i Version 2.0 Published: December 2018 Performance and Intelligence Team, Dumfries and Galloway Health and Social Care For more information please visit www.dghscp.co.uk ii Table of Contents 1. Introduction 1 Key Features 3 2. Describing the Region 4 2.1 Geography and Population 4 2.2 Community assets 7 2.3 Social Assets – Third and Independent Sector 8 2.4 What is it like to live here? 10 2.5 Rurality 12 3. Understanding Our Population 31 3.1 Factors Influencing Population Change: Patterns in Births 34 3.2 Factors Influencing Population Change: Patterns in Mortality 37 3.3 Factors Influencing Population Change: Patterns in Migration 40 3.4 Population projections 44 3.5 Life Expectancy 48 3.6 Healthy Life Expectancy 52 4. Reducing Inequalities 54 4.1 What are inequalities? 54 4.2 Measuring Inequalities 55 4.3 Inequalities Action Framework and Anti-Poverty Strategy 69 5. Housing 71 5.1 Housing Conditions 71 5.2 Single Adult Households 75 5.3 Local Consultation on Housing 79 6. Carers 80 6.1 Who are our Carers? 80 6.2 The health and wellbeing of Carers 84 6.3 Supporting Carers 87 7. Physical and Sensory Disability 92 7.1 Visual Impairment 92 7.2 Deafness and Hearing Loss 97 7.3 Physical Disability 102 8. Learning Disability and Autism Spectrum Disorder 104 8.1 People with learning disability 104 8.2 People with Autism 107 8.3 Supporting people with learning disabilities and autism 108 9. ‘At Risk’ Populations 110 9.1 Ethnic Minorities 110 9.2 Religion 114 9.3 LGBT+ (Lesbian Gay Bisexual Transgender Plus) 116 9.4 Armed Forces/Veterans 122 9.5 Homelessness 125 9.6 Gypsy Travellers 128 9.7 Prisoners and Offenders 129 9.8 Domestic Abuse 132 9.9 Agricultural Workers 136 10. Community based Care (Primary Care) 139 10.1 General Practice 139 10.2 Pharmacy 149 10.3 Opticians 150 10.4 Dental Health 150 10.5 Podiatry services 157 10.6 Social Work Services 158 10.7 Social Work Services for Older People 158 10.8 Physical and Sensory Disability 173 iii 10.9 Criminal Justice 174 10.10 Adult Support and Protection (ASP) 175 10.11 Social Services Workforce 179 11. Hospital based Care (Secondary Care) 183 11.1 Acute activity 183 11.2 DGRI Redevelopment 192 11.3 Admissions to Emergency Department (ED) 193 11.4 Hospital Bed Occupancy 194 11.5 Delayed Discharges 194 11.6 Readmissions to Hospital 199 11.7 Reablement - Short Term Assessment and Reablement Service STARS and CASS 200 11.8 NHS Dumfries & Galloway workforce trends 201 12. Long-Term Conditions and Multiple Complex Needs 203 12.1 Reported extent of long-term health related conditions 203 12.2 Prevalence of chronic conditions 204 12.3 Ill health amongst older residents 205 12.4 Multiple Complex Needs 208 12.5 Dementia 213 12.6 Screening and Communicable Disease Control 215 12.7 Patient Transport 217 12.8 Living and Dying Well 218 13. Mental Health and Wellbeing 224 13.1 Wellbeing 224 13.2 Self harm 226 13.3 Suicides 227 13.4 Referrals for psychological therapies 228 13.5 CMHT referrals and caseload 229 13.6 Psychiatric Hospital Admissions 231 13.7 Services 232 13.8 Living with Mental Illness 233 14. Health Behaviour 234 14.1 Drugs and Alcohol 234 14.2 Gambling 242 14.3 Sexual Health 244 14.4 Smoking 255 14.5 Weight Management 258 14.6 Diet 260 14.7 Physical Activity 262 Appendices I Glossary of Abbreviations: I Acknowledgements II List of Tables III List of Figures IX iv 1. Introduction The Strategic Needs Assessment for Adult Health and Social Care is a collection of evidence from a wide range of sources. It has been produced to help inform the Dumfries and Galloway Integration Joint Board’s Strategic Commissioning Plan. The evidence includes statistics and quotes from people who have been consulted about various aspects of health and social care. This needs assessment reflects the context in which the integration of health and social care must operate. It includes information about different groups of people, some of the challenges facing the Health and Social Care Partnership and information about the range of services currently being provided locally. This evidence is available for people to use as a reference for planning and making decisions. This needs assessment answers questions such as: How many people would this affect? Is this becoming more or less of an issue? Do we know enough about this? The needs assessment does not provide suggestions or quick fixes to address challenges. Neither does it discuss or consider organisational and financial arrangements. The health and social care system is immensely complex and it is very difficult to cover every aspect of every service. As such, this needs assessment provides a broad, shallow skim across a wide range of topics. The evidence was collated over the spring and summer of 2017 and is a snapshot in time which mostly references information published in 2016/17. In line with the health and social care strategic cycle, this needs assessment is updated once every 3 years. The needs assessment contains evidence about the following areas: Population and how it changes Geography and the influence of rurality Inequalities Housing Unpaid Carers Long-term conditions and multiple complex needs At Risk Populations Community based health and social care Hospital based health and social care Physical and sensory disability Mental health and wellbeing 1 1. Introduction When drawing all of the available data together, certain common themes began to emerge from the topics. We have brought these themes together to describe the challenges facing health and social care in the future. In the following sections, the themes are described and a small selection of the evidence has been provided from the full needs assessment: Figure 1: Emerging themes from the Dumfries and Galloway Health and Social Care Strategic Needs Assessment; 2018: Geographical Person and SoSocialcial Centred Isolation The needs assessment does not contain information about everything and some gaps in Right Support, local knowledge have been identified. These gaps include: Time and Resilient Place the challenges faced by the third sector work force, People and housing needs for vulnerable people, Communities the needs of black and minority ethnic communities, the physical health of mental health patients, social capital and community resilience, Increasing the impact of obesity and Complexity gambling. Health and Social There is work planned or already in progress across many of these areas, but may not be Inequalities Resilient available to support planning at this time. OrganisationsOrganisations 2 Key Features Throughout this document there are blue boxes (like this one) which highlight technical issues with data or where there is a significant lack of information. In addition, quotations from people who have experienced a service; users, staff and key stakeholders, are presented in dark blue. Quotations taken from existing reports are presented in light blue. Also, note that in accordance with the wishes of the Scottish Care Alliance, we have used the term “Carer”, which is deliberately capitalised, to indicate family and friends who provide unpaid help or support to another person. 3 2. Describing the Region 2. Describing the Region 2.1 Geography and Population Dumfries and Galloway is a mostly rural region in south-west Scotland (Figure 2). It covers 6,426 square kilometres, with a population of approximately 149,520 people.1 Figure 2: Map of Scotland showing facts about Dumfries and Galloway Many specialised services need to be accessed in the Central Belt at either Glasgow or Edinburgh, but some services over the English border in Carlisle are also used. Caution should be used when interpreting activity figures for Annandale and Eskdale to determine whether any activity has been under-reported due to activity which occurs in England. 1 Source: National Records of Scotland (NRS), Mid-Year Population Estimates, Table 2b: Estimated population by sex, single year of age and administrative area, mid 2016 4 Dumfries and Galloway has 4 traditional localities (Figure 3): Annandale and Eskdale Nithsdale Stewartry Wigtownshire. Figure 3: Map of Dumfries and Galloway illustrating traditional localities The main towns are Dumfries (and we often include Locharbriggs when we say ‘Dumfries’, which have a combined 39,000 residents), Stranraer (10,500), Annan (8,900), Lockerbie (4,300), Dalbeattie (4,300), Castle Douglas (4,100) and Newtown Stewart (4,000).2 All other towns and settlements have populations of fewer than 4,000 people and are shown in Table 1 (minimum 500 residents) below. At the 2011 Census, around one third of people (30.9%) in Dumfries and Galloway were living in settlements with fewer than 500 people (Figure 4). 2 Source: Census 2011 (NRS,Mid-2012 Settlement and Localities Link (last accessed 08/12/2017) 5 2. Describing the Region Table 1: Mid-2012 population counts for settlements (to nearest 100); Dumfries and Galloway; 2011 Census Settlement People Settlement People Settlement People Dumfries 33,300 Gretna 3,000 Wigtown 900 Stranraer 10,500 Moffat 2,600 Ecclefechan 900 Annan 8,900 Langholm 2,300 Whithorn 800 Locharbriggs 6,000 Lochmaben 2,100 Eaglesfield 700 Lockerbie 4,300 Kirkconnel 2,100 Creetown 700 Dalbeattie 4,300 Sanquhar 2,000 Glenluce 600 Castle Douglas 4,100 Eastriggs 1,900 Cargenbridge 600 Newton Stewart 4,000 Thornhill 1,600 Portpatrick 500 Kirkcudbright 3,400 Gatehouse of Fleet 1,000 Moniaive 500 Source: Census 2011 Figure 4: Map of Dumfries and Galloway illustrating settlements; 2011 Census 6 2.2 Community assets Community assets refer to the physical resources which can be used to improve the quality of community life for people.