Vulnerable Groups

Elderly man in a light therapy room


Some people are more vulnerable to poor health than others.  This poor health may arise for a variety of reasons, including the effects of deprivation and difficulty accessing services.  The health needs of vulnerable groups are often complex and require a co-ordinated and flexible response from services. It is easy for clients to fall into the gaps between different services leading to unplanned care and the risk of clients revolving through the system.

This theme summary groups together the complex health needs of many vulnerable groups, some of which may overlap and others that are highly specific.

Learning disabilities and Autism

  • Ensure the availability of choice and cost-effective provision which meets needs locally.
  • Improve the quality of primary care learning disability registers.
  • Promote personalised systems which place the person at the heart of any process, provide information and advice, and stimulate universal access to all services.

Physical disabilities and Sensory disabilities

  • Demand for community-based services is increasing, with increased requirement for supported living and reduced reliance upon residential care.
  • Promote personalised systems which place the person at the heart of any process, provide information and advice and stimulate universal access to all services.
  • The number of older people with a limiting long-term illness is expected to increase from about 17,500 in 2015 to 19,500 in 2020 and 22,000 in 2025.
  • The number of older people with moderate or severe visual impairment is expected to increase from about 3,000 in 2015 to 3,800 in 2025, a 29% increase.  There will be a similar increase in those with moderate or severe hearing impairment, from 14,100 to 18,500 between 2015 and 2025.

Domestic violence victims and Sexual violence victims

  • It is believed that many cases of both domestic and sexual violence are unreported.
  • The majority of known sexual violence victims are female and aged under 25 years.  Women are more likely to suffer domestic violence, particularly those aged under 30 years.
  • People from vulnerable groups (those with a physical disability, learning impairment and mental illness) are more likely to experience sexual violence, but may have difficulty verbalising their abuse.
  • There is a need for better data collection to enable improved analysis.
  • Alcohol is a contributing factor in a significant proportion of incidents of both domestic and sexual violence.

Carers and End of life care

  • There is a high number of carers who are unknown to carer support services.
  • Provide carers with the support required to enable them to continue their caring roles.
  • Remove the stigma surrounding death and dying.  Encourage healthcare professionals and people with end of life care needs, their families and carers to engage in open conversations.
  • Increase choice and personalisation within integrated, high quality services that meet the needs of people approaching the end of life.

Migrants and Travellers

  • Ensure migrants and travellers are aware of local health, care and education services and that these services are responsive to individual needs.

Ex-forces personnel

  • Provide adequate signposting to health and care services for armed service leavers.
  • Former forces personnel are more likely to need mental health care and rates of alcohol misuse are higher than for the general population.  This is particularly so for younger, male veterans who held lower ranks and were exposed to combat.
  • A small but significant proportion of veterans experience homelessness.


  • Prisoners have high rates of: poor mental health; alcohol and substance misuse; smoking; suicide and attempted suicide; and learning disabilities.
  • There are high levels of educational need.  About half of male, sentenced prisoners were previously excluded from school compared with 2% in the general population.
  • Offenders have increased difficulty in accessing employment and housing, and tend to be socially isolated.

The recommendations below relate to the Marmot review: Fair Society, Healthy Lives, the former National Support Team recommendations for tackling Health Inequalities and latest national policy and professional guidance.

Short-term (1-2 years)
1. Continue to develop personalised services and further improve access to universal services for vulnerable groups.
2. Improve data collection, in particular, identification of vulnerable members of society who are unknown to local services.

Medium-term (3-5 years)
1.  Increase the supply of housing which meets the needs of vulnerable groups.

Long-term (over 5 years)
1. Ensure that service capacity is sufficient for the anticipated increase in some of these vulnerable groups, particularly those with physical and sensory disabilities.


Summary author

Leon Green
Public Health Intelligence Specialist
Tees Valley Public Health Shared Service