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Health & Care Services

The proactive management of people with long-term conditions, including the promotion of self-care by patients, is a key priority for the NHS. General practice has a central role in delivering more integrated and personalised care, and in implementing policies that target 'at-risk' individuals with appropriate interventions.

One in three people aged over 65, and half of those aged over 80, fall at least once a year. Falls cost the NHS more than £2 billion per year. With the number of people aged 65 and over predicted to increase by 2 million by 2021, these costs are set to rise further. One way to help design better services with more integrated treatment and rehabilitation for falls patients is to look more closely at where the costs of treating patients are incurred across health, community and social care services. This paper uses Torbay’s unique patient-level linked data set to explore the NHS and social care costs of the care pathway for older people in the 12 months before and after being admitted to hospital as a result of a fall.

Key Findings

  • On average, the cost of hospital, community and social care cost services for each patient who fell were almost four times as much in the 12 months after admission for a fall as the costs of the admission itself.
  • Comparing the 12 months before and after the fall, the most dramatic increase was in community care costs (160 per cent), compared to a 37 per cent increase in social care costs and a 35 per cent increase in acute hospital care costs.
  • While falls patients in this study accounted for slightly more than 1 per cent of Torbay’s over-65 population, in the 12 months that followed a fall, spending on their care accounted for 4 per cent of the whole annual inpatient acute hospital spending, and 4 per cent of the whole local adult social care budget.
  • There was evidence of significant under-coding of co-morbidities for falls patients, particularly for dementia.

This report should be of interest to all those involved in the commissioning of services that deal with 'falls' and more generally health/social care integration.

The Potential Care Needs Index classifies the older population of Bolton (aged 50+) according to their risk of future early reliance upon intensive social care and support services.  The Index has been constructed by combining a range of risk factors known to be associated with early reliance on social care services such as living alone, having alcohol problems, and experiencing reduced daily activities and similar. The aim of the Index is preventative and is designed to target people before they become too ill and need to access social care. A full list of the indicators used and the methodology used to construct the Index is available in the accompanying brochure ‘Supporting independence and preventing the escalation of care need in older people in Bolton’. Below is a full list of all documents & resources linked to the Potential Care Needs Index:

The project brief for the 'Staying Well' project currently being piloted within Bolton. Bolton’s Public Health Department (Staying Well Project), jointly with Adult Social Services, Strategic Housing, NHS Bolton Clinical Commissioning Group and Customer Services Department are currently testing an approach to systematically identify individuals (age 65 & over) at high risk of developing future health and social care need and providing advice, support and assistance to enable people to remain healthy, happy and independent for longer as well as preventing future risk. The brief includes:

  • Overview/Rationale
  • Key Relationships
  • Emerging Findings
  • Evaluation Approach
  • Expected Benefits to Clients

This document should be a must-read for all those involved in the commissioning and delivery of services to vulnerable older people.

A survey of 6800 gay and bi-sexual men covering their approach and thoughts health lifestyle, common health needs and health sector experiences. A useful collection for commissioners and providers of services to the gay and bi-sexual communities. Attached is the complete survey findings and the North West dataset.

Other Bolton's Health Matters resources you find relevant:

A survey of over 6000 individuals that examines the health needs and experiences of care of lesbians. Although produced in 2008 it is still the most comprehensive, substantial and relevant piece of work surrounding lesbian health needs. Anyone involved in the commissioning or delivery of health and wellbeing services to the lesbian and bi-sexual communities. Attached is the original report and the north west dataset.

Other Bolton's Health Matters Knowledge Hub resources that may be relevant:

NICE set up a cost impact project to explore its approaches to assessing the cost effectiveness and cost impact of public health interventions, in response to growing demand from local commissioners and others, such as directors of public health, involved in making investment decisions. The report summarises potential new methods for determining the cost impact of - and returns on investment (ROI) from - public health intervention recommendations made by NICE. The project explored the feasibility and usefulness of producing a range of cost effectiveness and cost impact/ROI data and tools to support local decision-making. The study showed that a wide range of different metrics and tools are needed to support effective decision making at a local level, and the report contains a series of recommendations for taking this forward. This is an important report for all involved in commissioning of public health services.

You can view the report by clicking here:

This document sets out the priorities for Public Health England in 2013/2014. These are:

  1. Helping people to live longer and more healthy lives by reducing preventable deaths and the burden of ill health associated with smoking, high blood pressure, obesity, poor diet, poor mental health, insufficient exercise, and alcohol
  2. Reducing the burden of disease and disability in life by focusing on preventing and recovering from the conditions with the greatest impact, including dementia, anxiety, depression and drug dependency
  3. Protecting the country from infectious diseases and environmental hazards, including the growing problem of infections that resist treatment with antibiotics
  4. Supporting families to give children and young people the best start in life, through working with health visiting and school nursing, family nurse partnerships and the Troubled Families programme
  5. Improving health in the workplace by encouraging employers to support their staff, and those moving into and out of the workforce, to lead healthier lives

To underpin these outcome-focused priorities we will:

  1. Promote the development of place-based public health systems
  2. Develop our own capacity and capability to provide professional, scientific and delivery expertise to our partners

This is the Emergency readmissions within 28 days of discharge JSNA Indicator Sheet from the Disease and Ill Health section. JSNA Indicator Sheets summarise the current position and recent trends for Bolton, comparators to Bolton, and inequalities across population groups and geographical areas of Bolton.



  • Bolton has a lower rate of emergency readmissions within 28 days of discharge than both the North West region and England as a whole;
  • Bolton does however have a higher rate of emergency readmissions within 28 days for patients aged 0-15;
  • Bolton has a lower rate than is average for its statistical peer group, and the latest figure shows it to also have the lowest rate seen in the Greater Manchester connurbation.

This is the Emergency Admissions for Chronic Ambulatory Care Sensitive Conditions JSNA Indicator Sheet from the Disease and Ill Health section. JSNA Indicator Sheets summarise the current position and recent trends for Bolton, comparators to Bolton, and inequalities across population groups and geographical areas of Bolton.



  • Bolton currently has a higher rate of emergency admissions for chronic ambulatory care sensitive (ACS) conditions than England, but is just lower than the North West average;
  • There has been little change in the rate, both locally and nationally, since 2005/06;
  • Bolton has a higher rate of ACS admissions than the England average across all three diagnosis categories - acute, chronic, and vaccine;
  • Bolton has an average rate of ACS admissions for its statistical peer group

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