Results

Patients aged 50 and over registered with GPs in the NWL area between 2015 and 2022 were analysed, including 480 663 patients in 2015 and 701 858 by 2022 (890 335 patients contributing overall). Over the study period, 409 672 patients entered (225 603 turning 50 and the remainder due to registrations at GP practices), 67 107 died (7.54%) and 147 728 (16.59%) de-registered. Tables 1 and 2 describe the number of patient-years with contact with mental health, community health or publicly funded social care services and the average use within a year for people in the 16 age/frailty categories. There were 121 334 patient-years with at least one contact with mental health services, with the average number of contacts in a year varying between 7.0 (Severe, 85+) and 12.9 (Fit, 50–64). For community health, there were 663 969 patient-years with contacts, with the average number of contacts varying between 5.2 (Fit, 50–64) and 25 (Severe, 85+). For social care, there were 68 677 patient-years, with the average number of contacts varying between 4.5 (Fit, 50–64) and 5.6 (Severe, 65–74).

 | Frailty severity (eFI category)
 | Fit | Mild | Moderate | Severe | Overall
Person-years | N = 3 080 383 | N = 1 058 114 | N = 383 984 | N = 183 572 | 4 706 503
Age group |  |  |  |  | 
Community health services | 
50–64 years | 114 894, 5.1%a | 80 371, 18.1% | 28 524, 36.0% | 9086, 57.5% | 232 875, 8.4%
65–74 years | 42 511, 6.9% | 64 467, 19.0% | 41 324, 36.8% | 22 200, 59.5% | 170 502, 15.4%
75–84 years | 18 865, 9.8% | 51 660, 23.3% | 56 026, 41.4% | 48 161, 63.3% | 174 712, 27.9%
85+ years | 4811, 14.7% | 16 851, 31.2% | 27 861, 49.0% | 36 357, 66.9% | 85 880, 43.4%
Overall | 181 081, 5.9% | 213 349, 20.2% | 153 735, 40.0% | 115 804, 63.1% | 663 969, 14.1%
 | 
Mental health services | 
50–64 years | 27 058, 1.2% | 19 200, 4.3% | 7163, 9.0% | 2293, 14.5% | 55 714, 1.2%
65–74 years | 5739, 0.9% | 8614, 2.5% | 6079, 5.4% | 3821, 10.2% | 24 253, 0.5%
75–84 years | 3394, 1.8% | 8062, 3.6% | 8879, 6.6% | 8342, 11.0% | 28 677, 0.6%
85+ years | 879, 2.7% | 2366, 6.6% | 4048, 7.1% | 5397, 9.9% | 12 690, 0.3%
Overall | 37 070, 1.2% | 38 242, 3.6% | 26 169, 6.8% | 19 853, 10.8% | 121 334, 2.6%
 |  |  |  |  | 
Social care services | 
50–64 years | 3990, 0.18% | 5063, 1.1% | 3237, 4.1% | 1598, 10.1% | 13 888, 0.5%
65–74 years | 2055, 0.33% | 4149, 1.2% | 4476, 4.0% | 3999, 10.7% | 14 679, 1.3%
75–84 years | 1796, 0.93% | 4907, 2.2% | 7396, 5.5% | 9649, 12.7% | 23 748, 3.8%
85+ years | 802, 2.5% | 2273, 4.2% | 4766, 8.4% | 8521, 15.7% | 16 362, 8.3%
Overall | 8643, 0.28% | 16 392, 1.5% | 19 875, 5.2% | 23 767, 12.9% | 68 677, 1.5%

 | Frailty severity (eFI category)
Age group | Fit | Mild | Moderate | Severe
 | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD)
Community health services
50–64 years | 5.1a (11.8) | 7.5 (20.8) | 12.7 (37.7) | 22.4 (59.3)
65–74 years | 6.6 (17.7) | 8.5 (22.7) | 13.8 (39.7) | 23.4 (56.5)
75–84 years | 10.1 (30.2) | 11 (29.3) | 14.9 (38.5) | 24.5 (57.8)
85+ years | 13.4 (32) | 13.2 (30.6) | 17.3 (38.7) | 25 (52.8)

Mental health services
50–64 years | 12.9 (16.9) | 12.4 (16.4) | 12.6 (18.1) | 11.5 (16.2)
65–74 years | 11.7 (15.6) | 10.7 (14) | 10.1 (13.4) | 9.9 (13
75–84 years | 9.5 (11.2) | 9.0 (11.1) | 8.6 (10.4) | 8.6 (11.05)
85+ years | 8.1 (9.89) | 7.3 (8.85) | 7.1 (8.96) | 7.0 (8.84)
 |  |  |  | 
Social care services
50–64 years | 4.5 (5.61) | 5.1 (6.08) | 4.99 (5.61) | 5.5 (6.96)
65–74 years | 4.8 (5.95) | 4.95 (6.15) | 5.2 (6.29) | 5.6 (6.99)
75–84 years | 4.8 (5.79) | 5.1 (6.5) | 5.1 (6.15) | 5.3 (6.6)
85+ years | 5.1 (6.13) | 5.0 (6.15) | 4.9 (5.93) | 4.9 (5.9)

Service use projections for England

Average service use rates for each age and frailty group were applied to national population projections for England, to derive annual service use projections for mental and community healthcare and social care in England for 2025–40 (Table 3). Estimates for the number of mental health contacts for those aged 50 and over increase from 10 475 794 to 12 162 939 (16.1%) across the observed period. The estimated number of community health contacts increases from 83 061 668 in 2025 to 108 139 309 (30%) in 2040. The estimated number of contacts with publicly funded social care increases from 3 637 987 in 2025 to 4 741 892 (30%) in 2040. In each of the services, the demand from fit and mildly frail patients decreases over time whilst the demand from those patients with moderate and severe frailty increases as more of the population become frail.

Year | Mental health services | Community health services | Social care services (local authority)
Frailty status | Fit | Mild | Moderate | Severe | Fit | Mild | Moderate | Severe | Fit | Mild | Moderate | Severe
2025 | 1 012 097 | 3 761 942 | 3 334 964 | 2 366 790 | 2 706 212 | 16 298 992 | 27 611 575 | 36 444 890 | 103 572 | 686 908 | 1 239 912 | 1 607 595
2026 | 990 505 | 3 771 765 | 3 417 182 | 2 496 315 | 2 650 343 | 16 320 474 | 28 199 341 | 38 302 396 | 101 384 | 687 609 | 1 266 012 | 1 689 003
2027 | 968 480 | 3 772 026 | 3 490 076 | 2 622 498 | 2 594 247 | 16 310 632 | 28 724 976 | 40 107 418 | 99 091 | 686 726 | 1 289 068 | 1 768 001
2028 | 946 073 | 3 763 677 | 3 554 032 | 2 745 363 | 2 537 781 | 16 270 161 | 29 184 658 | 41 853 104 | 96 683 | 684 240 | 1 308 835 | 1 844 201
2029 | 924 011 | 3 748 244 | 3 608 952 | 2 862 431 | 2 485 894 | 16 224 426 | 29 611514 | 43 545 006 | 94 572 | 681 738 | 1 327 219 | 1 918 248
2030 | 905 226 | 3 728 803 | 3 655 653 | 2 972 857 | 2 444 467 | 16 185 878 | 30 015 796 | 45 181 386 | 92 975 | 679 825 | 1 344 803 | 1 990 134
2031 | 893 351 | 3 710 906 | 3 696 584 | 3 077 310 | 2 416 306 | 16 153 961 | 30 391 966 | 46 754 120 | 91 892 | 678 308 | 1 361 224 | 2 059 403
2032 | 885 375 | 3 695 583 | 3 733 185 | 3 177 128 | 2 393 326 | 16 115 239 | 30 722 426 | 48 252 231 | 90 928 | 676 381 | 1 375 484 | 2 125 343
2033 | 877 676 | 3 680 943 | 3 764 954 | 3 271 250 | 2 372 997 | 16 080 825 | 31 022 510 | 49 680 891 | 90 116 | 674 756 | 1 388 502 | 2 188 321
2034 | 870 254 | 3 667 189 | 3 791 223 | 3 354 686 | 2 359 557 | 16 081 903 | 31 348 670 | 51 055 144 | 89 918 | 675 548 | 1 403 564 | 2 249 908
2035 | 863 064 | 3 653 970 | 3 814 336 | 3 434 979 | 2 342 858 | 16 057 645 | 31 605 717 | 52 335 226 | 89 371 | 674 767 | 1 415 165 | 2 306 861
2036 | 855 745 | 3 642 379 | 3 835 597 | 3 512 329 | 2 322 535 | 16 015 703 | 31 808 006 | 53 530 056 | 88 581 | 672 979 | 1 424 105 | 2 359 717
2037 | 850 324 | 3 631 844 | 3 853 721 | 3 585 525 | 2 306 964 | 15 975 930 | 31 976 996 | 54 652 394 | 87 916 | 671 129 | 1431 417 | 2 409 165
2038 | 845 576 | 3 625 269 | 3 871 828 | 3 655 981 | 2 291 423 | 15 937 991 | 32 118 833 | 55 708 634 | 87 272 | 669 409 | 1 437 586 | 2 455 524
2039 | 840 741 | 3 622 273 | 3 890 385 | 3 723 922 | 2 274 242 | 15 901 472 | 32 239 957 | 56 705 620 | 86 609 | 667 874 | 1 442 978 | 2 499 168
2040 | 838 444 | 3 625 229 | 3 910 188 | 3 789 078 | 2 260 300 | 15 875 441 | 32 352 560 | 57 651 008 | 86 115 | 666 976 | 1 448 225 | 2 540 577

Differences in projected service use were explored under the two scenarios (Table 4). Under the first scenario (reduced incidence), the reduction in mental health contacts compared with baseline is between 67 510 and 95 160 each year, with a total of 1.4 million over the 16-year period. The reduction in community health contacts compared with baseline was between 426 329 and 809 942 each year, with a total of 10 850 449 over the 16-year period. The number of publicly funded social care contacts compared with baseline was reduced by between 18 299 and 34 609, with a total of 465 293 over the 16-year period. The reduction in number of mental health contacts could be doubled (to 2.8 million) if the second scenario (reducing frailty progression) is implemented. The reduction in number of community health contacts under the second scenario could be 45.3 million and the number of publicly funded social care contacts could be reduced by 2 million. Compared with the baseline scenario, reductions in service use are possible, but overall demand will continue to grow (See Appendices 4–6 in the Supplementary Data Section for further details).

 | Reduced incidence | Reduced progression
Year | Difference in mental health service use | Difference in community health service use | Difference in social care service use | Difference in mental health service use | Difference in community health service use | Difference in social care service use
2025 | −67 510 | −426 329 | −18 299 | −142 236 | −2 112 574 | −92 525
2026 | −72 933 | −475 904 | −20 447 | −152 521 | −2 286 812 | −100 028
2027 | −77 626 | −522 466 | −22 460 | −161 325 | −2 441 158 | −106 643
2028 | −81 622 | −565 633 | −24 323 | −168 775 | −2 576 623 | −112 417
2029 | −84 933 | −605 341 | −26 029 | −174 822 | −2 693 943 | −117 390
2030 | −87 593 | −641 489 | −27 576 | −179 511 | −2 793 966 | −121 603
2031 | −89 727 | −673 940 | −28 958 | −183 037 | −2 877 658 | −125 100
2032 | −91 470 | −702 620 | −30 175 | −185 655 | −2 946 383 | −127 942
2033 | −92 842 | −727 743 | −31 236 | −187 388 | −3 001 419 | −130 188
2034 | −93 806 | −749 427 | −32 139 | −188 005 | −3 042 037 | −131 805
2035 | −94 487 | −767 296 | −32 882 | −188 117 | −3 071 369 | −132 932
2036 | −94 948 | −781 620 | −33 474 | −187 836 | −3 090 946 | −133 638
2037 | −95 125 | −792 799 | −33 930 | −187 088 | −3 102 328 | −133 991
2038 | −95 160 | −801 121 | −34 267 | −186 065 | −3 106 751 | −134 050
2039 | −95 082 | −806 780 | −34 491 | −184 827 | −3 105 185 | −133 855
2040 | −94 906 | −809 942 | −34 609 | −183 385 | −3 098 161 | −133 429
Total for all years | −1 409 769 | −10 850 449 | −465 293 | −2840 592 | −45 347 312 | −1 967536