Halton Joint Strategic
Needs Assessment 2015/16
Older People:
Overall health and
wellbeing
Older People: overall health and wellbeing 2015/16
Reader information
Author
Contributors
Reviewer
Number of pages
Date release
Description
Contact
Sharon McAteer
James Watson
28
The document constitutes chapter 3 of the 2015/16 Older People’s
JSNA for Halton. It describes the overall state of health in the borough
for those aged 65 and over as well as the use of and level of
satisfaction with primary care and hospital services.
[email protected]
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Halton Joint Strategic Needs Assessment 2015/16
List of Abbreviations
ACS
Ambulatory care sensitive conditions
A&E
Accident and Emergency (hospital department)
CCG
Clinical Commissioning Group
CSU
Commissioning Support Unit
DFLE
Disability-free life expectancy
DSR
Directly age standardised rate
EU
European Union
GP
General Practitioner
HLE
Healthy life expectancy
JSNA
Joint Strategic Needs Assessment
LE
Life expectancy
LJMU
Liverpool John Moores University
LSOA
Lower super output area
LTCs
Long term conditions
NHS
National Health Service
ONS
Office for National Statistics
PCMD
Primary Care Mortality Database
PHE
Public Health England
PHOF
Public Health Outcomes Framework
UK
United Kingdom
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Older People: overall health and wellbeing 2015/16
Contents
Key findings ............................................................................................................................................. 6
1. Introduction ........................................................................................................................................ 7
2. Level of need in the population .......................................................................................................... 9
2.1 Wellbeing ...................................................................................................................................... 9
2.2. Life expectancy .......................................................................................................................... 10
2.2.1. Life expectancy at birth....................................................................................................... 10
2.2.2. Life expectancy at 65 .......................................................................................................... 10
2.2.3. Healthy life expectancy ....................................................................................................... 14
2.3. General health ........................................................................................................................... 16
2.4. Overall death rates (all-cause mortality) ................................................................................... 19
3. Service provision ............................................................................................................................... 21
3.1. Access to and satisfaction with GP services............................................................................... 21
3.2. Access to dental services ........................................................................................................... 24
3.3. Access to optometrist services .................................................................................................. 25
2.4. Admissions to hospital ............................................................................................................... 27
4. User Views......................................................................................................................................... 29
References ............................................................................................................................................ 30
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Halton Joint Strategic Needs Assessment 2015/16
Figures
Figure 1: Life expectancy at birth 1991-93 to 2012-14, males and females ......................................................... 10
Figure 2: Trend in life expectancy at age 65, 200-02 to 2012-14, males and females.......................................... 11
Figure 3: Trends in life expectancy at age 65, 75 and 85, Halton males and females .......................................... 11
[]
Figure 4: Percentage change in male life expectancy between 2011 and 2012 ................................................. 13
[a]
Figure 5: Percentage change in female life expectancy between 2011 and 2012 ............................................. 13
Figure 6: Snapshot od emoloyment levels amongst 50-64 year olds during the 12 month period ending
September 2015 .................................................................................................................................................... 15
Figure 7: Healthy life expectancy at birth, males and females ............................................................................. 15
Figure 8: Levels in very good or good health amongst those aged 65 and over, Halton and comparators ......... 17
Figure 9: Percentage of Halton population aged 65 and over in good or very good health, by electoral ward,
2011 ...................................................................................................................................................................... 18
Figure 10: Correlation between the percentage of Halton population aged 65+ in good or very good health and
deprivation at LSOA .............................................................................................................................................. 18
Figure 11: Trend in death rate from all causes amongst those aged 65 and over ............................................... 19
Figure 12: Q28. Overall experience of GP surgery, national picture ..................................................................... 21
Figure 13: dental access amongst those aged 50 and over, 2014 ........................................................................ 24
Maps
Map 1: Elective admissions by electoral ward, 2014/15 ...................................................................................... 27
Map 2: Non-elective (emergency) admissions by electoral ward, 2014/15.......................................................... 28
Tables
Table 1: Percentages with high levels of wellbeing and low levels of anxiety by age, UK Annual Population
Survey 2013/14 ....................................................................................................................................................... 9
Table 2: Disability free life expectancy and proportion of life disability free, at age 65 ....................................... 16
Table 3: levels in good health in Halton by age group .......................................................................................... 17
Table 4: Proportions in good, fair and bad health, Halton 65+ population, by tenure ......................................... 19
Table 5: Top 10 causes of death in Halton residents aged 65 and over 2010/14. ................................................ 20
Table 6: Overall experience of GP surgery, Halton patients ................................................................................. 22
Table 7: Q22. Confidence and trust in GP, Halton patients, all age and 65+, 2014 .............................................. 22
Table 8: Q24. Confidence and trust in nurse, Halton patients, all age and 65+, 2014 .......................................... 22
Table 9: Q15. Convenience of appointment, Halton, all age and 65+, 2014 ........................................................ 23
Table 10: Q18. Overall experience of making an appointment, Halton, all age and 65+, 2014 ........................... 23
Table 11: Q25. Satisfaction with opening hours, Halton, all age and 65+, 2014 .................................................. 23
Table 12: Q20. Impression of waiting time at surgery, Halton, all age and 65+, 2014 ........................................ 23
Table 13: Percentage seeking an NHS dental appointment who succeeded in getting one, by age, 2014/15 GP
Survey ................................................................................................................................................................... 25
Table 14: Rate, per 100,000 population of NHS sight tests given to population in Halton, 2012/13 ................... 26
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Older People: overall health and wellbeing 2015/16
Key findings
Older people are living longer and spending a greater proportion of their old age in relatively good
health. Being healthy is one of the most important factors determining people’s wellbeing. The
Office for National Statistics (ONS) Annual Population Survey indicates that older people have some
of the highest levels of wellbeing of any age with scores across the four indicators used being highest
in the 65-74 group.
Despite the increase in life expectancy, levels are lower in Halton than the North West and England.
Amongst women life expectancy at birth has shown a decrease for the first time during the latest
reporting period. This is due to falls in life expectancy at 65, 75 and 85. However, it is too early to
tell if this is simply a minor fluctuation or a change in the overall upward trend.
The greatest predictor of healthy life expectancy is employment at age 50-64 and levels in Halton are
lower than the regional and national averages. Healthy life expectancy for both men and women in
Halton is also lower than the North West and England averages. So not only do people in Halton not
live as long on average but they spend less time in good health. This is reflected in data from the
2011 Census when only 42% of people living in Halton who wereover the age of 65 said their health
was very good or good (36% said it was fair and 22% said it was very bad or bad). The percentage in
good health amongst those aged 65+ is the lowest of all the age groups and with each age group
post-65 it continues to fall.
At an electoral ward level, Halton’s 65+ population in very good or good health varies from just 30%
in Windmill Hill to 60% in Birchfield, with levels highest in the more affluent areas and lowest in the
more deprived areas.
Death rates amongst those aged 65+ have been falling both locally and nationally. Halton’s rates
were higher than the regional and national rates in 2006-08 and this relative position has remained
unchanged over time. Cancers and circulatory diseases are the top two causes of death. Respiratory
disease is the third cause and is the second cause amongst those aged 90+. Mental and behavioural
disorders become a more prevalent cause of death from aged 85+, mainly due to dementia.
Both nationally and locally most people over age 65 rate the overall experience of their GP surgery
very good or fairly good (over 90%). Most have confidence in their GP and nurse and find making an
appointment convenient. Slighty less, though still the majority, are satisfied with opening hours and
time spent waiting at the surgery. However, this last point was one highlighted by the Halton OPEN
surveys as something people were concerned about.
The majority of those who wanted to have an NHS dental appointment were able to do so.
However, Halton was joint lowest with Liverpool for the percentage of over-55s who go to the
dentist. Despite the fact that 45% of those registered blind and 59% of those registered as partially
sighted are aged over 75, Halton has lower rates (both all age and 65+) for NHS sight tests compared
to the North West and England.
Apart from Halton Lea, where levels of both elective and non-elective hospital admissions are high,
electoral wards with high elective admissions have low non-elective admissions and visa versa. This
difference is particularly so for older people from Riverside ward and to a certain extent in Kingsway
ward also.
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Halton Joint Strategic Needs Assessment 2015/16
1. Introduction
With increasing life expectancy, improved nutrition, reductions in smoking and improvements in
living standards, older people can expect to live at least part of their later years in relatively good
health. Even, when people have long term medical conditions (LTCs), provided these are identified
early and managed well in primary care and through self care, these do not need to be limiting
conditions. Having condidence in and satisfaction with local primary care services are important
indications of older people’s willingness to engage with such services.
Being healthy is one of the most important factors determining people’s wellbeing. Being able to
stay healthy and independant is one of the most widely expressed concerns of older people, both
nationally and locally. Being healthy is not just about lifestyle behaviours, but about having good
quality housing that meets an individuals needs, as well as issues to do with neighbourhoods and
social life.
As the term health can often be used symonomously to describe illness, the term wellbeing has been
increasingly used in international and national policy. The Department of Health describe wellbeing
as:
Wellbeing is about feeling good and functioning well and comprises an individual’s experience
of their life; and a comparison of life circumstances with social norms and values. Wellbeing exists
in two dimensions:
Subjective wellbeing (or personal wellbeing) asks people directly how they think and feel
about their own wellbeing, and includes aspects such as life satisfaction (evaluation), positive
emotions (hedonic), and whether their life is meaningful (eudemonic).
Objective wellbeing is based on assumptions about basic human needs and rights, including
aspects such as adequate food, physical health, education, safety etc. Objective wellbeing can be
measured through self-report (e.g., asking people whether they have a specific health condition),
or through more objective measures (e.g., mortality rates and life expectancy).
Department of Health 2014
Nationally, the Office of National Statistics now measures wellbeing. It does this via four questions
within the the Annual Population Survey:
1. Overall, how satisfied are you with your life nowadays?
2. Overall, to what extent do you feel the things you do in your life are worthwhile?
3. Overall, how happy did you feel yesterday?
4. Overall, how anxious did you feel yesterday?
There are other aspects of wellbeing alongside personal wellbeing including: relationships; health;
what we do; where we live; personal finance; education and skills; the economy; governance; the
natural environment. Many of these have been explored in the previous chapter of this JSNA.
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Older People: overall health and wellbeing 2015/16
Wellbeing is important to health and health is important to wellbeing. Healthier lifestyles and good
health status are both associated with higher levels of wellbeing. Therefore focusing policies on
wellbeing could lead to improved wellbeing and also improved health outcomes.
Having a high level of wellbeing has important implications for individuals, for their families and for
the health and social care sector. It:1








Adds years to life
Improves recovery
Is associated with positive health behaviours
Influences the wellbeing and mental health of those close to us
Is associated with broader positive outcomes such as employment, education, relationships
and crime
Affects how healthcare sector staff and providers work
Has implications for patient care practises and services
Has implications for treatment decisions and costs
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Halton Joint Strategic Needs Assessment 2015/16
2. Level of need in the population
2.1 Wellbeing
The Shaping our Age project aims to provide new ideas and insights to the emerging issues around
ageing by exploring how older people aged 65 and over understand and define their wellbeing
Participants defined their well-being as feeling healthy, free from pain and able to lead a positive
life. They describe the feelings of well-being as: happiness, contentment, satisfaction, peace of mind,
comfort, enjoyment and euphoria. Well-being is also associated with feelings of self-worth and
achievement.[2]
The Office for National Statistics (ONS) annual survey has found that those in the 65-74 age bracket
tend to have the highest levels of wellbeing and although the scores drop for the 75 and over age
group these too remain above the younger age brackets.
Table 1: Percentages with high levels of wellbeing and low levels of anxiety by age, UK Annual
Population Survey 2013/14
The Shaping our Age study indicates that the things that contribute the most to older people’s sense
of wellbeing are relationships and social contacts with family, friends and neighbours, providing fun,
support and feelings of belonging and being valued. Also important is getting out and having a range
of enjoyable interests and activities to fill the day. Keeping busy and having an active social life help
to divert attention from problems arising from ill health and impairments. Particularly important are
groups and clubs, which also provide structure to people’s lives and ‘something to look forward to’.
The well-being benefits gained from volunteering, supporting others and campaigning include
meeting people, feeling useful and building self-esteem. Physical or mental health is for many the
foundation for a positive, active and happy life. Having a positive outlook, self-motivation as well as
faith, religion/spirituality and having sufficient personal finances are also important.
This data is not available at a local authority level. However, data from the Liverpool John Moores
survey of older people does indicate a high level of satisfaction amongst Halton older people. (see
demographics, economic, living and social circumstances chapter for details)
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Older People: overall health and wellbeing 2015/16
2.2. Life expectancy
2.2.1. Life expectancy at birth
Life expectancy at birth is used as an overarching measure of the health of the population. Figure 1
shows how,overall, there has been a steady increase in life expectancy in Halton, with males
expected to live 3.6 years longer than they were in 2002 and females 2.4 years longer. Currently life
expectancy in Halton stands at 77.3 years for males and 80.4 years for females. This compares to
regional levls of 78 (males) and 81.7 (females) and national levels of 79.4 (males) and 83.1 (females)
respectively. Of note is the slight dip in life expectancy amongst women since it peaked in 2009-11
at 80.7 years. Thus within this pattern of increasing life expectancy, the 2.5 year gap between Halton
and England has remained during this time period.
Figure 1: Life expectancy at birth 1991-93 to 2012-14, males and females
There are also wide variations across the borough between wards and between the most deprived
and least deprived areas of the city. Whilst there has been an overall increase both in the most
deprived and least deprived areas, men born in the least deprived areas of Halton are expected to
live 8.9 years longer than their counterparts in the most deprived areas. Encouragingly, this gap does
appear to be narrowing, down from a high point in 2005/07 of 12.3 years difference.
The internal, borough-wide life expectancy gap for females in Halton has also narowed, from its
highest point in 2007-09 of 12.5 to 9.0 in 2011-13. However, for both males and females the gap
increased for 2011-13 compared to 2010-12.
2.2.2. Life expectancy at 65
Recently there have been concerns raised[3] following analysis by Public Health England (PHE)[4] of
official statistics which show a drop in life expectancy for female pensioners. Whilst neither PHE nor
ONS are speculating on causality in the report, public health experts suggest this is linked to the
changing lifestyle habits of the baby boomer generation, with more women smoking and drinking
alcohol, as well as the potential that cutbacks in care may be impacting on outcomes for older
people. Influenza and the weather may also be influencing the trend. However, it could just as
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Halton Joint Strategic Needs Assessment 2015/16
easily be a statistical anomaly. PHE warn that such fluctuations have occurred before and it is too
early to tell if this is a change in the overall upward trend at this stage. They will continue to monitor
this annually. This dip can be seen in Halton’s statistics for those aged 65 and over (Figure 2) as well
as across the older age groups individually (Figure 3). The dip is especially marked for women aged
85.
Figure 2: Trend in life expectancy at age 65, 200-02 to 2012-14, males and females
Figure 3: Trends in life expectancy at age 65, 75 and 85, Halton males and females
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Older People: overall health and wellbeing 2015/16
Halton follows a broadly similar pattern to that of England with small increases in the percentage
changes in males for ages 65 and 75 and larger percentage changes for those aged 85. For females
at age 65, the percentage change is the same as England and similar or better than the local
authorities across the City Region apart from Liverpool. However, this is against a baseline of lower
life expectancy than England, United Kingdom (UK) and European Union (EU). Compared to the City
Region authorities life expectancy in Halton for those over age 65 for both males and females is
generally the lowest in the sub-region for both 2011/13 and 2012/14.
Figure 4 demonstrates that for males Halton’s level of improvement has been greater than the UK
and EU and similar to the England and regional levels. For age 85, the level of improvement has
been substantially better than all comparators. Figure 5 shows that for females Halton’s level of
improvement has been greater than the England, UK and EU for age 65 and similar or greater than
all across the Liverpool City Region except Liverpool. For age 75 the fall in life expectancy is less than
UK, EU, Sefton and Knowsley. At age 85, the fall in life expectancy is more marked than all other
comparators.
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Figure 4: Percentage change in male life expectancy between 2011 and 2012
[a]
Figure 5: Percentage change in female life expectancy between 2011 and 2012
[a]
a) NB EU and UK difference based on single year, rest of date based on differences between consecutive three-year periods 2011/13 and 2012/14
2.2.3. Healthy life expectancy
Health expectancies add a quality of life dimension to estimates of life expectancy (LE) by dividing
expected lifespan into time spent in different states of health. We routinely publish 2 types of health
expectancies. The first is healthy life expectancy (HLE), which estimates lifetime spent in “Very good”
or “Good” health based on how individuals perceive their general health. The second is disabilityfree life expectancy (DFLE), which estimates lifetime free from a limiting persistent illness or
disability. This is based upon a self-rated assessment of how health limits an individual’s ability to
carry out day-to-day activities. Both health expectancies are summary measures of population
health and important indicators of the well-being of society.
The importance of HLE as a summary measure of population health is reflected in its inclusion in the
2 high level outcomes for the public health outcomes framework (PHOF). The first outcome is
increased HLE, taking account of the quality as well as the length of life. The second is to reduce
differences in LE and HLE between communities, through greater improvements in more
disadvantaged communities.
The HLE figures reported in this statistical bulletin are a snapshot of the health status of the
population(s) in England during 2011 to 2013. The health status and mortality rates of a population
change year on year due to exposure to different risks and treatments affecting health, and also
through inward and outward migration. Therefore, the estimates reported in this bulletin should not
be interpreted as the actual number of years a person will live in “Good” health. HLE figures are a
likely estimate should the health status and mortality rates remain fairly stable over the life course.
Healthy life expectancy (HLE) is calculated by combining morbidity (ill health) and mortality (deaths)
data to produce estimates of the span of life that a person can expect to live in very good or good
health.
Current and future trends in life expectancy are key impact factors on the demand for social care
services over the next few years. However, probably more influential will be the length of healthy
life expectancy, and indeed the difference between the two as an indication of potential increased
years of ill health and consequent requirement for health and social care with associated costs. The
comparison between male and female HLE is interesting at a population level, as although women
are living longer than men their healthy life expectancy is not much greater. So women are living
longer but in poorer health. This mismatch has been highlighted by the World Health Organization's
Global Burden of Disease report[5] – i.e. the concern that although we are living longer, those
additional years being spent struggling with ill-health and disability.
Research by Public Health England suggests that the greatest predictor of HLE is employment at 5064. Halton has lower percetnages of the 50-64 age population in employment than the North West
and England averages.
Halton Joint Strategic Needs Assessment 2015/16
Figure 6: Snapshot of employment levels amongst 50-64 year olds during the 12 month period
ending September 2015
Given this it is not surprising to see that HLE is lower in Halton than in the North West and England.
In 2011-13, Halton HLE was 58.3 years, lower than the North West (61.2 years) and England (63.3
years) averages. Halton females HLE, as with overall life expectancy, is higher than males at 61 years
but again this is lower than the North west (61.9 years) and England ( 63.9 years) respectively.
Figure 7: Healthy life expectancy at birth, males and females
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Older People: overall health and wellbeing 2015/16
Disability free life expectancy (DFLE) at age 65 can give an indication of the disabling health
problems that people at the point of retirement age can expect. It can also highlight the inequality
between populations in different locations. Between 2006-08 to 2009-11 men and women at age 65
had significant improvements in DFLE both at the England and regional levels. Although DFLE has
significantly increased for males and has remained broadly stable for females, the proportion of
expected life with a disability has increased. This increase in the proportion of life with disability is
driven by faster increases in Life Expectancy than in DFLE. Taking England as a whole, males and
females at birth in 2009-11 can expect to live more years with a disability than in 2006-08.[6] One
explanation, of many possible, is that the period 2009-11 falls entirely in a time of recession and
slow recovery. 2009-11 was economically less favourable than 2006-08 (the data was collected
largely before the effects of the banking crisis). It is feasible that the functional health (including
conditions such as anxiety and depression) of those under 65 may have been more affected by
pressures on individuals and households. Data from a recent release on the effects of taxes and
benefits on household income shows the income of pensioners has been largely protected
compared to those of working age.[7]
Although Halton’s relative ranking has improved between 2006-08 and 2009-11, it the level of DFLE
remains lower than the North West and England averages fro both men and women. Thus Halton
older people do not live as long (life expectancy) and they live a greater proportion of their shorter
lives with a disability.
Table 2: Disability free life expectancy and proportion of life disability free, at age 65
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Halton Joint Strategic Needs Assessment 2015/16
2.3. General health
The 2011 Census asked people to describe their general health. As with the national picture, the
percentage of those in Halton describing their health as either very good or good fell with each age
band. Only 4 out of 10 (41.6%) of Halton residents aged over 65 years of age said they were in good
or very good health compared to nearly 8 out of 10 residents overall. Just over one in five
(22%)describing it as bad or very bad, compared with fewer than 1 in 10 for all residents.
Table 3: levels in good health in Halton by age group
Very good or
Fair health
good health
All age
Age 0 to 15
Age 16 to 24
Age 25 to 49
Age 50 to 64
Age 65 and over
78.6%
97.2%
94.5%
85.9%
65.2%
41.6%
13.7%
2.2%
4.2%
9.6%
21.4%
36.4%
Bad or very
bad health
7.7%
0.6%
1.3%
4.5%
13.4%
22.0%
Source: 2011 Census, Nomis 2014
Figure 8: Levels in very good or good health amongst those aged 65 and over, Halton and
comparators
There was a strong correlation between older people describing their general health as good or very
good and deprivation. Only a third of older people living in Windmill Hill, Halton Lea, Riverside,
Appleton and Halton Castle described their health in this way, compared over half in the more
affluent wards of Birchfield, Hale and Daresbury.
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Figure 9: Percentage of Halton population aged 65 and over in good or very good health, by
electoral ward, 2011
Further analysis of levels of good health show an inverse relationship with deprivation (using the
Index of Multiple Deprivation (IMD) scores at lower super output area (LSOA) level). With a
correlation of 0.82, the relationship is a strong one.
Figure 10: Correlation between the percentage of Halton population aged 65+ in good or very
good health and deprivation at LSOA
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Halton Joint Strategic Needs Assessment 2015/16
Housing tenure is also associated with differences in levels of good health in the borough, with those
65 and overs who own their own homes outright having better health than those in social rented
accomodation. As seen in chapter 2 most older people either own their own home (mostly outright)
or live in social rented accomodation.
Table 4: Proportions in good, fair and bad health, Halton 65+ population, by tenure
2.4. Overall death rates (all-cause mortality)
In 2013 the European Standard Population which is used in the calculation of age standardised
mortality rates was changed for the first time since 1976. This change allocated a greater weight to
the older population to better reflect the ageing population across Europe. The effect of this has
been to increase mortality rates for conditions commonly associated with older ages.
Figure 11 shows the directly age standardised mortality rate for those aged over 65. Although the
mortality rate for Halton has been decreasing steadily for a number of years there is a significant
difference between the mortality rates for the borough and those of the North West and England.
Before 2005/06 this difference was statistically significantly higher than both the North West and
England. It has remained statistically higher than the England rate throughout the time period.
Figure 11: Trend in death rate from all causes amongst those aged 65 and over
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Nationally, cancers continue to be the leading cause of death amongst people aged 65 to 74.
Coronary heart disease and respiratory disease are also leading causes. This is the case both
nationnally and locally. There are socal inequalities in these conditions due to lifestyle behaviours,
awareness, culural competence amongst professionals and housing conditions.[8] Over the whole
ifespan aged 65 and over diseases of the circulatory diseaase and cancers cause roughtly the same
percetnage of deaths. Together with respiratory disease they make up over two-thirds of all deaths
in those aged 65 and over. The top 10 reasons make up over 97% of all deaths.
Table 5: Top 10 causes of death in Halton residents aged 65 and over 2010/14.
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Halton Joint Strategic Needs Assessment 2015/16
3. Service provision
Older people, as with the general population, have access to and utilise a wide range of public,
private and third sector services. These are described in the various chapters of this JSNA, such as
health improvement and disease prevention, general practice care, hospital admissions and social
care, as well as those provided by the voluntary, charitable and faith sectors.
This section looks very generally at older people’s access to and satisfaction with GP services, NHS
dental services and NHS optometrist (vision) services.
3.1. Access to and satisfaction with GP services
Each year a representative sample of patients across each GP practice in England is invited to
participate in a survey about their experience of the GP practice they are registered with as well as
answering questions about their own health and wellbeing.The latest data are from the January
2015 publication, collected during January-March 2014 and July-September 2014.
There are a range of questions concerning ease of contacting the surgery, seeing prefered GP,
accessing a nurse, opening times and ease of getting an appointment and many others. Results for
Halton CCG show that overall a greater proportion of older people rated their overall satisfaction as
very good than the all age figure and this was true across all the satisfaction and experience
questions in the survey.
The full survey results can be found at https://gp-patient.co.uk/
Figure 12: Q28. Overall experience of GP surgery, national picture
Compared to the national results, Halton patients overall experience of their GP practice shows a
similar pattern, with the percentage stating it was very good rising with age, with a lower proportion
in the older age bands stating it was fairly good. The percentage of Halton patients sampled stated
overall expereicne was very good compared to their age band nationally. Numbers in the sample
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Older People: overall health and wellbeing 2015/16
were too small to provide analysis for those aged 65 and over for the ‘poor’ categories. However,
91% of 65-74, 97% of those aged 75-84 and 95% of those aged 85 and over rated their overall
experience as either very good or good.
Table 6: Overall experience of GP surgery, Halton patients
As with the overall experience, a greater percentage of older people stated that they had confidence
and trust in their GP and nurse than across all the age groups collectively. However, satisfaction was
high generally, as Tables 3 and 4 show. A slightly higher percentage of respondents in the 65+ groups
stated they were definitely confident than seen nationally, although the difference was small.
Table 7: Q22. Confidence and trust in GP, Halton patients, all age and 65+, 2014
Table 8: Q24. Confidence and trust in nurse, Halton patients, all age and 65+, 2014
The survey also asked about people’s views and experience of GP systems; convenience of
appointments, experience of making appointments, opening hours and waiting times at the surgery.
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Halton Joint Strategic Needs Assessment 2015/16
With all of these, as with the other findings, results were not dissimilar to the national ones, and
with greater percentages of older people rating satissfaction/experience high than the reults across
all ages. This may reflect difficulties people who work may have with accessing appointments at
times that fit with work and family life.
Table 9: Q15. Convenience of appointment, Halton, all age and 65+, 2014
Table 10: Q18. Overall experience of making an appointment, Halton, all age and 65+, 2014
Table 11: Q25. Satisfaction with opening hours, Halton, all age and 65+, 2014
Table 12: Q20. Impression of waiting time at surgery, Halton, all age and 65+, 2014
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Recent research has shown that there has been an increase in both the volume and length of GP
appointments, including the increase in the number of telephone consultations. It also shows that
the increase has been greatest in older people, especially the oldest old i.e. thosed aged 85 and
over. This is without considering non-direct patient care such as time spent on professional
committees or ensuring primary care staff keep up-to-date with their training/knowledge needs.
The increase has been especially marked for GPs but is also so for nursing staff working in general
practcie. The research authors suggest the general practice delivery may be reaching saturation
point.[9]
3.2. Access to dental services
Routinely collected data is not available on access to NHS dental services by age group. A recent
survey by Liverpool John Moores University (LJMU) of residents aged 50 and over across most of
Cheshire & Merseyside asked “Do you go to the Dentist?”. The survey found that attendance at a
dentist varied greatly across the sub-region with a difference of 18%. Halton was joint lowest with
Liverpol at 67%.
Figure 13: dental access amongst those aged 50 and over, 2014
Data from the GP Survey 2014/15 asked how many people had tried to access and NHS dentist in the
past two years, and of these how many had succeeded. With only around a third of questionaires
returned, numbers for Halton were small. However, it found braodly similar percentages to the
North of England and England as a whole and no substantial differences across the age groups. The
vast majority of those who said they has tried to get an NHS dentist appointment did manage to get
one.
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Halton Joint Strategic Needs Assessment 2015/16
Table 13: Percentage seeking an NHS dental appointment who succeeded in getting one, by
age, 2014/15 GP Survey
There is a growing evidence base of the challenges faced by older people in accessing dental health
services. Use of professional dental services is low amongst older people, particularly the
socioeconomically disadvantaged.[10] Challenges include:


Impaired mobility in frail elderly people hinders access to care
There can be a financial hardship following retirement and the cost of dental work can be a
worry
 A lack of dental tradition amongst older people can present a barrier to accessing services
 Older people may have negative attitudes towards oral health care
With the aim of evaluating existing oral health practices, staff training and the impact of poor oral
health, PHE carried out a North West Survey[11] of services supporting dependant elderly people in
three settings:
1. ‘Care in your home’ services provided by agencies, for care of adults over 65 years
2. Adult residential and nursing homes, including hospices, in which adults over 65 years were
resident
3. Wards in hospitals providing in- patient care for adults over 65 years
Of the ‘care in your home’ services, over a third (37%) did not undertake any formal assessment of
clients’ oral healthcare needs. More than half (54%) provided no staff training on assessing a client’s
need for assistance with oral hygiene. In contrast, a formal assessment of oral health needs was
conducted in 90% of the residential homes in the survey (77% as part of a care plan). However there
were still around two-thirds (32%) where there was no training provided for staff on assessing a
client’s need for assistance with oral hygiene. In 84% of hospitals, a formal assessment of the oral
health needs of patients aged over 65 on admission was carried out (53% as part of a care plan).
More than 1 in 4 (28%) hospitals provided no training for staff in assessing patients’ needs for
assistance with oral hygiene.
The surveys identified gaps in policy, training and knowledge across all agencies, but especially in
‘care in your home’ services. There was a clear demand for training by professionals and provision of
leaflets and guidance. In residential homes there was a request for better access to domiciliary
dental treatment.
3.3. Access to optometrist services
The principal eye conditions causing disability and impairment are cataracts, diabetic retinopathy,
macular degeneration and glaucoma. Perhaps the most important risk factor for visual impairment is
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Older People: overall health and wellbeing 2015/16
ageing. Old age is the single biggest risk factor for Age-related macular degeneration, glaucoma and
cataracts. For example, the prevalence of cataracts increases sharply with age from about 60 years
onwards. Ethnicity and family history are also important non-modifiable risk factos. Living in a
deprived area is associated with sight loss. This is likely to be because people living in deprived areas
have been shown to present to services later than those living in more affluent areas.
In Halton 45% of those registered as blind and 59% of those registered as partically blind are over
the age of 75.
The Global Burden of Disease study, found that across the UK, in people of 70 years and over, agerelated hearing loss is the eighth most important contribution to the Years Lived with Disability. This
burden has remained the same for the last 20 years with 3.2% of the total Years Lived with Disability
attributable to hearing loss. As the population ages, the impact of hearing loss is likley to increase.
Whilst there has been substantial progress in improving the health services over the last ten years,
significant challenges remain.[12] A particular challenge is meeting the hearing needs of the rapidly
growing older population. 5.3 million older people (aged over 65) in England have a hearing loss and
this will have a disproportionate effect on their wider physical and mental health, and
independence.
Most NHS eye health services are provided by community optometrists, , a small number of
ophthalmic medical practitioners and GPs. This isunder the General Ophthalmic Services, of which
the objective is to providepreventative and corrective eye care for children, people aged 60 and
over, people on lowincomes and those suffering from orpredisposed to eye disease.
Community optometrists (and ophthalmic medical practitioners) provide both private and General
Ophthalmic Services tests and prescribespectacles or contact lenses where these are required. Sight
tests include tests that assessthe eye health. Optometrists have a duty of care to refer patients to
other appropriateprofessionals, usually ophthalmologists, where disease or abnormality of the eye is
detected.The dispensing of glasses, contact lenses and in some case low vision aids may be
carriedout by dispensing opticians in addition to optometrists.
Halton's average rate of NHS sight tests among all age groups is lower than the North West and
England averages.
Table 14: Rate, per 100,000 population of NHS sight tests given to population in Halton,
2012/13
Age Group
All Ages
Aged 65+
Aged 15 and under
Halton
23,231
38,284
20,322
North West
23,844
39,744
23,941
England
23,276
46,318
23,449
Source: Royal National Institute for the Blind
Sight Loss Tool, 2014
More detail on eye health prevalence is available in Halton’s JSNA Physical and Sensory Disabilities
amongst Adults http://www3.halton.gov.uk/Pages/health/JSNA/adults/sensoryphysical.pdf
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Halton Joint Strategic Needs Assessment 2015/16
2.4. Admissions to hospital
In 2001 the Department of Health published its National Service Framework for Older People which
outlined the government’s aim to prevent unnecessary hospital admissions.[13] The King’s Fund
analysed peer-reviewed literature providing evidence of what works in avoiding hospital
admissions.[14] They found good evidence to support the following interventions:




Self-management training for patients with ambulatory care sensitive (ACS) conditions
Senior clinician review in A &E
Continuity of care with a family doctor
Healthcare professionals providing treatment at the patient’s home. These schemes can
deliver similar outcomes to admission at equivalent or lower cost
 Structured discharge planning
Elective admissions are often part of a wider, ongong package of care to enable people to manage a
particualr medical condition. The increase in unplanned, emenrgency admissions, impacts on
elective admissions, with these scheduled treatments being cancelled to deal with emergency cases.
Halton’s pattern of elective and non-elective (emergency) admissions shows that apart from Halton
Lea which has admissions rates through both routes, those wards with high elective admissions ahev
lower non-elective admissions and visa versa. This difference is particular seen in Riverside ward
with low elective and high non-elective admissions, and to a certain extent in Kingsway ward aslo.
Map 1: Elective admissions by electoral ward, 2014/15
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Older People: overall health and wellbeing 2015/16
Map 2: Non-elective (emergency) admissions by electoral ward, 2014/15
The causesof these admissions will be explored in chapter 5 Ill health, unplanned care and support
to live independently.
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Halton Joint Strategic Needs Assessment 2015/16
4. User Views
One of the most consistent and widespread findings of local surveys conducted by Halton Open/Age
UK Mid-Mersey is that older people are concerned about being able to remain healthy and
independent fort as long as possible. Conversely, they fear loosing this independence and having to
go to live in a care home.
In oder to assist them in remaining healthy and independent, they voice concerns about the quality
and accessibility of local health services; in particualr about access to GPs and transport to hospital
appointments. Having local social activities was also an important feature, enabling people to make
friends and stay connected with their wider community.
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Older People: overall health and wellbeing 2015/16
References
1. Department of Health (2014) Wellbeing Why it matters to health policy Health is the top thing
people say matters to their wellbeing
2. Hoban M., James V., Pattrick K., Beresford P. and Fleming J. (2011) Voices on well-being A report
of research with older people
3.http://www.telegraph.co.uk/news/health/news/11507678/Alarm-over-sudden-drop-in-femalelife-expectancy.html
4. Public Health England (2016) Recent Trends in Life Expectancy at Older Ages
5. World Health Organisation Global Burden of Disease Geneva: WHO
6. Office for National Statistics (2014) Statistical Bulletin: Disability-Free Life Expectancy by Upper
Tier Local Authority: England: 2009-11 and comparison with 2006-08
7. ONS (2014) The Effects of Taxes and Benefits on Household Income, 2012/13. Office for National
Statistics
8.Roberts J. (2015) Social Inequalities in the Leading Causes of Early Death A Life Course Approach
UCL Institute of Health Equity
9. Hobbs F.D.R., Bankhead C., Mukhtar T., Stevens S., Perera-Salazar R., Holt T., Salisbury C. (2016)
Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England,
2007–14 The Lancet, Available online 5 April 2016, DOI: http://dx.doi.org/10.1016/S01406736(16)00620-6
10. Petersen PE, Holst D. (1995) Utilization of dental health services. In: Cohen L, Gift HC, editors.
Disease Prevention and Oral Health Promotion.
11.Public Health England (2015) Dental public health intelligence programme: North West oral health
survey of services for dependant older people, 2012 to 2013.
12. NHS England and Department of Health (2015) Action Plan on Hearing Loss
http://www.england.nhs.uk/wp-content/uploads/2015/03/act-plan-hearing-loss-upd.pdf
13. Department of Health (2001) National Service Framework for Older People
14. Purdy S (2010) Avoiding hospital admissions; What does the research evidence say? London:
Kings Fund
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