Vulnerable Adults

• Wirral, like North West and England, has seen an increase in new client support requests for working age adults (18–64 years) increasing from 1,275 per 100,000 population in 2016/17 to 1,560 in 2018/19 (Page 9)

• While new client support requests for those over 65 years in Wirral have fallen from 13,455 in 2016/17 to 11,805 per 100,000 population, while North West and England have remained relatively static. It should be noted that local data suggests for 2018/19 Wirral had lower rates of requests for support than both North West Local Authorities and England (Page 9)

• Data suggests that between 2016/17 and 2018/19 the long-term care numbers at a Wirral and North West, for both working age adults and aged over 65 years, level remained static or fell slightly. This is equally true for short term care at a North West regional level but not for short term care on a Wirral footprint. This has seen the number of clients accessing support, as a rate per 100,000 population, falling from 17% (2016/17) to 11% (2018/19) for those aged 18 to 64 years and from 37% (2016/17) to 27% (2018/19) for those aged over 65 years (Page 10)

• Since 2010/11, these means test thresholds for the social care financial assessment have not been increased in line with inflation; if they had, the Kings Fund estimate the upper threshold would now be £2,811 higher at £26,061. This also implies that people whose assets today are between £23,250 and £26,061 have effectively lost their eligibility for publicly funded social care support. At this moment Wirral charges 100% of expendable income after all the required deductions and discretionary allowances have been made. (Page 11)

• Kings Fund research points to the fact that publicly funded social care is available only to people with high enough needs. But identifying the incidence of need, such as numbers and levels of disability, in the population is far from straightforward (Page 12)

• For Wirral, using Family Resources Survey and Office for National Statistics population data as Kings Fund used it is estimated that 67,739 people in Wirral had some form of a disability in 2018. This figure consists of 4,730 children, 31,594 working-age adults and 31,415 state pension age adults. This is an increase of almost 9,000 people since 2011, when there was estimated to be 59,028 people having a disability. Though understanding the needs and supporting these estimated populations is complex (Page 13)

• Data suggests that Wirral has followed a similar pattern to England with increasing numbers of working age claimants receiving disability benefits since Personal Independence Payments (PiP) replaced Disability Living Allowance (DLA) and PIP numbers increasing since 2014. Although there is a less pronounced fall for Wirral, it has still followed England, and seen a reduction in DLA and Attendance Allowance (AA) claimants aged over 65 (page 15)

• Kings Fund suggest that has risen since 2014/15, when local authorities have sought to protect adult social care budgets, but in real terms, the level of expenditure nationally in 2017/18 was still £700 million below the level of 2010/11, with increasing demand for services (Page 16)

• For Wirral, the social care income sources, show an almost 12% increase (from £50.24 million to £56.12 million) between 2016/17 and 2018/19 whilst other North West Local Authorities show an increase of 6% increase over those three financial years (Page 16)

• Nationally, local authorities have increased spending on adult social care in the past two years, but the cost to them of providing residential and nursing care and home care has risen at more than the rate of inflation. At the same time, the cost of providing care for older residents has grown faster than that for working-age adults (Page 17)

• The number of care home and residential beds available for people aged over 75, as the main users, has declined consistently in the past few years and compared to population the number of nursing home beds has remained flat while the number of care home beds has fallen. For Wirral it is a similar picture with the number of care home beds and nursing home beds generally following a similar national trend as reducing over time but higher relative numbers than England (Page 21)

• Both vacancy and turnover rate in Social Care and the NHS jobs has been increasing nationally since 2012/13 though, in most situations, both vacancy and turnover rates are lower in Wirral than nationally (Page 23)

• Nationally more carers are receiving ‘information, advice and other universal services/signposting’ from local authorities, but other types of support have not increased. Data for Wirral between 2016/17 and 2018/19 suggests that in many cases there has been a reduction across all types of support from the local authority (Page 24)

• Nationally, more carers are receiving Carer’s Allowance, and this is the case for Wirral too with a steady increase in residents in receipt of this payment since 2010 from 4,360 to 6,370 in November 2018 (latest published data), or 46% increase in 8 years (Page 25)

• For Wirral just above two-thirds of care services are rated by Care Quality Commission as good (64.7%) and outstanding (2.4%) and this is below the national result (79% in 2018) with those providers and venues requiring improvement locally at 18.2% and above the national figure of 17% in 2018 (Page 26)

• Service users' satisfaction with the care funded by local authorities appears to have remained consistently high over the past four years, and in 2018/19 those saying they were either extremely or very satisfied for Wirral at 64.8%, then at 65.0% for North West Local Authorities and 64.3% for England (Page 28)

• The proportion of Wirral service users using direct payments jumped substantially in 2018/19 to 26.3% from 21.9% in 2017/18 and closer to England (28.3%) and above North West region comparators (25.4%) (Page 30)

• The overall number of Wirral residents entering residential or nursing care homes has increased in recent years for working age adults (aged 18 – 64) unlike nationally where this is a static figure with reductions for those aged over 65 years, which are similar to national outcomes though a much greater fall in the same three year period, albeit from a higher starting figure (Page 31)

• For Wirral, 2018/19 data for delayed transfers from hospital due to social care (all three measures) suggests a positive picture for Wirral when ranking better (lower) or equal to both North West and England figures (Page 33)

• In 2018/19 Wirral was similar to both North West and England in proportion of older people (65+) accessing reablement service on discharge from acute or community hospitals, but whilst this has remained steady over three years for England and North West then this has been falling for Wirral since 2015/16 (Page 34)

• Wirral has slightly higher rates for Continuing Health Care (CHC) and NHS Funded Nursing Care (FNC) when compared to NHS England North (Cheshire and Merseyside) Commissioning organisations but higher again than England for both CHC and FNC. Between 2017/18 and 2018/19 reduced its rates for FNC (202.84 to 188.50) but with an increase in CHC (Page 35)

• The number of Disabled Facilities Grants nationally increased in 2016/17 to recover to 2010/11 levels with Wirral, between 2016/17/ to 2018/19, significantly higher than national figures (Page 36)

• Adult Obesity

• Alcohol

• Armed Services (Ex-Military Personal/Veterans)

• Asthma

• Autism

• Black, Asian and Minority Ethnic (BAME) Groups

• Cancer

• Cardiovascular Disease

• Carers

• Chronic Kidney Disease

• Chronic Obstructive Pulmonary Disease

• Dementia

• Dental

• Diabetes

• Domestic Abuse and Domestic Violence

• Drug Misuse

• End of Life

• Epilepsy

• Excess Winter Deaths

• Eye Health (Adults)

• Falls (Older People)

• Gambling

• Heart Disease

• High Blood Pressure

• Homelessness

• Hypertension

• Learning Disabilities

• Lesbian, Gay, Bisexual and Transgender

• Life Expectancy

• Liver Disease

• Mental Health

• Mortality

• Older People

• People with Long-Term Conditions

• Respiratory

• Sexual and Reproductive Health

• Social Isolation and Loneliness

• Stroke

• Suicide

• Tobacco

• Unemployment

• Wirral Equality, Diversity and Protected Characteristics

• Adult social care market shaping (March 2017) This Department of Health guidance is aimed at people who buy social care services, including local authority and clinical commissioning group commissioners, as well as personal budget holders and people who fund their own care, care service providers and potential investors in the care sector.

• Creating the five year forward view for social care: How transformed and integrated health and care could improve outcomes and cost-effectiveness (March 2017)The Five Year Forward View sets out a case for upfront investment in the NHS to transform it into a service which reaches people in their homes and communities with early, effective interventions and builds partnerships with people with long term health conditions and their families. It is widely accepted that this will only succeed where social care makes the same transformation.

• Adult Social Care tool
  This updated tool for older people and adults with learning disabilities provides comparative information on spending per head, quality of services and access to services. These are the two largest groups who receive adult social care. View the UK website for more information

• AQA Quality and Efficiency Scorecard for Frail Elderly (2017) This North West Benchmarking tool provides comparative information for local commissioners and service planners

• News articles on this site

• Other key sources of data and information

All children are considered vulnerable by virtue of their age and immaturity, but which adults can be considered ‘vulnerable’?

Many people think of adults as being vulnerable if they’re permanently or temporarily unable to care for themselves and their interests, either through a mental or physical cause.

Vulnerable adults are open to risks of psychological and physical harm or being exploited for other people’s benefit.

The following groups of people could be considered as ‘vulnerable adults’:

• older people who are physically or mentally frail
• people with learning disabilities
• people with a mental health condition such as dementia or personality disorder
• people who are ill and need help to carry out normal daily functions
• people with physical disabilities
• people who have undergone a recent trauma – a bereavement, a divorce or loss of a job, for instance
• people who, for whatever reason, are in abusive relationships or are homeless.

But care needs to be taken about who are considered ‘vulnerable’. Just because someone is, for instance, older, or has a mental health condition or a learning disability, or has a physical disability, they are not necessarily ‘vulnerable’. Indeed, they may take great offence if you were to consider them so. Everyone needs to be wary of applying ‘labels’ to the people in our care.

it is also important to recognise that being vulnerable isn’t necessarily a long-term state. People who come into hospital for operations, for instance, will be very vulnerable immediately before, during and after the operation when they are not able to care for themselves and rely on health care staff to protect them and ensure their well-being. But in the vast majority of cases they will soon be completely independent again, so the vulnerable state is only temporary.

Individuals want to live rich and fulfilling lives, participating in their local community and contributing to its vibrancy. Families want this for their loved ones too.

They, and society at large, also want to ensure that those who need care and support – whether a young learning-disabled person or a 90 year-old with dementia – are supported in ways which enable them to feel safe, happy and where possible to take part in the life of their community. 

Those who work in or receive adult social care services recognise this. This is the core social purpose of care and support – not to control people’s lives for them but to work with them as equal partners to help them achieve what they want from life.

The vision and aims of the Government’s White Paper, Caring for our future (2012) include:

• Choice and control
• Working in partnership
• Personalised care
• Keeping people healthy and involved with their communities

Social care (‘care’) comprises personal care and practical support for adults with physical disabilities, learning disabilities, or physical or mental illnesses, as well as support for their carers. 

Adults’ care needs are often multiple and interrelated with other needs. Adult social care is therefore part of a complex system of related public services and forms of support.

How well services meet adults’ needs depends on all parts of the system working together. For example, good medical management of long-term conditions can prevent a person developing care needs, and welfare benefits can maintain independent living.

With reform of England's social care system still some way off amid wider uncertainty, Nuffield Trust have been looking at England's nearest neighbours, where 20 years of devolution have led to important differences, to assess how each country operates and what each might learn from the others. This explainer series kicks off looking at key themes around funding, eligibility and ‘offer’ in each of the four UK countries, while considering the direction of current reform efforts.

• What steps are currently being taken to reform social care?

• Who organises and funds social care?

• How much social care does each country fund?

• Offer and eligibility: Who can access state-funded adult care and what are people entitled to?

• Other types of support: how do the countries compare?