64 years old | 65-84 years old | Over 85 |
---|---|---|---|
2020 | 2928 | 566 | 467 |
2025 | 2929 | 575 | 572 |
2030 | 2904 | 657 | 633 |
2035 | 2880 | 713 | 701 |
2040 | 2871 | 693 | 793 |
Forecast year | 18-64 years old |
---|---|
2020 | 16775 |
2025 | 16815 |
2030 | 16679 |
2035 | 16543 |
2040 | 16479 |
Forecast year | 18-64 years old |
---|---|
2020 | 2040 |
2025 | 2046 |
2030 | 2030 |
2035 | 2013 |
2040 | 2006 |
This indicates that we need to develop a greater range of options for older disabled people, such as extra care designed around people with learning disabilities, in the coming years. Approximately 200 learning disabled adults aged 55+ in Wiltshire currently live in residential care. Where supported living is not suitable, due to age-related frailty or cognitive disorders such as dementia, extra care will be our preferred option as, unlike residential care, it provides the person with a tenancy and is more cost-effective than more restrictive alternatives such as residential care.
Forecasting demand for accommodation and support
Our market position statement provides more detail about our demographics, and in particular the prevalence of learning disabilities, autism spectrum conditions and mental health conditions. This section summarises what this means in terms of forecasting demand for accommodation and support:
- as of May 2022, there are around 4,800 households on the housing register. Of these, around 1,000 are on the open market register - this means they do not qualify to join the main Housing Register, but they are interested in housing options such as Low-Cost Home Ownership
- there are around 18,000 serving military personnel living in Wiltshire, many of whom will have partners and families
- there are around 4,400 children and young people (CYP) with an education, health and care plan (EHCP), of whom around 60% are secondary school age (year group 7 onwards). The number of CYP with EHCPs is rising. 9% of school-age children and young people are from non-White British backgrounds
- there are around 425 children looked after (CLA), of whom 20% are non-White British. There are around 20 unaccompanied asylum-seeking children and around 275 care leavers at any one time. We know that poor social, emotional and mental health are more prevalent in these groups
- there are around 55,000 adults of working age living in Wiltshire with common mental illnesses such as anxiety and depression, 17,000 with a personality disorder, 2,000 with a psychotic condition such as bipolar disorder and schizophrenia, 15,000 with post-traumatic stress disorder (particularly prevalent, given Wiltshire's military population) and 6,000 with an eating disorder4
- there are likely to be around 4,300 autistic adults and 2,000 autistic children and young people in Wiltshire. The rate of children and young people diagnosed with an autism spectrum condition increased by 83% between 2015 and 2020, whilst the rate of autistic adults per 1,000 population has remained static. Around one third of autistic people are likely to also have a learning disability. 40% of autistic people experience anxiety5
- the national PANSI System estimates that there are around 7,000 adults with an LD in Wiltshire, of whom around 1,600 have moderate to severe LD6
- the overall number of people with LD is unlikely to change much over the next 10 years, but the number of older people (aged 65+) with a moderate to severe LD is forecast to increase from 308 in 2020 to 428 in 2040. This is likely to mean a higher prevalence of learning disabled people with dementia and other age-related frailties in the coming years
The impact of the pandemic on mental health
We have seen the impact of the pandemic on mental health. National research in 2020 and 2021 has predicted that up to 10 million people, including 1.5 million children, are likely to need new or extra mental health support as a direct result of COVID-197. Carers UK estimated in June 2020 that an additional 4.5 million people nationally had become unpaid carers since the pandemic began. By October 2020, 81% of unpaid carers said that they were providing more care since the start of the pandemic. Charities have reported significant increases in demand for advice and information8 and there are reports of more people experiencing mental distress presenting in emergency departments and acute trusts struggling to find appropriate care and support in the community9. A Young Minds survey of 2,500 CYP with mental health needs in January 2021 found 67% believed the pandemic would have a long-term negative effect on their mental health10.
Mental health patients with learning disabilities
At any one time there are 40 to 50 patients registered with a Wiltshire GP who are inpatient in a mental health hospital bed, around a fifth of whom have a learning disability and/or autism spectrum condition. Many of these people will need support and accommodation once they are discharged, which helps them live well in the community.
In November 2021, there were 1,154 adults from the Council's Learning Disabilities & Autism Service (LDAS) and Mental Health adult social care teams placed in supported living or residential care. The data below breaks this down by customer group, and shows how many of these people are placed outside of Wiltshire:
Customer group | Total in need | Placed out of county |
---|---|---|
LDAS - supported living | 419 | 26 |
LDAS - residential care | 302 | 102 |
Mental Health - supported living | 157 | 32 |
Mental Health - residential care | 276 | 44 |
Children and young people with learning disabilities
There are currently around 2,200 young people who are secondary school age and above with an education, health and care plan (EHCP). The table below shows this broken down by educational Key Stage.
Key Stage | Number of pupils with an EHCP |
---|---|
KS3 | 965 |
KS4 | 539 |
Year 12 to 13 | 425 |
Year 14 plus | 300 |
The following chart shows the primary need of this group of children and young people with an EHCP:
Primary need type | Number of pupils with primary need |
---|---|
Speech, language, communication | 342 |
Learning disability | 608 |
Sensory impairment | 60 |
Autism spectrum condition | 680 |
Social, emotional and mental health | 450 |
Physical disability | 608 |
Whilst not all these young people will need support from adult social care when they reach adulthood, we can begin planning and designing this accommodation and support to help young adults to live independent lives.
In May 2022, a needs analysis was undertaken of all young people and adults with disabilities who have been identified by social care teams as needing or wishing to move, but for whom finding appropriate accommodation and support is challenging. A detailed breakdown of their needs can be found in Appendix 3. There are some gaps in the data, which points to the need to improve data quality to help us plan for the future. The needs analysis can be summarised as follows:
There were 162 people ready to move, of whom:
- gender: around 60% were male, 40% female
- age: most were relatively young, with more than 80% being under 40, and nearly 60% being under 25
- primary needs: The majority of people had two or more different needs; more than half had a learning disability, and over a third had a mental health condition; perhaps surprisingly, less than a quarter had an autism spectrum condition
- current location: 39% lived in the South of Wiltshire, 31% lived in the West, and 14% lived in the North. The most popular locations are Salisbury (53 people), Trowbridge (18 people) and Chippenham (11 people)
- current situation: Over a third were living with family (with a significant number in full-time education)
- capacity to share: Over half said they were able to and/or wanted to share with others (for some, it was specified that they could/would share with people of a similar age, similar ability, a specific person, or either males or females only)
- where people want to live: the most popular destinations for people were Salisbury (38 people), Trowbridge (15 people) and Chippenham (12 people). For 40 people, geographical preference was not stated
1 Wiltshire Intelligence Network (wiltshireintelligence.org.uk) (opens new window)
2 Projecting Adult Needs and Service Information (pansi.org.uk) (opens new window)
3 Projecting Older People Population Information (poppi.org.uk) (opens new window)
4 Projecting Adult Needs and Service Information (pansi.org.uk) (opens new window), Projecting Older People Population Information (poppi.org.uk) (opens new window)
5 Figures taken from Wiltshire Autism Strategy, to be published in 2022.
6 Locally, we believe this is an over-estimate. The PANSI gives the following background for how this figure is calculated: "These predictions are based on prevalence rates in a report by Eric Emerson and Chris Hatton of the Institute for Health Research, Lancaster University, entitled Estimating Future Need/Demand for Supports for Adults with Learning Disabilities in England, June 2004. The authors take the prevalence base rates and adjust these rates to take account of ethnicity (for example, the increased prevalence of learning disabilities in South Asian communities) and of mortality (for example, both increased survival rates of young people with severe and complex disabilities and reduced mortality among older adults with learning disabilities). Therefore, figures are based on an estimate of prevalence across the national population; locally this will produce an over-estimate in communities with a low South Asian community, and an under-estimate in communities with a high South Asian community."
8 Demand for mental health advice soars in year after first lockdown (rethink.org) (opens new window)
9 CQC, 'The state of health care and adult social care in England 2020/21', October 2021.
10 Young Minds, 'Coronavirus: impact on young people with mental health needs', February 2021.