The Stockport Health & Wellbeing Board was scheduled to convene to address key healthcare matters in the borough. The agenda included reviewing the financial performance of the Better Care Fund, considering the Joint Strategic Needs Assessment plan, and approving the Pharmaceutical Needs Assessment for publication. Also listed for discussion was the board's forward plan.

Stockport Pharmaceutical Needs Assessment 2025

The board was scheduled to consider the Stockport Pharmaceutical Needs Assessment 2025 Model Report, a document that Stockport Health & Wellbeing Board are required to publish every three years.

The report stated that the 2025 Stockport Pharmaceutical Needs Assessment (PNA) examined the provision of pharmaceutical services across Stockport as of spring 2025. It assessed whether the services met the population's current needs and identified potential gaps in service delivery. According to the report, the NHS Greater Manchester Integrated Care Board (ICB) would use the PNA in its approval process for applications to join the pharmaceutical list under the NHS Pharmaceutical Services and Local Pharmaceutical Services Regulations 2013.

The draft PNA was published for consultation for 60 days, and the final version incorporated changes agreed upon following a steering group review of comments.

The report concluded that the population of Stockport had sufficient service provision, including pharmacy contractors, to meet their essential pharmaceutical needs. This conclusion was based on the following points:

• There were 59 community pharmacies, 3 internet/distance selling pharmacies, 1 dispensing appliance contractor (DAC), and 1 hospital pharmacy in Stockport.
• The number of pharmacies per 100,000 population was similar to the England average, despite four community pharmacies closing since 2022.
• An additional 14 community pharmacies across Cheshire East, Manchester, and Tameside provided services to Stockport residents.
• More than 92% of the population had access to pharmacies within one kilometre of their home.
• More than 96% of the population lived within 2km of three or more pharmacy providers.
• Future anticipated population growth was unlikely to change this position in the lifetime of the PNA (to 2028).
• Analysis of opening hours and trading days showed adequate provision for out-of-hours service across the borough, with more than 90% of residents living within 30 minutes public transport access of pharmacies open on weekday evenings and weekends.
• There were opportunities to improve access to pharmacy services in the following areas and times:
  • Bramhall and Cheadle Hulme Neighbourhood 18:30 to 20:00 on a weekday
  • Marple Neighbourhood 18:00 to 20:00 on a weekday
  • Stepping Hill Neighbourhood 18:30 to 20:00 on a weekday

The report stated that there was already sufficient service provision in other areas in the borough accessible from these neighbourhoods by public transport at these times, so there was no gap in provision.

The report recommended that the board review the findings and, if in agreement with the conclusions, approve the Stockport PNA 2025 for publication. Once published, the NHS Greater Manchester ICB would use the PNA in its approval process for applications to join the pharmaceutical list.

Stockport Joint Strategic Needs Assessment (JSNA) 2025/26 Plan

The board was scheduled to consider a report providing an overview of JSNA activity in 2024/25 and the proposed work plan for the Stockport Joint Strategic Needs Assessment (JSNA) 202526 Plan Model Report.

The report stated that Joint Strategic Needs Assessments (JSNAs) summarise the current and future health and wellbeing needs of a local population. They also establish the evidence base for strategically commissioning and planning health and care services to improve population health and reduce health inequalities.

The report stated that in 2024/25, the following analyses were proposed:

• Create a JSNA for Specialist and Support Housing.
• Update the JSNA for Mortality.
• Update the JSNA for frailty and falls.
• Prepare a draft update of the Pharmaceutical Needs Assessment 2025 for consultation.
• Create a JSNA for inequalities.

The report summarised the key evidence found in the 2024 JSNA for Supported Housing:

• Care experienced young people up to 25 and those transitioning into adult care services.
  • In June 2024, the analysis identified 484 care experienced people aged 16 to 25 years in Stockport who had reached the threshold for receiving leaving care services, around 22% of whom had a disability.
  • Over the last few years an average of 52 16-17 year olds a year were placed into semi-independent supported accommodation, the majority of whom are currently placed with external providers.
  • Modelling suggested that if the numbers of young people in care remained stable, the number of over-18 year olds needing supported accommodation in 2034 would be around 40, with numbers peaking in 2026 (at 80) and then falling each year to 2034.
• People with serious mental illness
  • There were 3,040 people registered with a Stockport GP with a diagnosis of a severe mental health disorder.
  • The health inequality in the prevalence of physical health conditions between those with SMI and all patients was around double for multi-morbidities, and the under 75 mortality rate for all causes was 4.3 times higher for those with an SMI than the rest of the population in Stockport.
  • In July 2024, 353 adults supported by Adult Social Care had a primary need of serious mental health.
  • Analysis showed that in 2024, 111 people with SMI lived in supported placements in Stockport and 50 individuals lived out of borough in supported accommodation. It's recommended that Stockport ensure that the most complex needs can be met within the borough as appropriate for the individual.
• Autistic people
  • National prevalence estimates suggested that there were 3,000-3,250 autistic people in Stockport, with around 1,000 of these being children and 2,250 being adults. GPs had 2,116 autistic people on their records in Stockport. GP recording levels had increased by more than 80% from 2016 when the number diagnosed was 1,170. Most of the increase had occurred in those under 30 years old.
  • National data showed that 76.0% of autistic adults aged 16-64 report living with their parents, compared to 19.2% of those with no disability. However, autistic people may also live alone, or in their own family units. Autistic people may be at greater risk of social isolation than other groups. There is a need to ensure that there is planning for longer term accommodation and support for adults currently living with their families.
  • Autism is currently not routinely asked for within government statistical returns for housing as a separate condition. Stockport Homes have carried out some data collection and have found that in Stockport currently there are 102 people who have identified as being autistic on the Stockport housing register waiting to be rehoused. This makes up 1% of applicants which would be statistically below the diagnosis rate. The Stockport autism strategy has highlighted the need to look further at the housing needs of autistic people in the borough.
• People with a learning disability
  • There currently are 1,813 people at a GPs in Stockport with a record of learning disability (March 2024). Learning disability is usually diagnosed in childhood and impacts abilities to cope independently for life. Trends show that the numbers of people registered with learning disability are rising; this could be due to better diagnosis, but also due to increases in life expectancy.
  • As of September 2024, there were 411 supported housing placements for people with Learning Disabilities and / or Autism in Stockport and a further 82 referrals for Adults with a Learning Disability and/ or Autism with planned need for supported housing.
  • There are currently 100 different schemes across the borough that provide accommodation for adults with learning disabilities and/or Autism. This figure includes single occupancy supported tenancies, as well as larger apartmentbased provision. It also includes placements where Stockport does not maintain nomination rights and placements that are funded through Individual Service Funds and Spot Purchases.
  • In 2022/23 93% of adults aged 18-64 years in contact with Adult Care with a learning disability, in Stockport were assessed as living in stable and appropriate accommodation. This rate has been stable since 2015/16 and is higher than the national average (81%).
• Older people
  • The population of Stockport, like many areas, is ageing. In 2022 the population aged 65+ has grown by 13% in the last 10 years and is projected to do the same over the next 10 years. The population aged 85+ has grown by 23% in the last 10 years (up by 1,500 people) and is projected to rise by 28% over the next 10 (reaching 11,000).
  • National evidence suggests 45% of those aged 85+ experience difficulty with one or more daily living tasks,
  • In the year to July 2024 Adult Social Care front door services received around 4,100 referrals for adults aged 65+; physical and social support are the most common primary support reasons.
  • 3,206 people registered with Stockport GP Practices have a diagnosis of dementia, an increase of around 800 (34%) over the last ten years, partly as a result of the focus on improved detection but also due to the increasing older population. By 2035, the prevalence of dementia is estimated to increase to 5,445 people.
  • There are currently 651 extra care beds as outlined in the draft housing needs assessment in Stockport with 270 of these being council commissioned.
• People with physical disability
  • In Stockport, the overall population of people disabled under the Equality Act has increased from 52,259 to 53,495 (2.4% increase) between the 2011 and 2021 Censuses. Rates have increased the most in the more deprived parts of the borough, including Brinnington, Adswood and other parts of the town centre. Around 22,710 of these people report that their day-to-day activities are limited a lot by their condition.
  • Rates increase with age, from 2.7% of those aged 0-4 years, to 36.7% of those aged 85+ years.
  • A physical disability does not in and of itself mean that a supported housing offer is needed. However, there is clear evidence that the lack of adapted and accessible housing provision impacts on people with a physical disability.
  • In July 2024 there were 727 people on the housing transfer list awaiting some form of adaptation. Of these people 44 need a fully wheelchair adapted home.

The report summarised the key findings of the 2024 JSNA – Mortality Review analysis:

• Life expectancy:
  • Males in Stockport are now expected to live to 79.3 and females to 83.4 years. Life expectancy for males and females in Stockport is similar to the national average.
  • The rate in improvement in life expectancy has slowed since 2011 and male life expectancy fell as a result of COVID-19 although levels are now recovering.
  • There are clear deprivation profiles in life expectancy with males in the most deprived quintile expected to live 10.6 years less and females 8.2 years less, than people in the least deprived areas.
  • The inequality gap in male life expectancy has increased over the last four years and in 2021-2023 is the largest it has been. For females the inequality gap has been stable for the last 8 years, though has grown since 2002/04.
  • For males life expectancy in the most deprived quintile has fallen, while levels in the other four quintiles have remained relatively stable.
  • For females life expectancy in the least deprived quintiles has continued to improve, while levels in the other four quintiles have remained relatively stable.
  • Ward level inequalities show similar patterns, and the gaps between life expectancy between the highest and lowest wards are now at 13.6 years for males and 10.5 years for females.
  • The main causes of death responsible for the inequality in life expectancy are currently coronary heart disease, digestive disease (most commonly chronic liver disease) and accidental poisoning (mostly related to drugs and alcohol) for males and digestive disease, coronary heart disease, accidental poisoning and lung cancer for females.
  • The main contributing age group to life expectancy inequality is those dying between the ages of 60 and 79.
• Major causes of death:
  • Cancer and circulatory disease are the biggest causes of death amongst Stockport residents in all ages and aged under 75; for all age groups these two major disease groups combined are the underlying cause of 51.4% of all deaths in Stockport in 2023.
  • Mortality rates for these conditions are falling or stable apart from circulatory disease mortality aged under 75 years, where an increase is starting to occur. This is a concerning trend and is strongly linked to areas of higher deprivation and is likely driving the widening health inequalities observed above.
  • Dementia is increasingly becoming a major cause of death and rates of mortality for this cause are rising, particularly for people over the age of 80 years. This is in part due to a change in coding and better identification and diagnosis of dementia alongside the trends in ageing population.
  • In under 75s, external causes and digestive disease are a larger cause of death than for older ages. External causes are primarily due to accidental deaths (most commonly from falls or accidental poisoning) and self-harm. The rates of both external causes of mortality and digestive disease are increasing.
  • This increase is particularly being driven by increases accidently poisoning and rates in Stockport are higher than the national average.
  • Stockport also has higher rates of deaths from accidental falls although trends are stable.
  • There are inequalities in all causes of death between the most deprived and least deprived areas, these are most significant for circulatory disease, and mortality for circulatory disease in the most deprived areas has recently risen, marking a change in a significant long-term trend.
  • The underlying risk factors for many of these causes of death are preventable.

The report summarised the key findings of the JSNA for frailty and falls:

• Frailty
  • Frailty varies in severity and is not static people can become both more and less frail over time.
  • There are different ways to assess and measure frailty, including face to face clinical assessment (Clinical Frailty Scale (CFS or Rockwood Scale)) and algorithm-based assessments using data from patient records (electronic frailty index (eFI).
  • In Stockport 35% of people aged 65+ have a CFS/ Rockwood score recorded, 22% have an eFI and 42% had no frailty assessment.
    • Analysis by age shows that those aged at the younger end of the range are much less likely to have had their frailty level assessed and recorded (65% without a frailty assessment aged 65-69) than those at the older end (by age 85-89 the proportion with no assessment is 19%).
    • Analysis also shows variation in recording levels between different GP practices with the use of the eFI varying in particular.
  • The JSNA has produced a range between which the likely prevalence of frailty lies, with the higher estimate apportioning the not recorded across the frailty scale following the age / sex proportions in the current data and the lower estimate calculated by apportioning the not recorded to the fit / not frail group.
  • The estimates suggest a frail population of between 9,100 and 13,950 at 65+ which is between 15.4% and 23.6% of the total population.
  • Levels of frailty increase with age so that for the lower estimate range, where 15.4% of the population aged 65+ are moderately or severely frail levels rise from around 5% of those aged 65-69 to over 30% by age 85-89 years and to around 60% by age 95-99.
  • At all ages females have a slightly higher frailty rate than males.
  • Areas of higher deprivation also have higher levels of frailty.
• Falls
  • Anyone can have a fall, but older people and those who are frail are more likely to fall and are more likely to experience long term effects after falling, especially if they have a long-term health condition.
  • There is no definitive record of the number of falls in Stockport each year, as many falls cause no or minor injuries which do not lead to the need for care. Evidence suggests that around 1 in 3 adults over 65 who live at home will have at least one fall a year, and about half of these will have more frequent falls, in Stockport this would equate to a total 18,100 falls each year for those aged 65+.
  • In 2022/23 1,495 emergency hospital admissions were made by Stockport patients aged 65 and over as a result of a fall. Rates are significantly higher than the national average, although the overall long-term trend is decreasing slowly.
  • In 2022/23 there were 405 emergency hospital admissions made by Stockport patients aged 65 and over as a result of a hip fracture (fracture neck of femur); rates are not declining.
  • Around 70 people in Stockport die as a result of a fall each year, the majority of these deaths are for those aged 80 years and older. Mortality rates in Stockport are around 60% higher than the national average, however previous investigation has shown this to be as a result of local coroner protocols. The rates of fall deaths are increasing fastest in the oldest age group (90+) as this population grows.

The report stated that the Stockport Pharmaceutical Needs Assessment 2025 was being presented at the Health and Wellbeing Board as a separate item and once approved would be published.

The planned JSNA for inequalities had been delayed until 2025/26 following the national announcement of the publication of an updated Index of Multiple Deprivation (IMD) scheduled for autumn 2025.

The report proposed that in 2025/26, analysis be undertaken to:

• Create a JSNA for Inequalities and Multiple Deprivation.
• Produce a JSNA for Adolescent Health and Wellbeing.
• Create a JSNA for long term conditions.
• Update the JSNA for vulnerable and excluded groups.
• Develop a JSNA for Learning disability.

The report also stated that the continual improvement of analysis and insight was a key priority for 2025/26. It was proposed to use the learning from a Manchester JSNA review to undertake an assessment of the Stockport JSNA in 2025/26 to understand from stakeholders what works well, what is less effective, and areas to improve.

The report recommended that the Health and Wellbeing Board consider and comment on the proposals for the 2025/26 JSNA and approve the priorities for the work programme for the year.

Better Care Fund Monitoring Report Q1 2025-26

The board was scheduled to consider a report detailing the Better Care Fund (BCF) Q1 template, which was submitted to the national BCF Team by 15 August 2025. The report also provided an update on the overall financial performance of the BCF as of 30 June 2025 (Quarter 1).

The report stated that the Better Care Fund (BCF) is a government initiative aimed at encouraging integration between the NHS and local authorities to improve health and social care services. Integrated Care Boards (ICBs) and local government are required to agree a joint plan, overseen by the Health and Wellbeing Board (HWB), and BCF funds are pooled under section 75 of the NHS Act (2006).

The BCF policy framework sets out the vision, funding, oversight and support arrangements, focused on two overarching objectives for the BCF in 2025/26:

• Supporting the shift from sickness to prevention
• Enabling people to live independently and the shift from hospital to homebased care

The BCF 2025-26 Q1 Reporting Template submission included data collection on the following areas:

• National conditions
• Metrics assessment
• Financial Performance

The report stated that the national conditions for the BCF 2025-26 were all being met:

• There is a jointly agreed plan between health and social care commissioners, signed off by the Health and Wellbeing Board.
• Implementing the objectives of the BCF
• Complying with grant and funding conditions, including maintaining the NHS minimum contribution to adult social care (ASC).
• Complying with oversight and support processes.

The BCF performance measures in Stockport were in line with the plan submitted for 2025/26, and there had been no adjustment to the plan.

Actual spend for the period was £10.784m, an underspend of £0.764m against the planned expenditure of £11.548m. Forecast outturn expenditure was £45.273m against an annual plan of £46.182m, a forecast underspend of £0.909m.

The report detailed variances to plan for different services. For example, the underspend of £0.027m to date and forecasted underspend of £0.043m for Neighbourhood Services was due the costs of the 2025/26 annual pay award for council BCF posts being funded recurrently by the council, rather than the BCF planning assumption of the funding being identified within residual BCF balances.

There was a £0.218m year-to-date underspend and a £0.826m forecast underspend against the budget for short-term nursing bed placements, which are used when no commissioned community beds are available or when a patient's acuity cannot be met within the commissioned bed base. The underspend reflected a concerted effort to reduce the number of unmet need beds commissioned by maximising the use of the existing community bed base and deploying additional resources to ensure that patients in short-term bed provision receive rehabilitation care and have their long-term care needs assessed promptly, thereby reducing length of stay.

The report recommended that the board:

• Approve the BCF 2025-26 Q1 Reporting Template submitted to the National BCF Team by 15 August 2025.
• Note the finance performance of the BCF as of 30th June 2025 (Quarter 1).

Forward Plan for Health & Wellbeing Boards

The board was scheduled to consider a report providing the Forward Plan of agenda items for future meetings of the Health & Wellbeing Board.

The report recommended that the board:

• Consider the information in the report and put forward any agenda items for future meetings of the Board.
• Approve the Forward Plan as presented subject to any changes agreed.