Assisted Living UK Capabilities
and
Opportunity Report

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Wales - full text version

1 Introduction

This case study provides a high-level snapshot of the Assisted Living (AL) sector in Wales. The purpose of this study is to provide key facts and information about the geographic, demographic, economic, and health factors that have an impact upon the potential for Assisted Living. This study also highlights the main regional innovations, collaborations, and industry initiatives in AL. The main aim of the study is to provide an overview of where the opportunities lie within Wales for the development of the Assisted Living sector.

Throughout this study, the most recent information and data have been sourced and, where possible, are presented at County/Unitary Authority (UA) level. If data is not available at this level of detail, then regional or national data is provided instead. 

 

2 Regional Overview

Wales is part of Britain and the United Kingdom. It is situated to the west of England and is around 170 miles (256 km) long and 60 miles (96 km) wide with an area of just over 8,000 square miles (20,720 km²).The landscape of Wales includes upland areas with mountain ranges (Snowdon is the highest mountain at 3,560 ft) and deep river valleys. Lowland areas are mainly along the coastal areas and the valley floors. Wales has a coastline of approximately 750 miles (1,200km). Major towns in the region include the capital, Cardiff with a population of 341,054, Swansea, Newport and Wrexham[1].

      2.1 Administrative Regions

The Welsh Government, headed by the First Minister of Wales, is the devolved government for Wales and has policy and law making authority. The Welsh Government is responsible for areas such as health, social welfare, housing, education, language and culture and public services. The Welsh Government is separate from the British Government, which retains responsibility for UK-wide areas such as tax, benefits, defence, and foreign policy.

The Welsh Government sets the national priorities, strategic context and overall level of funding for services. Twenty-two Unitary Authorities (UAs) are responsible for delivering these services at a local level. Eight of the UAs (Bridgend, Cardiff, Merthyr Tydfil, Neath Port Talbot, Newport, Torfaen, Wrexham and Rhondda Cynon Taf) have county borough status (reflecting their existence as large population centres), whilst the other 14 have county status (reflecting at least some aspect of rurality). (see Figure 1) 

 

      2.1 Demographics

The following sections describe the age demographics of the region. The population statistics quoted are from the Office of National Statistics (ONS) and Statistics for Wales.



Map of Wales including approximate County and Unitary Authority Boundaries

Figure 1: Map of Wales including approximate County and Unitary Authority Boundaries (ONS 2011[2])

 

      2.1.1 Population

Wales is ranked 10th in terms of population size when compared to the other regions in the UK (see Figure 2). In mid-2009, Wales had a population of around 3 million. Between 2004 and 2009, the population of Wales increased by 1.9% compared to an overall increase of 3.3% for the UK as a whole[3].Between 1999 and 2009 the number of people aged under 35 decreased by 2.6% while the number aged 65 and over increased by 9.1%.[4]

The population of Wales is also affected by migration, both international migration and internal UK migration. Table 1 below is based on data from the ONS report on international migration and shows that in 2009 and 2010 more people moved into Wales than migrated from Wales.

Table 1 International Migration Estimates for Wales (Source ONS)

 


Year

Migrating to Wales (thousands)

Migrating from Wales

2010

15,000

11,000
     

2009

14,000

13,000
     

2008

16,000

16,000
     

 

The number of people moving into Wales from the rest of the UK in the twelve months ending March 2010 was around 50,300. The number of people moving from Wales to the rest of the UK was around 47,900. This gives a net inward migration of around 2,400 for the period March 2009 to March 2010[5].



Figure 2:  UK Regional Populations – mid 2010 (Source ONS)

 

      2.1.2 Population Density

The average density in Wales is 145 people per square kilometre. The North East (Flintshire, Wrexham and Denbeighshire unitary authorities) and South East (Swansea, Neath Port Talbot, Bridgend, Rhondda, Cynon, Taff, The Vale of Glamorgan, Merthyr Tydfil, Cardiff, Caerphilly, Blaenau Gwent, Torfaen, Newport, Gwynedd, Powys) of the region are the most densly populated, with over 250 people per square kilometre. The remaining regions – the North West, Mid Wales and the South West, have a population density of 99 people per square kilometre or under.[6]

 

      2.1.3 Urban v Rural Populations

The majority of Unitary Authorities in Wales are classified as urban or semi-urban. According to the Welsh Assembly Government UA the following classifications apply to the Unitary Authorities in Wales:

  • Rural (a predominantly rural composition) - The Isle of Anglesey; Gwynedd; Conwy; Denbighshire; Ceredigion; Powys; Carmarthenshire; Pembrokeshire; Monmouthshire
  • Semi-Rural (mixture of rural and urban characteristics) - Flintshire; Wrexham; The Vale of Glamorgan
  • Urban (mostly heavily populated areas however small areas can display rural characteristics) - Swansea; Newport; Ceredigion
  • Valley (populated areas confined by the unique physical environment some areas can also contain small elements of rural) - Neath Port Talbot; Bridgend; Rhondda, Cynon, Taff; Merthyr Tydfil; Caerphilly; Blaenau Gwent;Torfaen.


Table 2 shows the rural/urban classification of each UA, and where data is available, the population of the UA as a percentage of the population of Wales, and area as a percentage of the total area of Wales.

 


Unitary Authority

Classification

Population (as a % of Population of Wales)

Area (as a % of the total area of Wales)

Abertawe – Swansea

Urban

7.7%
 

Blaenau Gwent

Valley

2.3%
 

Vale of Glamorgan

Semi-rural

4.2%

1.6%

Cardiff

Urban

11.2%
 

Caerphilly

Valley

5.8%
 

Newport

Valley

4.7%
 

Neath Port Talbot

Valley

4.6%
 

Conwy

Rural

3.7%

5.4%

Gwynedd

Rural

4.0%

12.2%

Merthyr Tydfil

Valley

1.9%
 

Bridgend

Valley

4.5%
 

Powys

Rural

4.4%

25.0%

Rhondda Cynon Taff

Valley

7.8%
 

Pembrokeshire

Rural

3.9%

7.8%

Ceredigion

Rural

2.5%

8.7%

Denbighshire

Rural

3.2%

4.0%

Monmouthshire

Rural

2.9%

4.1%

Carmarthenshire

Rural

6.0%

11.4%

Flintshire

Semi-rural

5.0%

2.1%

Isle of Anglesey

Rural

2.3%

3.4%

Torfaen

Valley

3.0%
 

Wrexham

Semi-rural

4.4%

2.4%

 
Table 2 ONS Wales Rural and Urban Area Classification 2009

      2.1.4 Population over 65 years

The population of the UK is ageing. In the period 1985 to 2010, the percentage of the population aged 65 and over increased from 15 per cent to 17 per cent, an increase of 1.7 million people. Not only is the population ageing, but there has been an increase in the number and proportion of those aged 85 and over. In 1985, there were around 690,000 people in the UK aged 85 and over (1 per cent of the population). By 2010, the numbers have more than doubled reaching 1.4 million, (2 per cent of the UK population).

By 2035 the number of people aged 85 and over is projected to be 2.5 times larger than in 2010, reaching approximately 3.6 million and accounting for 5 per cent of the total population[7].

Figure 3 shows the population of Wales by age band and sex as a percentage of the total population of Wales in 2010. The chart shows a similar percentage of males and females in each age category. The population of both males and females as a percentage of the overall population begins to decline after the ages of 49-59, where the population for males and females is 13.0% and 13.7% respectively, then drops more markedly to 1.9% for males and 3.3% for females over the age of 80.



Figure 3 Male and Female Population of Wales by Age Band and Sex as a percentage of the total population(Source ONS[8])

Figure 4 shows that within Wales, there are significant variations in age distribution, with Merthyr Tydfil with the lowest population of over 65s (9,046) and the urban conurbations of Cardiff (44,565), and Swansea (40,792 ) with the highest.

       2.1.5 Life Expectancy

One key indicator of health in a region is life expectancy, which is an estimate of the number of years that a person can expect to live, on average, in a given population. One of the findings from an ONS study (Kyte and Wells, 2010) that explored variations in life expectancy at birth between rural and urban areas of England during the period 2001 to 2007, was that people in rural areas lived longer than those in urban areas – an additional 2.1 years for males and 1.4 years for females[9].

Life expectancy in Wales for both males and females has increased since 1976. Women have a higher life expectancy than men, but the gap is closing. In 2007, Wales had a slightly lower life expectancy than the UK average, with life expectancy at birth for females of 81.4 years and males of 77 years, compared tothe UK average of 82.0 for females and 77.9 for males[10]. 




Figure 4 Populationby county withinWales – Male and Female over 65 (Source ONS[11])

        2.1.6 Population Projection

The population of Wales is projected to increase by 5% to 3.17 million by 2020 and by 12% to 3.37 million by 2035. Figure 5 shows the population projections for males over 65 years and females over 60 years from 2010 to 2033 for the English regions and Wales. The chart shows that the population of older people (Male 65yrs+ Female 60yrs+) in Wales is projected to increase by 43% by 2033.




Figure 5 Population Projection – Older People (Male 65yrs+Female 60yrs+)(Source ONS[12],[13])

 

       2.1.7 Old Age Support Ratio

The old age support ratio is a measurement of how many people of working age (20-64) there are relative to the number of retirement age (65+). The lower the ratio, the fewer younger people there are to support the over 65s.

The population of the UK is ageing. In the period 1985 to 2010, the percentage of the population aged 65 and over increased from 15 per cent in to 17 per cent, an increase of 1.7 million people. Over the same period, the percentage of the population aged under 16 decreased from 21 per cent to 19 per cent. This trend is projected to continue. By 2035, 23 per cent of the population is projected to be aged 65 and over compared to 18 per cent aged under 16.

Figure 6 shows the support ratio for the UAs in Wales for 2009 and what this support ratio is projected to be in 2033.The chart shows that the ratio of working-age people to elderly is declining in all areas except for Cardiff and Swansea where the ratio remains the same at 4.3 and 2.9 respectively. For those areas where the ratio is declining, this means that there will be an increasing number of elderly people being supported by fewer people of working age. The average support ratio for Wales in 2009 is 2.7, decreasing to 2.2 in 2033.




Figure 6 Wales Old Age Support Ratios (Source ONS[14])

 

      2.1.8 Older People and the Internet

The demographic information relating to Internet access and usage in this section is sourced from the ONS and Ofcom (the independent regulator and competition authority for the UK communications industries). At present, it has not been possible to obtain useful county/UA level demographic data on how older people access and use the Internet, so national data has been used to identify information and trends that could be seen as relevant at a regional level.

Ofcom produces an annual Communications Market report[15], which provides data and analysis on broadcast television and radio, the Internet and on fixed and mobile telephony, and provides some useful demographic information on broadband take-up and Internet usage in the UK. It also offers insights into how people are using mobile technology to access audio-visual and online content.

The last 10 years has seen rapid change in the communications market with the fast emergence and take-up of digital technology. New communications devices and services have been adopted by consumers across all age groups.

Ofcom’s key finding relating to the demographics of Internet access is that older people and those in lower socio-economic groups are less likely to have Internet access. Despite this, take-up for older people is increasing: 55% of 65-64s and 26% of over-75s have home Internet access. Of those over 65s that don’t have Internet access, the main reasons are: 

  • 31% lack of interest – no need for the internet
  • 24% age - too old to use the internet
  • 17% need - did not want a computer
  • 15% training - did not know how to use the internet / a computer
  • 3% cost - it was too expensive

Television has proved a resilient audio visual broadcast medium, and has evolved to encompass digital technology, with smart TVs starting to provide Internet access. Consumption of TV increases with age - the over 65s spend on average 5.7 hours a day watching television compared to an average of 4 hours for the typical viewer in 2010[16]. With access to the Internet via TV becoming more widely available, this may be relevant to the delivery of AL services for the older demographic.

      2.1.8.1 Mobile Internet connections

The ONS has noted a significant growth in the adoption of mobile Internet technology over the previous 12 months. Six million more people reported using their mobile phone to access the Internet in 2011 than in 2010. Although this growth is fastest among those aged 16-24, with Internet use over a mobile phone increasing from 44% to 71% over the previous 12 months, there have been notable increases across all age groups (see Figure 7).

Since 2009, when the measurement of mobile phone Internet use began, the number of women using mobile phones to access the Internet has more than doubled, from 18% of Internet users to 39% in 2011.Mobile Internet use via a laptop, tablet or other portable computer also proved popular in 2011, with 38 per cent of Internet users using these mobile devices away from the home or workplace.[17]

      2.1.8.2 Confidence in using the Internet

Another of Ofcom’s key findings is that although older people are becoming increasingly confident in using the Internet, they are still the least confident of all users, with one in ten of over-65s saying they are not confident, compared to only one in 50 of under-34s.

However, the biggest increases in confidence were in the 45-54s and 55-64s age groups, with a ten percentage point rise in both age groups; more than 90% now claim to be confident. Men are still marginally more likely to be confident in using the Internet than women (97% to 94%), but the gap has been closing[18]. 



Figure 7 Mobile phone Internet connections by age group (Source ONS 2011[19])

 

      2.1.8.3 Internet activities

In 2011, the ONS reported just over one in five (21%) Internet users made telephone or video calls online. This activity is not dominated by a specific age group; older age groups show similar patterns of use to the younger age groups. Of those aged 65 and over, 17% used this technology, compared to 22% of those under 24[20].

Figure 8 shows that older people are using the Internet increasingly to make purchases. Whilst there has been an increase in purchases made by both those over 55s and over 65s year on year since 2008, there has been a significant increase in the percentage of those aged 55 purchasing online. Fifty nine percent of over 55s compared to 27% of over 65s making purchases in 2011. This pre-disposition to purchase goods and services online in the over-55s may be of relevance to the AL market[21].




Figure 8 Internet purchases by over 55s (Source:ONS 2011[22])

Figure 9 shows the type of goods and services purchased online by those aged 55 and over as reported to the ONS in 2011. The most popular purchases were holiday accommodation (10%), other travel arrangements (11%), which includes flights, car hire and other transport tickets; books magazines and newspapers (11%); clothing and sports goods (10%) and household goods (10%).




Figure 9 Internet purchase by type by over 65s (Source ONS 2011[23])

 

 

3 Regional Economy


      3.1 Economic Overview of Wales

The key economic sectors[24] supported by the Welsh Government are:

  • Creative industries
  • Information, Communication and Technology (ICT)
  • Energy and Environment
  • Advanced materials and manufacturing
  • Life Sciences
  • Financial and Professional services
  • Food and Farming
  • Construction
  • Tourism


The latest Key Statistics Bulletin for Wales[25] reports that in 2010, Gross Value Added (GVA) for Wales was £45.5 billion or £15,145 per head of population. This was 74.0% of the average for the total of all UK regions. Wales had the lowest level of GVA per head in the UK regions, behind Northern Ireland (76.4%) and the North East, (76.9%).

In 2009, gross disposable household income (GDHI) for Wales was £40.4 billion or £13,484 per head of population. This represented 87.9% of the UK figure. GDHI per head in Wales is closer to the UK average than GVA per head, and is higher than that for both the North East and Yorkshire and the Humber.

During December 2011 to February 2012, the employment rate in Wales, as estimated by the Labour Force Survey, was 68.3% of those aged 16-64.This is lower than the UK rate (70.4%) for the same period. During the same period, the unemployment rate in Wales was 8.9% of the economically active population, which was slightly higher than the UK rate (8.3%) for the same period.

In April 2011, the average workplace-based gross weekly earnings of full-time employees in Wales were £519, which is 85.8% of the UK average.

      3.1.1 Older People’s Income

According to the HMRC, the average annual income for a pensioner in Wales is £17056.96[26].

For the UK as whole, the Older People’s Day Statistical Bulletin reports that in 2009-2010:

  • ‘Pensioner couples received an average gross income of £607 per week, single male pensioners received £320 per week and single female pensioners £274.
  • The largest source of income for pensioners is 'benefit income', which includes state pension income and benefits.
  • Occupational pensions are also a significant source of income. Average incomes conceal considerable variations between poorer and richer pensioners.
  • On average, older pensioners have lower incomes than younger pensioners and male pensioners have higher incomes than female pensioners.
  • Couples where the household head was aged 75 or over had an average gross income of £491 a week compared with £653 for those with a household head aged under 75;
  • Single male pensioners aged 75 and over had an average gross income of £315 per week compared to £325 per week for single male pensioners aged under 75;
  • Single female pensioners aged 75 and over had an average gross income of £255 per week compared to £297 per week for single female pensioners aged under 75.

Despite increases in pensioner incomes over the last fifteen years, in 2009/10, the incomes of an estimated 1.8 million pensioners in the UK (16%) fell below the most commonly used official measure of relative poverty (less than 60% of equivalised contemporary median income after housing costs). Two-thirds of these pensioners were women’[27].

      3.2 Regional Economic Infrastructure

In 2010, the UK Government developed a National Infrastructure Strategy[28] as a first step towards providing a more integrated approach to infrastructure development across the five sectors and networks that directly contribute to economic growth (energy, transport, water, waste and communications). This strategy has distilled into a National Infrastructure Plan, first issued in 2010[29] and revised to include more regional detail in 2011[30].

The Welsh Government is currently preparing a strategy to define its approach to its social and economic infrastructure for the areas for which it has devolved responsibility. The strategy, Wales Infrastructure Investment Plan (WIIP) is currently undergoing consultation and will be published at the end of May 2012.

In 2012, the Welsh Government published Wales Infrastructure Investment Plan (WIIP) [31] – which outlined its a strategy to define its approach to its social and economic infrastructure for the areas for which it has devolved responsibility. In it, the Welsh Government states its intention to invest over £3.5bn over the next 3 years, and around £15bn over the next decade, on infrastructure priorities:

  • Improving transport networks, in particular east-west links in North and South Wales.
  • Improving telecommunications networks.
  • Supporting the development of the energy industry in Wales.
  • Investing in housing.
  • Delivering more efficient and economical public services.
  • Improving the quality of the educational estate.
  • Developing our Enterprise Zones

The Welsh Government has made a commitment to provide a regular update on approved investments and will focus on Ministerial approved projects and programmes with a total project value greater than £15m. The pipeline will be updated regularly, with the latest update published in June 2013 [32] .

A region’s economic infrastructure can have a significant impact upon the ease with which technology innovations can be deployed to meet social objectives such as healthcare. The sectors and networks that are of most relevance to AL are energy, transport, and digital communications and surrounding them all is the region’s ability to generate intellectual capital. Given the recent nature of the strategy and plan, there are few statistics at the moment to support the development of the economic infrastructure at regional level. Instead, regional initiatives and projects have been used to illustrate activities in the relevant areas.

Based on the framework in the National Infrastructure Plan[33], Figure 10 shows the interrelationships and inter-dependencies between the care network and the regional economic infrastructure. For example, a poor transport infrastructure can offer opportunities for AL services, whereas a poor digital communications network would be a constraint.

All the elements within this infrastructure depend on utilizing the Intellectual Capital within a region, and it in turn depends on these networks to facilitate the take-up of science and technology innovations. The 2011 Infrastructure Plan recognizes the importance of good transport and digital communication links in facilitating the development of innovation hubs, science parks and clusters, which will all benefit from investment in world-class research facilities. Co-location of these innovation clusters with universities will also foster knowledge transfer and expertise exchange. 


Regional Infrastructure
Figure 10 Regional Infrastructure Interrelationships (Source UK Strategy for Nat Infrastructure)

      3.2.1 Transport

In March 2010, the Welsh Assembly Government published its National Transport Plan[34]. This plan, together with the Regional Transport Plans deliver the Wales Transport Strategy. These plans aim to ensure consistency of service provision across the transport network and will work together to support economic growth, link people to jobs, improve access to key services, deliver products to markets and support domestic and international trade. The National Plan outlines the key regional proposals and targeted investments, with supporting maps of the transport infrastructure improvements.

      3.2.2 Digital Communications

Ofcom, the independent regulator and competition authority for the UK communications industries, has reported [36] that during the last 10 years, the UK's communications market has been totally transformed. Digital technology has developed extremely quickly, and has changed the way that communications services work for consumers. It has also had a major impact on businesses and networks. For AL to take advantage of these rapid developments, a region must have an adequate digital communications infrastructure. Ofcom is now tasked with reporting on broadband take-up, speeds and availability, using data provided by communications providers.

The connectivity of a region has a direct impact upon the implementation and take-up of AL products and services. The UK Government aims to have the best superfast broadband network in Europe by 2015 by providing all homes and businesses in the UK with access to at least 2Mbit/s broadband and that superfast broadband should be available to 90 per cent of people in each local authority area. There will be a particular focus on making sure that people in remote, as well as urban areas, get good online access.

The most recent information on broadband in the UK has been compiled by Ofcom. The Digital Economy Act 2010 requires Ofcom to report on the state of the UK's communications infrastructure every three years. The Communications Infrastructure 2011 report [37] has been published and provides some useful regional information not only for local authorities developing broadband plans, but also for businesses wanting to develop and deliver services – see Figures 11, 12 and 13.

In addition to its first UK Communications Infrastructure Report, Ofcom has produced the UK's first interactive map showing accurate information on broadband take-up, speeds and availability, using data provided by communications providers.

Figure 11 shows the availability of broadband across Wales based on:

  • the percentage of homes with broadband currently not achieving 2Mbit/s speeds
  • the percentage of addresses which are within the coverage area of superfast (over 24Mbit/s) broadband networks
  • the number of existing broadband connections as a proportion of premises (including superfast broadband connections)
  • the percentage take-up of superfast broadband.

The chart shows that only 11 of the 22 areas have superfast broadband available. An average of 19.6% of homes are currently not achieving 2Mbit/s speeds.



wales-broadband takeup 2012
Figure 11 Broadband availability by Welsh Local Authority (Source Ofcom) 

Ofcom has also collected data on the average maximum speeds of existing broadband connections, although notes that speeds achieved in the home will be slower. Figure 12 shows the Average modem speed (Mbit/s) by Local Authority. 

wales-sync speed 2012Figure 12 Average modem speed (Mbit/s) by Local Authority (Source Ofcom)


Ofcom[38] has ranked each area on a scale of 1 to 5, with 1 the highest or fastest, and 5 the lowest or slowest on how they score on four broadband metrics:

• Average modem sync speed (Mbit/s): The average maximum speeds of existing broadband connections. Speeds achieved in the home will be slower.
• Percentage receiving less than 2Mbit/s: The percentage of homes with broadband currently not achieving 2Mbit/s speeds.
• Superfast availability: The percentage of addresses, which are within the coverage area of superfast (over 24Mbit/s) broadband networks.
• Average take-up:The number of existing broadband connections as a proportion of premises, excluding superfast broadband connections.

Figure 13 shows the ranking (1 = highest /fastest, 5 = lowest/slowest) within Wales by administrative authority.

wales-quality score 2012
Figure 13 Overall Broadband Performance by Welsh Administrative Authority (Source Ofcom)

       3.2.3 Digital Wales

Providing a first class digital infrastructure is a key feature of the Delivering a Digital Wales strategic framework. In December 2010, the Welsh Assembly Government published its strategy for making Wales a truly digital nation by 2020 - Delivering a Digital Wales (2010). The vision is that:

  •  ‘everyone is able to enjoy the benefits of digital technologies;
  • everyone is able to acquire the skills necessary to confidently and effectively use digital technologies;
  • we have a thriving economy driven by our technology research and development with a flourishing Welsh cultural creativity;
  • we have a more convenient and efficient public services with joined-up delivery of education, health and social care;
  • we have a first class digital infrastructure with an enhanced mobile phone and wireless coverage across Wales.’

The Welsh Government’s Digital Wales: Delivery Plan[39] describes how this vision will be achieved in the five key thematic areas of Digital Inclusion, eSkills, Competitiveness, Public Services Transformation and Digital Infrastructure.

Of particular relevance to AL services, is the goal to reduce levels of digital exclusion amongst people aged 50 and older, which will deliver the following anticipated benefits:

  • Reduced level of digital exclusion amongst adults in Wales.
  • Reduced level of digital exclusion amongst older people in Wales.
  • Increased number of organisations which can engage with and deliver digital inclusion programmes for older people.
  • Older people in Wales have the ability and understanding to make the most effective and appropriate use of ICT to enhance their quality of life.

Specifically, the Delivery Plan has a target to reduce digital exclusion amongst people aged 50 and older from 49% (515,000) in 2010 to 45% (473,000) by 2012 and to 40% (421,000) by 2015.

      3.2.4 Broadband Support Scheme

In 2010, the Welsh Government launched a £2mBroadband Support Scheme[40]which provides a grant of up to £1,000 to residents, businesses and third sector organisations in broadband ‘notspots’ to enable them to obtain a broadband connection using the most appropriate technology available. The project was due to end in March 2012, but was extended to 30 September 2o13 ensure the Welsh Government can respond to individuals with immediate broadband issues. To date, 2,038 applications have been approved, which includes funding for sixteen community schemes covering 918 homes, representing a financial commitment of £1,662,709 [41].

The Broadband Support Scheme will operate in parallel to the Next Generation Broadband for Wales (NGBW) project which will bring high speed broadband to homes and businesses that the market will not reach unaided.

      3.2.5 Next Generation Broadband for Wales

The Welsh Government is investing in Next Generation Broadband[42] infrastructure to ensure that Wales is at the forefront of the digital economy. The aim is for everyone in Wales to access next generation broadband (minimum 30Mbps) by 2015. All residential premises and all businesses in Wales will have access to Next Generation Broadband by 2015, with the intention that 50 per cent or more have access to 100Mbps. The NGBW project will begin in 2012, with the roll out of infrastructure, and end in 2015 [43].

      3.2.6 Mobile Coverage

The Welsh Government is working with the mobile industry, Ofcom and the UK Government to improve mobile coverage across Wales. A key focus of this work is to ensure that Wales benefits from the UK Government's Mobile Infrastructure Project, a £150 million investment, to address mobile notspots. The Welsh Government is working with the Mobile Operators following the 4G spectrum auction. The licence which was awarded to Téléfonica O2 carries a coverage obligation of at least 95% of the population in Wales by the end of 2017. The Welsh Government is also investigating options to improve mobile coverage across Wales, including mobile services across the rail network [44] .

      3.2.7 Energy

With smart meters being considered as a potential important opportunity for the delivery of AL, the roll-out of smart meters represents a significant milestone. As part of its 2011 National Infrastructure plan[45], the UK Government aims to make every home and every business an intelligent part of an electricity network, to help moderate demand at peak times and to preserve supply and demand balance despite increased amounts of intermittent, renewable electricity generation. The aim is also to ensure greater energy interconnection with continental Europe and Ireland.

Currently, there is no regional data available, but by 2019, the Government will ‘complete the rollout of smart meters, so that electricity customers can participate actively in helping reduce carbon intensity (by consuming less energy) and maintain security of supply (by smoothing their consumption over time). Development of the communications and data infrastructure required to support smart meters is expected to commence by 2014.’[46]

According to the Government’s National Infrastructure Plan‘widespread use of smart meters can be accommodated within the current digital communication network infrastructure, but potential future developments of smart energy grids might require further innovation and investment in communications infrastructure.’[47]

      3.2.8 Intellectual Capital

Intellectual capital is vital for attracting inward investment, stimulating innovation and allowing the UK and its regions to be competitive in the global knowledge economy. In its Infrastructure Plan 2010[48], the Government recognized the important role that Intellectual Capital plays in the UK’s economic infrastructure and is committed to providing funding to develop the UK’s Intellectual Capital, for example:

  • enabling investment in science, research and innovation through provision of research facilities and equipment in universities.
  • supporting (including by way of capital investment) the work of the Research Councils and investing in innovative technologies in and for infrastructure.
  • supporting the Technology Strategy Board to incentivise business led technology innovation;
  • establishing a network of Technology and Innovation Centres.

See Section 7 for information about regional Centres of Expertise and Innovation.

4 Health and Social Care


 This section aims to provide an overview of the health of over 65s in the region compared to the provision of services, in particular, the availability of NHS beds, beds in residential care homes, domiciliary care, and care provision by the Third Sector.

NHS Wales is the publically funded National Health Service of Wales providing healthcare to around 3 million people who live Wales [49]. The reorganisation of NHS Wales, which came into effect on October 1st 2009, created single local health organisations that are responsible for delivering all healthcare services within a geographical area, rather than the Trust and Local Health Board system that existed previously. The NHS now delivers services through seven Health Boards and three NHS Trusts in Wales.

Local Heath Boards
The seven Local Heath Boards (LHBs) [50] in Wales plan, secure and deliver healthcare services in their areas , replacing the 22 LHBs and the 7 NHS Trusts which together performed these functions in the past:

  • Aneurin Bevan Health Board;
  • Abertawe Bro Morgannwg University Health Board;
  • Cardiff & Vale University Health Board;
  • Hywel Dda Health Board;
  • Cwm Taf Health Board;
  • Betsi Cadwaladr University Health Board; and
  • Powys Teaching Health Board.

NHS Trusts
There are currently 3 NHS Trusts in Wales with an all - Wales focus. These are the Welsh Ambulance Services Trust for emergency services, Velindre NHS Trust offering specialist services in cancer care and a range of national support services and the new Public Health Wales.

  • Welsh Ambulance Services NHS Trust
  • Velindre NHS Trust

Public Health Wales is the unified Public Heath organisation in Wales.
The organisation became fully operational on 1 October 2009 and now exercises the functions of the National Public Health Service, Wales Centre for Health, Welsh Cancer Intelligence & Surveillance Unit, Congenital Anomaly Register & Information Service for Wales, and Screening Services Wales all with a nation wide remit.

A common pathway for an individual with an illness is to self refer themselves to a GP, for the GP to get them admitted to a hospital, for them to recover from their acute episode and be discharged to a community hospital to recover as much of their pre-event capacity as possible and then to return home where they may need social care. Social care (such as providing help with bathing and dressing) is provided by the local authorities. Private sector and third sector bodies (for example, charities and not-for-profit organisations) are available to provide social care should public sector provision not be available to the individual.

      4.1 Health in Wales – Long Term Conditions

Long Term Conditions (LTCs), are conditions such as diabetes, asthma and arthritis, that cannot currently be cured, but whose progress can be managed and influenced by medication and other therapies.

Information and statistical data about the number and type of LTCs and patients suffering from LTCs in Wales is not readily available, however, A Profile of Chronic and Long Term Conditions in Wales[52], produced in 2006 by the National Public Health Service for Wales and the National Assembly for Wales’s Statistical Directorate and Health Policy Divisionprovides the following summary of LTCs in Wales:

‘Currently there are a limited number of data sources that can provide information on chronic conditions in Wales or comparisons across Britain. Much of the information available comes from population surveys, which rely on self-reported data rather than clinical data. The following points provide a broad picture of chronic conditions (excluding mental health and cancer) in Wales:

  • One third of adults in Wales (an estimated 800 thousand adults) reported having at least one chronic condition.
  • Of people aged over 65 in Wales, two thirds reported having at least one chronic condition, and one third had multiple chronic conditions.
  • Over three-quarters of people aged over 85 in Wales reported having a limiting long-term illness.
  • For treated chronic conditions in Wales, the most commonly reported by adults is arthritis (14% of the population aged 16 and over) followed by respiratory conditions (13%) and chronic heart conditions (9%).
  • Of people aged over 65 in Wales, 34% reported being treated for arthritis, 21% for a respiratory illness and 30% for a heart condition.
  • 23% of people in Wales reported having a limiting long-term illness, compared with 18% in England and 20% in both Scotland and Northern Ireland.
  • The percentage of people in Wales who reported having a limiting long-term illness varies from 19% in Cardiff to 30% in Merthyr Tydfil.
  • Intensive users of inpatient services have on average three chronic problems, about 6% of adults reported having 3 or more chronic conditions.

The report also concludes that in future, demographic trends indicate that there will be an increasing burden on health and social care services with respect to the prevalence and impact of LTCs. The report estimates that by 2014, there will be a 12% increase in the number of adults with at least one chronic condition and a 20% increase in those aged 65 and over with a chronic condition.

Going forward, more information, both at a national and local level will become available as a result of the new General Medical Services contract’s Quality and Outcomes Framework (QOF), whereby information related to some conditions (including coronary heart disease, stroke, diabetes, chronic obstructive pulmonary disease and asthma) will be routinely and consistently recorded. 

 

5 Existing Care Provision


A variety of sources have been used to collect the data in this section, including the Wales.gov, Health in Wales, the Care and Social Services Inspectorate Wales (CSSIW) and Statistics for Wales.

Care provision in Wales is subject to the Care Standards Act, 2000[53]. The Care and Social Services Inspectorate Wales (CSSIW)www.cssiw.org.uk, is responsible for inspecting registered services against the regulations in the Care Standards Act and ensuring that providers comply with it’s requirements to meet legal standards.

The latest data for Wales from the CSSIW website shows the following care provision is available in Wales: 

 406 registered home care agencies

  • 285 registered care homes with nursing
  • 878 registered care homes without nursing
  • 23,191 beds in registered care homes for Older Adults (65yrs+)
  • 3,441 beds in registered care homes for Younger Adults (under 65yrs)

Each year, the CSSIW, reports on social care and social services in Wales. The 2010-2011 Annual report show that:

  • Delays in helping people leave hospitals have steadily reduced over the past few years.
  • The rate of delays for social care reasons has reduced from 9.49 per 1,000 population aged 75 and over in 2006-7 to 5.76 in 2010-11
  • Progress has been evident in the timeliness of reviews of care plans - 76% of people had a review within the year in 2010-11
  • Over the past three years, the rate of older people supported in care homes relative to the population of older people has remained at the same level in Wales while the rate of older people being supported in the community has declined
  • The number of people receiving direct payments in Wales amounts to 4.17% of all adults who use services - a relatively low figure for an option that is well regarded by those who receive it.

Figure 14 provides an overview of the care provision in England and Wales (NHS and independent hospitals, care homes and domiciliary care agencies) compared to the population of older people. Please note that in Figure 16, the population figures are indicative only for the purposes of providing a comparison with care provision. To obtain actual population figures, multiply the figures shown in the table by a thousand.

In general, social care provision echoes the size of the elderly population within a region. NHS hospitals and Independent hospitals and clinics also follow this general trend, although it must be noted that NHS and Independent hospitals also serve the wider population, so a direct comparison can not be made.

Figure 14 shows that Wales has the smallest population of older people (male 65 years and female 60 years) (504,700) served by care provision comprising 125 NHS hospitals and clinics, 36 Independent hospitals/clinics, 285 care homes with nursing, 878 care homes without nursing and 408 domiciliary care agencies. The South East has the largest population of older people (male 65 years and female 60 years) and greatest number of domiciliary care agencies and care homes both with and without nursing. The North East has the second smallest population of older people and the fewest domiciliary care agencies and care homes without nursing.

All regions apart from Wales, the North East and the South West have at least twice the number of Independent hospitals and clinics as NHS hospitals.



Figure 14 Care Provision across English Regions and Wales (Source: CQC[54]& CSSIW[55]Health in Wales[56]2011) 

      5.1 Adult social care provision in Wales

The Welsh Government is responsible for funding, policy making, reviewing and inspecting and regulating social services. In Wales, social services are delivered by the 22 local authorities, and private and independent organisations. Around 150,000 people receive support from Social Services[57].

Care services can be provided in a variety of ways:

Care homes, including residential homes and nursing homes
Care in own home, usually referred to as domiciliary care or home care
Community venues, such as day care centres and drop-in centres.

There are also different types of social care available: 

  • Personal care, such as help with washing, toileting, dressing, and eating, etc
  • Practical help, such as help with shopping, cleaning, etc
  • Nursing care, which is any service provided by a registered nurse in any setting

The different types of care are not necessarily dependent on the care setting; for example, domiciliary care can include both practical help and personal care.

      5.1.1 Access to social care

If people living in Wales are finding it difficult to cope with daily living without assistance, they can self-refer by contacting their local authority’s social services department and ask for an assessment. People can also be referred by a hospital, primary health service or relative of friend.

      5.1.2 Eligibility criteria

In Wales, for people to receive non-residential social services (such as home care or day care) they must first be assessed by their local council. If their care needs meet the council’s local eligibility criteria, services can then be provided by the council or arranged by the council through an independent provider of services.

The document ‘Health and Social Care for Adults: Crating a Unified and Fair System for Assessing and Managing Care’[58]provides eligibility criteria guidance for local authorities and health services in Wales. Specifically, the guidance provides local authorities with a framework for determining their eligibility criteria. The intention of the framework is that local criteria should be developed in conjunction with statutory health bodies, and will ultimately lead to the development of unified eligibility criteria. The framework provides the following bands of need:

Critical 

  • Life is, or could be, threatened; and/or
  • Major physical or mental health problems have developed or are likely to develop; and/or
  • There is, or could be, an extensive loss of choice and control over vital aspects of the immediate environment; and/or
  • Abuse or neglect (self or other) have occurred or are likely to occur; and/or
  • There is, or could be, an inability (physical or mental) to carry out vital personal care, domestic or other routines; and/or
  • Vital involvement in work, education or learning is, or could be, at great risk of not being sustained; and/or
  • Vital social support systems and relationships cannot or will not be sustained; and/or
  • Vital family and social roles and responsibilities cannot or will not be undertaken.

Substantial

  • Significant physical or mental health problems have developed or are likely to develop; and/or
  • There is, or could be, some significant loss of choice and control over the immediate environment; and/or
  • There is, or could be, an inability (physical or mental) to carry out the majority of personal care, domestic or other routines; and/or
  • Involvement in many aspects of work, education or learning is, or could be, at risk of not being sustained; and/or
  • The majority of social support systems and relationships are, or could be, at risk; and/or
  • Individuals cannot undertake, or will be unlikely to be able to undertake, some significant family and social roles and responsibilities that are important to them and others.

Moderate

  • There is, or could be, some inability (physical or mental) to carry outseveral domestic or other routines; and/or
  • Several aspects of work, education or learning are, or could be, at risk of not being sustained; and/or
  • Several social support systems and relationships are, or could be, at risk; and/or
  • Individuals cannot undertake, or will be unlikely to be able to undertake, several family and social roles and responsibilities.

Low

  • There is, or could be, some inability (physical or mental) to carry out oneor two domestic or other routines; and/or
  • Involvement in one or two aspects of work, education or learning cannot or will not be sustained and/or
  • One or two social support systems and relationships are, or could be, at risk of not being sustained; and/or
  • Individuals cannot undertake, or will be unlikely to be able to undertake, one or two family and social roles and responsibilities.

      5.1.3 Paying for Care

New legislation (the Social Care Charges (Wales) Measure 2010, effective from 11 April 2011) gives local councils a discretionary power to charge for services.

If a person has been assessed as eligible to receive social care services, they may be required to pay for or make a financial contribution towards the cost of these services. In Wales, people are eligible for financial assistance if they have capital below of £22,500; over this, they fund the cost of their care up to a maximum of £50 per week, irrespective of income.

Councils can set charges at what they see as reasonable levels. To introduce consistency in the way councils use this discretion, and to provide financial safeguards for those on low incomes, the Welsh Government have made regulations part of the measure. Where councils decide to charge adults for their non-residential social services, the following regulations apply[59]:

  • councils cannot set charges that are more than £50 per week for all of the services a service user receives (except where they charge a flat rate for a service such as meals);
  • councils must issue an invitation for a means assessment (a financial assessment) to those receiving services for the first time where it plans to make a charge. They must also issue an invitation to existing service users where it plans to alter a charge as a result of a change in the service they receive or in their finances;
  • councils must undertake this assessment where service users request one and provide the information needed to do this;
  • councils cannot charge for particular services, including transport to attend a day service where attendance at and transport to are included in the agreed services to be provided;
  • councils also cannot charge for providing information about their services or the charges they set for these. In addition, they cannot charge for undertaking assessments of care needs or means assessments;
  • in setting charges councils must allow service users to keep at least the amount of their Income Support, Employment and Support Allowance or Pension Credit Guarantee Credit plus 35% of that amount. They must also allow service users to keep a further 10% as a contribution towards their daily living costs which may be higher as a result of a disability or medical condition;
  • councils must not take into account any money earned by a service user;
  • councils must operate a scheme where service users can ask for charges set to be reviewed.

       5.2 Domiciliary Care (Home Care)

Domiciliary care is care delivered in a person’s own home and can be either personal care, such as help with washing, toileting, dressing, and eating, etc, or practical help, such as help with shopping, washing and ironing, cleaning, etc or a combination of both. Domiciliary care services can be provided by either the local authority or an independent care agency.

According to the CSSIW website there were 406 home care agencies providing services to adults in Wales in December 2011. The South East has the highest number, with 1079 agencies, followed by the North West and London with 795 and 745 agencies respectively. The North East has the lowest number of domiciliary agencies, with 263. Agencies vary in size and the number of people they serve. A single agency will usually be registered to provide care for more than one type of person.

During a sample week in September 2011 (the last full week in September) 17,205 people aged 65 and over were receiving home care services in Wales. Clients aged 65 yrs and over receive an average of 8 hours home care per week[60].

      5.3 Residential Care

Care homes fall into two categories, those that provide nursing care and those that do not. Some care homes may be registered as both ‘with nursing’ and ‘without nursing’. When collecting data about care homes, it is not always possible to distinguish between the different types, so numbers are not mutually exclusive. Care homes are usually registered to care for more than one type of person.

In July 2011 in Wales, there were 285 registered care homes with nursing and 878 registered care homes without nursing. Figure 16 shows the regional variations in the number of care homes with nursing, care homes without nursing, and domiciliary care agencies. The estimated population of older people (M65+/F60+) in Wales in 2010 was 505,000. In July 2011, in Wales, there were 32,450 beds in care homes without nursing and 18,042 beds in nursing homes with nursing.

Figure 15 shows the percentage of older people aged 65 yrs and over in receipt of various social care services in Wales compared to the total population of people aged over 65 yrs in Wales.




Figure 15 Older people receiving social care services in Wales as a percentage of the population aged 65 years and over(Source: Welsh Government[61])

      5.4 NHS and Independent Hospital Care

In Wales in 2011, there are 125 NHS hospitals and clinics across the region, and 36 Independent hospitals and clinics.

The latest statistics report on NHS beds in Wales was released in October 2011[62]. The report shows that in 2010-11 there were 12,149beds (average daily available) in NHS hospitals in Wales, of which 12% were for geriatric medicine, 66% for acute, 16% for mental illness, 4% for maternity, and 1% for learning disabilities.

Between 2009-10 and 2010-11 the average number of available beds fell by 719 (6%), with all specialty groups showing a decrease. The largest decrease, in terms of numbers, was in acute and geriatric, down by 584 (6%). This compares to 2008-09 and 2009-10 where the average number of available beds fell by 248 (2%). Most specialty groups showed a decrease, but there was a large increase 16% for geriatric medicine (218 beds).In 2010, the average length of stay in a geriatric bed was 23.1 days, compared to the average length of stay for all specialties of 7.5 days.

      5.5 Local Authority Expenditure on AL in Health and Social Care

Over the past few years, interest in telecare has been growing, as has investment in these areas, both by solutions providers and care commissioners. Telecare is defined as 'the delivery of social care services to an individual using a combination of information and communication technologies and sensor technologies'.

Local authorities are beginning to recognize the role telecare can play in easing the demands on a health and social care system that is suffering from budget restrictions and increasing demographic challenges.

In 2006 a capital grant of £8.92 million was announced by the Minister of Health and Social Services for Wales, with a target of equipping 10,000 homes in Wales with telecare sensors and equipment. The grant has achieved its target and as a result of this investment nearly 20,000 people in Wales are living more independently. Table 3 shows the allocation of the capital grant across the Unitary Authorities in Wales. The SSIA website contains links to Local Authority Telecare Strategies [63] and evaluations [64] of those strategies.

In addition, a Revenue Grant of £880,000 was made available to enable Local Authorities and Local Health Boards support the delivery of telecare services through use of funds made available through the Telecare Capital Grant[65] .

 Table 3 Distribution of the Telecare Capital Grant 2008[66]


Unitary Authority

£ Allocation (2008)

Swansea

733,653

Blaenau Gwent

232,956

Vale of Glamorgan

326,841

Cardiff

776,308

Caerphilly

481,197

Newport

388,480

Neath Port Talbot

469,172

Conwy

431,969

Gwynedd

383,064

Merthyr Tydfil

171,943

Bridgend

376,090

Powys

411,532

Rhondda Cynon Taff

711,122

Pembrokeshire

362,433

Ceredigion

228,223

Denbighshire

344,048

Monmouthshire

244,960

Carmarthenshire

603,216

Flintshire

377,181

Isle of Anglesey

218,856

Torfaen

272,567

Wrexham

374,189

Wales

8,920,000

The Welsh Government has a programme for renewal of social services in Wales, set out in its recent Paper Sustainable Social Services for Wales: A Framework for Action[67]. This Paper quotes the findings of a review in November 2010, by The Independent Commission on Social Services, on the opportunities technology in delivering social services:

“Social services and social care services in Wales need to place themselves firmly in the digital age. New technology can assist in the design and delivery of services and can improve the engagement of service users and workers. It opens up the possibilities of high quality, innovative services that are also resource efficient.”[68]

In the Paper, the Government sets out two priorities:

‘First, to support the development of new service models. Communication opportunities allow service users to share experiences and provide mutual support. Telecare is one such service model and plays an important role in providing support to people at risk of losing independence. It is a service which enables people to remain in their own homes. As at 31 December 2009, telecare services had been delivered to 19,699 people in Wales. We will expect those responsible for regional commissioning and delivery of telecare to resolve issues such as costs to the service user, and integration with community equipment services and telehealth services.

  • Secondly, technology allows the more efficient use of resources and in particular of information systems that support professional and management practice. We will expect to see technology at the heart of our drive for better efficiency and professional practice.'

       5.6 Third Sector Provision for the Elderly

Third Sector Organisations (TSOs) include small local community and voluntary groups, large and small registered charities, foundations, trusts, social enterprises and co-operatives. They are also referred to as Voluntary, Community and Social Enterprise (VCSE) sector organisations.

The Welsh Assembly Government recognises the roles that these organisations play in the prevention of ill health, the provision of health, social care & well being services and support for carers and local communities across Wales. They provide services such as advocacy, volunteering, information and advice provision, needs identification and fundraising, and as such they are a key partner in the delivery of health and social care services across Wales.

Designed to Add Value - a third dimension[69] has been produced by the Welsh Assembly Government in recognition of the third sector’s important contribution to health and social care. This guidance document is intended to guide planners and providers of health and social care services across Wales and build upon key themes identified in the Welsh Assembly Government’s ‘The third dimension’ A Strategic Action Plan for the Voluntary Sector Scheme.

Designed to Add Value identifies the strategic direction for the third sector in supporting health & social care in the future in Wales through the following themes: 

  • Stronger partnership working within the third sector and between the sectors
  • Improved service planning, delivery and resourcing
  • Supporting self care and independence
  • Improving access to services for specific communities
  • Promoting and improving health & well being
  • Volunteering for health & social care
  • Developing social enterprises in health & social care
  • Integrated services and workforce planning
  • Reducing hospital admissions and improved discharge
  • Research & development

Wales has 75 third sector organisations involved in providing services for the elderly, with the largest number of these in Bridgend (8), Cardiff (9), and Newport (10). From the data available, the following counties did not appear to have any TSOs operating in the county:

  • Carmathenshire
  • Isle of Anglesey
  • Monmouthshire
  • Powys

Table 4 shows the number of TSOs operating in each region, their income and expenditure. Please note that the table only contains those TSOs (63) where financial data was available. Those counties not included in Table 4 including the number of TSOs operating in that county are:

  • Blaenau Gwent (1)
  • Caerphilly (1)
  • Ceredigion (1)
  • Conwy (1)
  • Denbighshire (2)
  • Neath Port Talbot (2)
  • Rhondda, Cynon, Taff (2)
  • Vale of Glamorgan (2)


The total income of the top 3 organisations operating in Wales is £23,057,132with total expenditure of the top 3 of£20,471,993.

Table 4 Distribution of Third Sector provision for the elderly across Wales(Source: Guidestar)



Bridgend

Cardiff

Flintshire

Gwynedd

Merthyr Tydfil

Newport

Pembrokeshire

Swansea

Torfaen

Wrexham

Total/average

Total number of TSOs

8

9

3

6

3

10

5

7

4

8

63

% of total TSOs

12.7

14.3

4.8

9.5

4.8

15.9

7.9

11.1

6.3

12.7

100.0

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Total Income (£) of top 3 TSOs

1910197

4795183

205147

785657

77753

1715430

375143

12659297

513231

20094

23057132

% of total income TSOs

8.3

20.8

0.9

3.4

0.3

7.4

1.6

54.9

2.2

0.1

100.0

Average Income (£) of top 3 TSOs

636732

1598394

102574

261886

38877

571810

125048

4219766

171077

6698

7,732,862

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Total Expenditure (£) of top 3 TSOs

1,820,604

2,499,571

212,483

794,200

63,970

1,669,913

389,741

12,528,252

481,104

12,155

20,471,993

% of total expenditure TSOs

8.9

12.2

1.0

3.9

0.3

8.2

1.9

61.2

2.4

0.1

100.0

Average Expenditure (£) of top 3 TSOs

606868

833190

106242

264733

31985

556638

129914

4176084

160368

4052

6870074

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 



The largest TSOs (in terms of income) providing services to the elderly across all regions in Wales are shown in Table 5.

Table 5 Largest Third Sector Organisations (by income) in Wales (Source: Guidestar)


Third Sector Care Organization

£ Income (all counties)

Perthyn

11,043,310

Age UK

5,615,589

Cartref Limited

4,421,636

West Wales Federation of Free Church Women's Councils (Incorporated)

729,189

Voluntary Emergency Transport Service (VEST)

342,472

 

 

6 Current Assisted Living Activity

      6.1 Suppliers of Products and Services

Figure 16 below illustrates private companies selling products and services into the Assisted Living market. The chart includes companies whose primary area of business is manufacturing and / or selling the following products and services:

1. Telecare: Telecare products and services only, includes devices and managed services
2. Telehealth: Telehealth products and services only, includes devices and managed services
3. Telecare & Telehealth: Combined Telecare & Telehealth products and services, includes devices and managed services
4. Environmental Control: Home automation and Environmental Control solutions
5. Communication aids: Including Video Conferencing solutions and products and services for people with Dementia, Learning Disabilities and Sensory loss.
6. Care Technology: Devices and services to support care workers delivering assisted living services in the community

Statutory Telecare and Telehealth providers are excluded from these figures unless they provide a privately managed service option.



Figure 16 Type and number of companies by region (Source: Medilink UK)


There is little data available for companies operating solely in the Assisted Living sector in Wales, with evidence of 1 company involved in AL solutions.

The Technology Strategy Board’s Assisted Living Innovation Platform (ALIP) has a directory [70] of technology suppliers ranging from traditional Telecare and Telemedicine through to Environmental control and Memory support and Prompting devices, that can be searched on by region.

      6.2 UK AL Projects and Initiatives

At the time of writing 2 major initiatives are looking to support and underpin the mainstreaming of Telecare and Telehealth.

      6.2.1 Delivery Assisted Living Lifestyles at Scale (dallas)

dallas is an initiative backed by the Technology Strategy Board, The UK’s innovation agency; it kicked off in 2012 and currently is supporting four delivery partner organisations around the UK.

living it up logo

Living it Up (LiU), a digitally-enabled community that supports better health, wellbeing and active lifestyles in Scotland. LiU provides personalised experiences to keep people connected with one another and with their health and wellbeing.

ifocus logo

i-focus collaborates with health organisations on interoperability and best practice to transform health and care by providing better service delivery through digital comms and technology. Part of i-focus, Warm Neighbourhoods helps families stay connected by using simple sensor technology. It provides support and reassurance for families with vulnerable members who live alone.

mi logo

Mi (More Independent), a Liverpool-based scheme designed to enable people to take charge of their health, wellbeing and lifestyle through technology. Mi allows people to live more independently in their own homes, offering peace of mind both to them and their family, whilst reducing the amount of time spent on appointments by supporting people to manage better at home.

image007

Year Zero is creating a suite of innovative digital products based on personal health records (PHRs) to allow people to take greater control of their own health and wellbeing, while transforming the relationship between patients and health care professionals. Products developed to date include the online personal care planning tool A Better Plan, digital care and support network Good Neighbours, a diabetes goal-tracking app uMotifand a digital version of the Personal Child Health Record (also known as the Redbook) eRedbook.

With an investment of £37.3million dallas aims is to improve health, wellness and quality of life through innovation, technology and digital services.

For more information see: http://connect.innovateuk.org/web/dallas

      6.2.2 TECS Technology Enabled Care Services (3 Million Lives)

NHS England Integrated Care for 3millionlives :
(Delivering Improved Heath and Wellbeing through Technology Enabled Care Services (TECS))

Launched in December 2011 3millionlives is underpinned by the idea of service integration to improve patient care and outcomes. When different services and sectors work together, towards shared goals, patients get far more flexible, better, and more appropriate care. To achieve true service integration, NHS England recognise that 3millionlives needs to be delivered through a genuine partnership across NHS England facilitating collaboration between clinicians, and empowering patients to better self manage their conditions, with the use of technology. They also recognise this cannot be achieved through technology alone the key will be to deliver service transformation through realising the potential of that technology to support clinicians, patients and carers.

It is known that there is a growing elderly population, a growing number of people with Long Term Conditions (LTCs), and growing numbers of people with multiple LTCs. This is putting an increasing strain on already stretched NHS resources. One in three people are living with at least one chronic condition, such as asthma, heart and lung disease, arthritis, hypertension and diabetes and half of people over the age of 60 have one. One in three of the population in England amounts to just over 15 million people with an LTC and its estimated that by 2025 this will rise to 18 million. People with LTCs are the biggest users of the NHS, accounting for around 50 per cent of GP appointments, 64 per cent of inpatient appointments and 70 per cent of inpatient hospital beds meaning 30 per cent of the population accounts for 70 per cent of the spend. If care is continue to be managed in the same way as it is now then NHS can expect to see an estimated of additional cost in five years. In the new NHS and social care landscape, we need to find new approaches and service delivery models that will deliver more efficient and effective care. There is a need for better health outcomes and innovations that support people to live more independently, and the NHS know that technology enabled care services can transform peoples lives. The challenge now faced is integrating these technologies into the NHS and wider health and social care services, so they become a mainstream service, not a side-line proposition. And this is where the 3millionlives programme, delivered in the right way, can really make a significant difference

NHS England took action on implementing the delivery programme from April 1st 2013, a rapid review of 3millionlives implementation to date was conducted, as there was a significant risk the programme as previously delivered would not hit the interim ambition of 100,000 new users in 2013. The review resulted in a need for a significant shift in strategic direction for the 3millionlives programme, including a redefined vision, mission and objectives for delivery, and bringing on board strong clinical and technological advocacy and a reframed partnership with Industry.

An early outcome from the review was an agreed change in governance arrangements, so that 3millionlives will be delivered going forward through a matrix approach of clinical advocacy, service improvement and technology strategy making it a true partnership and synergy within NHS England.

There is now tri-partite accountability for the successful delivery of the programme at Director level, with co-ordination for delivery and implementation of the programme residing with the Collaboration for Excellence Team.

Under a redefined vision for the programme, the Collaboration for Excellence Team intend to engage with, work with, and enable the 3millionlives brand to be associated with a much broader range of technology solutions and organisations. Its therefore essential to ensure that industry is working with NHS England as a true strategic partner in the delivery of 3millionlives. NHS England has now convened a much wider 'Integrated Care for 3millionlives Stakeholder Forum', bringing together Industry including all of the original members of the Industry Group commissioners, providers, colleagues from Social Care, the Third sector, and Local Government and housing, to form a collaborative group to collectively debate and resolve key system-wide issues around the delivery and implementation of the programme.

Now all of the different stakeholder groups with an interest in delivery of 3millionlives have been brought together to look at issues collaboratively and The Forum met for the first time in October 2013. The programme will also now look much more widely across the system, to harness where the energy lies locally for delivery of 3millionlives.

The programme is closely aligned with both the integrated care and technology strategy agendas, and has been repositioned as Integrated Care for 3millionlives It will be delivered as a unique collaboration between the NHS, Social Care and Industry to support integrated care, management of Long Term Conditions, and the enablement of 7 day services.

The team established four rapid Task and Finish Groups, one to progress each priority area and the findings and recommendations of these Task and Finish Groups informed the publication of a 3millionlives NHS England Delivery Plan for 2014-17.

http://www.england.nhs.uk/wp-content/uploads/2014/04/ppf-1415-1617-wa.pdf

      6.3 Regional AL Projects in Health and Social Care

As part of the Rural Health Plan, in January 2011 the Rural Health Implementation Group (RHIG) developed a map of telemedicine activity in Wales with the aim of sharing this knowledge with healthcare practitioners across Wales.

There are currently 17 Telecare initiatives [73] across Wales.

The SSIA website contains links to Local Authority Telecare Strategies [74] and evaluations [75] of projects carried out as part of these strategies.

In 2006 a capital grant of £8.92 million was announced by the Minister of Health and Social Services for Wales, with a target of equipping 10,000 homes in Wales with telecare sensors and equipment. The grant has achieved its target and as a result of this investment nearly 20,000 people in Wales are living more independently. The SSIA website contains links to Local Authority Telecare Strategies [76] and evaluations [77] of those strategies.

 

7 Centres of Excellence


      7.1 National

      7.1.1 The Telecare Learning and Improvement Network

The Telecare Learning and Improvement Network (LIN) is the national network supporting local service redesign through the application of telecare and telehealth to aid the delivery of housing, health, social care and support services for older and vulnerable people. For more information see the Telecare LIN website: http://www.telecarelin.org.uk/

       7.1.2 The Kings Fund

The King’s Fund is a charity that aims to understand how the health care system in England can be improved with the intention of helping to shape policy, transform services and bring about behavioural change. Telecare and Telehealth is one of the topic areas that the Fund covers in detail. In particular, the Telehealth Evidence Database is a free resource for anyone looking for information on telecare, telehealth and the management of long-term conditions. The database is updated weekly and holds 1,000 records of publications, journal articles and web resources. For more information see the King’s Fund website: http://www.kingsfund.org.uk/topics/technology_and_telecare/index.html

      7.2 Regional

      7.2.1 The Welsh Institute for Health and Social Care

The Welsh Institute for Health and Social care (WIHSC) is an academic department in the University of Glamorgan’s Faculty of Health, Sport and Science. Its role is to connect the worlds of research, policy and practice, to mutual benefit. This involves primary and secondary research, in consultancy, and in working in partnership with others to find answers together. http://wihsc.glam.ac.uk/

       7.2.2 Community Lives Consortium

Community Lives Consortium (known as The Consortium) provides support for people who want to live successful lives in the Community. The Consortium provides services under contract with the City and County of Swansea or Neath Port Talbot County Borough Council. Community Solutions is a service set up by Community Lives Consortium in response to interest shown in the service development work that the Consortium has been involved in. Community Solutions is committed to supporting agencies, families or individuals to find creative solutions that help vulnerable adults to get the most out of their lives and lead the lives they may not think possible. http://www.communitylives.co.uk/

       7.2.3 Institute of Rural Health

The Institute of Rural Health was established in 1997, to lead the way in informing, developing and promoting the health and wellbeing of rural people and their communities. Much of its work refers to Wales. As part of the Rural Health Plan, in January 2011 the Rural Health Implementation Group (RHIG) developed a map of telemedicine activity in Wales with the aim of sharing this knowledge with healthcare practitioners across Wales.
http://www.rural-health.ac.uk/

       7.2.4 The National Leadership and Innovation Agency for Healthcare

The National Leadership and Innovation Agency for Healthcare is part of NHS Wales. Its role is to share expertise, knowledge and resources to support NHS Wales staff in improving patient care. http://www.wales.nhs.uk/sitesplus/829/home

       7.2.5 Science Parks and Business Incubators

A Science Park is a business support and technology transfer initiative. It provides a links between the knowledge base and businesses to facilitate the exchange of expertise and ideas and collaborations. Innovation, science and technology are critical to East of England’s prosperity. Underpinning this success is the region’s network of science parks and incubation centres, providing the environment to support the growth of innovative and enterprising individuals and companies.There are 14 science parks are in the region. For more information see the UK Science Park Association: http://www.ukspa.org.uk/

       7.2.6 Business Incubators

Business incubators provide start-up businesses with low-cost facilities and support during the critical early stages of their growth. Incubators enable businesses to take advantage of a range of support and facilities, and access to advice expertise.Incubators can be public of private organizations. They are sometimes based within or near to a region’s universities. See the UK Business Incubation (UKBI) website for business incubators in the region: http://www.ukbi.co.uk

 

8 Research and Education


 Figure 17 shows the expenditure on research and development (R&D) in Wales for 2008 and 2009 as reported by the ONS (8 June 2011).
Note: The figures for government include estimates of NHS and local authorities' research and development and estimates for those areas in central government not available from the Government Survey and local authorities. Due to the unavailability of regional data, the total for all R&D sectors does not include expenditure on the private non-profit (PNP) sector.

In 2008, Wales had the third lowest (£595m) total expenditure on R&D in the UK after the North East of England (£553m) and Northern Ireland (£337m). This position remained the same in 2009, with Wales’ expenditure increasing slightly to (£607m), the North East of England (£556m) and Northern Ireland (£478m)

In 2008, the East of England had the highest R&D expenditure in the UK (£5162m) slightly ahead of the South East (£5083).In 2009 these positions were reversed, with the East of England spending (£4896m) on R&D behind the South East, which had the highest R&D expenditure (£5,323m). 




Figure 17 Expenditure on Research and Development in Wales 2008-2009 (Source: ONS 2011[79]

       8.1 Universities and Higher Education Institutions

The region is home to 17 universities and HEIs in Wales, including the Universities of Cardiff, Swansea, Aberystwyth, Bangor and Swansea.

The number of projects focused on Assisted Living involving Universities in Wales in the period 2006 to 2010 is 8 with a value of just over £ 8.2million. The universities receiving funding for AL associated projects are Cardiff (just over £4.7m), Swansea(just under £.3m), Bangor (£1.9m), Aberystwyth (just over £.4m) and University of Wales (just over £.7m).

There is little, if any, university-based training provision specific to AL, but all the universities in the region have courses or modules in clinical or technical subject areas with potential relevance for AL. Specific AL training is fragmented, varies in its subject coverage and content, and is generally offered by individual service providers or local adult social care departments.

 

9 Regional Opportunities for Assisted Living


The population of Wales is increasing more slowly than the rest of the UK. More importantly a decline in the number of over 35’s and an increase in the number of over 65’s is predicted over the next few years. Large parts of Wales are rural with low population densities though there are conurbations in the South. These conurbations house large numbers of elderly people as well. The Welsh Assembly Government (WAG) has recently published a number of policy documents addressing these issues. It is committed to creating “Digital Wales” and to the development and implementation of AL services to improve access and efficiency.

It can be assumed that in the Wales the markets for AL products and services delivered by the statutory sector (prescribed) and for AL products and services marketed directly to the individuals (elective) are both going to grow. The market for prescribed services will grow because the statutory services will increasingly come to depend on such services, either provided by themselves or by Any Qualified Provider

(AQP), to meet the predicted growth in demand. The market for elective services will grow because it addresses the preventative and self-care agenda that have long-term benefits for the individual and the statutory sector alike. The development of the elective market might be slower in Wales because the average household income is lower.

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