Physical disabilities

The Equality Act 2010 defines disability as an impairment that has a substantial and long-term adverse effect on a person’s ability to perform normal day-to-day activities. Such impairments can vary considerably and include both congenital and acquired disabilities.

In England it is estimated that there are 3.3 million people aged 16-64 with a moderate or severe physical disability (PANSI, 2012).  In addition there are 4.3 million people aged 65 and over with a limiting long-term illness (POPPI, 2012).  Furthermore an estimated 0.8 million children in the UK have a disability (DWP, 2012), approximately 670,000 in England.  Combining these shows about 8.3 million people in England have a physical disability.

People with physical impairments face many barriers to living a fulfilling and independent life. Not only do they have the practical problems of everyday life to struggle with that a physical disability brings but they have to face the negative public perceptions of disabled people and problems gaining access to everyday facilities and services. The support required for people with physical impairment may be multi-dimensional and therefore needs to be tailored to address their specific individual needs.

People with physical impairment also face prejudice.  Prejudice is not always hostile; benevolent prejudice results from the belief that a disabled person needs looking after.  Benevolent prejudice can be just as consequential as hostile prejudice, making it likely disabled people will be treated less favourably in respect of the opportunity for advancement because they are seen as less capable.

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Last updated: 2018-02-22 16:32:32
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1. What are the key issues?

In the next 20 years there are likely to be many more older people who need help with day-to-day activities.  The number of people aged over 65 with a limiting long-term illness is forecast to increase by 8% in 2016 and 27% by 2025.

Current services may not be accessible to people from all ethnic groups.

There is a gap in the current provision of enablement services to people aged under 65.

Many service users find regular transport to be a problem due to their disabilities.

 

Last updated: 28/01/16

2. What commissioning priorities are recommended?

2012/01 - remains a priority
Develop services and responses that will prevent people from developing a long-term condition – promote health and wellbeing and identify and support people at risk of developing a long-term condition.

2012/02 - remains a priority
Make self-care the norm – encourage people to maintain their own health and lead independent lives.

2012/03 - remains a priority
Deliver more services close to home – provide personalised community-based integrated care.

2012/04 - remains a priority
Reduce the number of admissions and the length of hospital stay for those with long-term conditions.

2012/05 - remains a priority
Develop a workforce which has the skills to deliver care in the right place at the right time – invest in professional education and skills development.

2012/06 - remains a priority
Harness technology to support those who care for and those who live with long-term conditions – take advantage of the possibilities opened up by new technologies.

2012/07 - remains a priority
Reduce inequalities in local health and experience and access for those managing long-term conditions – deliver convenient, quality services.

2012/08 - remains a priority
Commission services and measure outcomes that matter to those living with a long-term condition – find out what people want from services working with a range of providers to commission effective, holistic responsive packages of care.

2012/09
Commission services and measure outcomes that matter to those supporting and caring for people with a long-term condition – create an environment that allows carers to take greater control over their own health and the health of others in their care.

2012/10 - remains a priority
Provide a systematic, person-centred approach to the management of long-term conditions.

No additional priorities identified in 2015.

Last updated: 28/01/16

3. Who is at risk and why?

Age
The chances of suffering physical disability increase with age.  About 5% of people aged 18-25 have a moderate or severe physical disability.  At age 55-64 it is almost 21% (PANSI, 2012).

About 47% of people aged over 65 have a limiting, long-term illness, rising to 57% of people aged over 85 (POPPI, 2012).

Young disabled people (aged 16-34) are at greater risk of being a victim of crime than their non-disabled counterparts (Office for Disability Issues, 2012).

Gender
As women age they are more likely to suffer mobility problems than men.  At age 65-69 about 8% of men and 9% of women have a mobility problem, but at age 85+ it is 35% of men and 50% women.

Socioeconomic status
Disabled people are less likely to be employed (49%) than non-disabled people (78%).  Of those who are employed, about one-third of disabled people are in part-time employment compared with one-quarter of non-disabled people (Office for Disability Issues, 2012).

Disabled people tend to earn at a lower hourly rate (£11.78) than non-disabled people (£12.88) (Office for Disability Issues, 2012).
Disabled people are more than twice as likely to have no qualification and half as likely to have a degree level qualification as non-disabled people (Office for Disability Issues, 2012).

In families where no one is disabled, 18% of children live in poverty, but in families where there is at least one disabled person, 22% live in poverty (Office for Disability Issues, 2012).

Nearly one-quarter (23.6%) of households with a disabled person are in fuel poverty compared with 16.3% of households where no disabled people live (Office for Disability Issues, 2012).

Ethnicity
None identified.

Other risks
Stroke victims are at risk of developing a physical disability.

People with progressive degenerative diseases (for example, arthritis; muscular dystrophy; multiple sclerosis) are at increased risk of developing a physical disability.

People sustaining a brain injury are at increased risk of physical disability.  Brain injury is the fastest growing cause of disability in young people in the UK.


Compared with non-disabled people, disabled people are:

  • More likely to live in poverty – the income of disabled people is, on average, less than half of that earned by non-disabled people.
  • less likely to have educational qualifications – disabled people are more likely to have no educational qualifications.
  • more likely to be economically inactive – only one in two disabled people of working age are currently in employment, compared with four out of five non-disabled people.
  • more likely to experience problems with hate crime or harassment – a quarter of all disabled people say that they have experienced hate crime or harassment.
  • more likely to experience problems with housing – nine out of ten families with disabled children have problems with their housing.
  • more likely to experience problems with transport – the issue given most often by disabled people as their biggest challenge.
  • more likely to experience problems with access to information & guidance relating to their condition and care.

(Source: Department of Health, 2005).
 

Last updated: 28/01/16

4. What is the level of need in the population?

The number of clients receiving services has increased from 3,400 in 2005/06 to 4,200 in 2011/12, a 24% increase over 7 years.  The rate of service provision in Hartlepool is above both England and the North East and is increasing where national and regional rates are decreasing (Source: NASCIS; RAP P1).

Hartlepool adults with physical disability receiving services

 

The data on service provision provides an indication of what types of services have been provided.  In Hartlepool, a higher than average proportion of services are community-based.  The number of people receiving residential care services has tended to fall whereas nursing care and community-based services have increased (numbers are rounded to the nearest 5).

Hartlepool adult physical disability services by type

 

Using data from the Projecting Adult Needs and Service Information (PANSI) for people aged 18-64 and Projecting Older People Population Information (POPPI) for people aged 65 and over it is possible to estimate the number of people with physical disabilities.  In Hartlepool, 41% of those with severe physical disability (age 18-64) or with a limiting long-term illness (age 65+) receive services, compared with 29% in England.  It is likely that not all people identified will require services, but nearly 6 in 10 of those with physical disabilities currently don’t receive services in Hartlepool.

Tees predicted number of adults with physical disability

 

Last updated: 08/11/12

5. What services are currently provided?

Hartlepool Centre for Independent Living (CIL)
The centre is home to voluntary and community sector organisations offering advice, information, advocacy and practical help for those living with a disability. The service offers the opportunity to try a range of daily living aids such as bath-lifts and hoists, as well as smaller pieces of equipment. An occupational therapist provides advice on the equipment available and how to use it safely.

Hartlepool Borough Council Child & Adult Social Care teams
The disability service is made up of several teams providing specific services to adolescents and adults with disabilities.  The sensory loss service provides specialist support and assistance across all age ranges.

 

Last updated: 28/01/16

6. What is the projected level of need?

The number of people with a moderate or serious physical disability aged 18-64 is expected to peek within the next 8-10 years and then begin to fall slowly.  In contrast the number of people aged over 65 with a limiting long-term illness is forecast to increase by 8% by 2016, and in 2025 the number will be 27% higher than in 2012 and continuing to increase further by 2030.

Hartlepool people predicted to have physical disability

 

Last updated: 08/11/12

7. What needs might be unmet?

Service uptake within specific ethnic groups
The 2005 Equality Impact Assessment identified lowered levels of service uptake within certain black and ethnic minority communities. This needs to be investigated further to clarify whether adequate care is being provided from alternative sources and/or whether the development of additional council services is justified.

Enablement
Research carried out by the Care Services Efficiency Delivery team (CSED) has highlighted a gap in the current provision of ‘enablement services' to under 65s. The specific client groups affected include learning disabilities, physical impairment, and social inclusion care management. Further investigation will be undertaken to see how this can be developed.
 
Transport
An issue that is raised regularly by people attending local consultation groups is transport. It was noted that “many service users find regular transport to be a problem due to their disabilities or deteriorating conditions”. The taxis were seen as very expensive and often unable to provide wheelchair access.

 

Last updated: 28/01/16

8. What evidence is there for effective intervention?

National Institute for Health and Clinical Excellence (NICE)

Active for life: Promoting physical activity with people with disabilities (guidelines)

Multiple sclerosis: Management of multiple sclerosis in primary and secondary care (CG8)

Osteoarthritis: The care and management of osteoarthritis in adults (CG59)

Rehabilitation after critical illness (CG83)

Depression in adults with a chronic physical health problem: Treatment and management (CG91)

Spasticity in children and young people with non-progressive brain disorders: Management of spasticity and co-existing motor disorders and their early musculoskeletal complications (CG145)

Osteoporosis: assessing the risk of fragility fracture (CG146)

 

The IBSEN project - National evaluation of the Individual Budgets Pilot Projects

The National evaluation of the Individual Budget pilots notes that -
“(younger physically disabled people) were significantly more likely to report higher quality of care (having taken up an Individual Budget), and were more satisfied with the help they received. The choice and control afforded by an Individual Budget has apparently given them the opportunity to build better quality support networks”.


The Care Services Efficiency Delivery (CSED) guidance addresses issues of enablement / inclusion for a number of client groups including those with physical impairment.   This service has been co-designed with health organisations and begins at the stage when they require community care assessments for care packages.  The aim is to have intensive periods of reablement and assessment (6-8 weeks) to enable people to gain confidence in independent living skills prior to having independent care providers carry out these tasks.  It is hoped that through this mechanism people will have tailor-made care packages which will be specific to their needs.

Raising Expectations and Increasing Support (DWP, 2008) announced the government’s intention to introduce legislation to give disabled people the right to control certain public funds spent on their support.

National Service Framework (NSF) for Long Term Conditions (DH, 2005a) aims to transform the way health and social care services support people with long-term neurological conditions to live as independently as possible. It puts the people who have these conditions, along with their family and carers, at the centre of care by setting evidence-based quality requirements from diagnosis to end of life care.  Although the NSF is focused on people with long-term neurological conditions, the principles enshrined in the framework apply to all people with a physical disability.

Independence, Well-being and Choice (DH, 2005c) offers a vision for the future of social care for adults in England. Person-centred, proactive and seamless services are promoted so that people who use social care services will have more control, more choice, and the chance to do things that other people take for granted.

Our Health, Our Care, Our Say (DH, 2006) set the Government’s vision for health and social care services.  It is underpinned by achieving four main goals:

  • better prevention and early intervention for improved health, independence and well-being;
  • more choice and a stronger voice for local individuals and communities;
  • tackling inequalities and access to services;
  • more support for people with long-term needs.

 

Putting People First (DH, 2007) is a ministerial concordat establishing a shared vision and commitment across Government. It sets out the shared aims and values, which will guide the transformation of adult social care.

Improving the Life Chances of Disabled People (DH, 2005b) is a cross-government policy. The vision is for disabled people in Britain to be respected as members of society by 2025.

Disabled People's User-led organisations - organisations led and controlled by the users, are a vital part of the new approach which supports independent living.

 

Last updated: 28/01/16

9. What do people say?

Information from the Life Chances Partnership Board identified five key themes important to improving the lives of Disabled People.  These are:

  • Access - members of the life chances group suggested that a one-stop shop for disability-related information and services was needed.
  • Transport - difficult to access public transport in the evening and there had been a reduction in the number of accessible taxis.
  • Housing - a broad range of housing, care and support services is needed to enable vulnerable people and their carers to improve the quality of their lives and maximise their own resources, including financial resources.
  • Health - members of the Life Chances group supported recommendations to ensure equality of access to health care for people with disabilities was considered for all primary, secondary and tertiary health care provision.
  • Employment - people wanted more support from Job Centre Plus and specialist employment agencies to reduce levels of unemployment for people with a disability.

 

Last updated: 28/01/16

10. What additional needs assessment is required?

There is a need for improved service user feedback:

Current commissioning needs assessment efforts are impeded by the limited availability of accurate service delivery monitoring information. Such efforts would be directly informed by better data regarding current user satisfaction levels and patterns of service take up.

Whilst there is evidence to suggest that the number of people with a sensory impairment and individual budget is rising, it is not know what services are being purchased and whether such services are improving the lives of disabled people.

The provision of such data would also greatly facilitate the improved identification of significant trends such as variations in service usage by ethnic group.

 

Last updated: 28/01/16

Key Contact

Name: Neil Harrison

Job Title: Head of Service Adult Social Care

e-mail: neil.harrison_1@hartlepool.gov.uk

phone:01429 523913

 

References

Local strategies and plans

 

 

 

 

National strategies and plans

Department of Health (2005a). The National Service Framework for long term conditions

Department of Health (2005b). Improving the life chances of disabled people

Department of Health (2005c). Independence, Well-being and Choice: Our Vision for the Future of Social Care for Adults in England.

Department of Health (2006). Our health, our care, our say: a new direction for community services: A brief guide

Home Office (2010). Equality Act.

 

Other references

Bakejal et al., (2004). Review of Disability Estimates and Definitions

Department for Work and Pensions (2012). Family Resources Survey 2010/11.

Department for Work and Pensions (2008). Raising expectations and increasing support: reforming welfare for the future.

Department of Health (2007). Putting people first: a shared vision and commitment to the transformation of adult social care.

Department of Health (2005). Improving the life chances of disabled people.

HM Governnment: Office for disability issues.

National Adult Social Care Intelligence Service (NASCIS). http://nascis.ic.nhs.uk

Office for Disability Issues (2012). Disability Equality Indicators.

Office for Disability Issues (2011). Strengthening Disabled People's User-Led Organisations Programme.

Office for Disability Issues (2010). Public Perceptions of Disabled People: Evidence from the British Social Attitudes Survey 2009

Projecting Adult Needs and Service Information (PANSI). www.pansi.org.uk

Projecting Older People Population Information (POPPI). www.poppi.org.uk