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: 2016-01-27 10:26:05
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1. What are the key issues?

  • The demand for residential and nursing care placements for people with physical disabilities is decreasing as demand for community-based services increases.
  • The full range of housing (from fully serviced residential care through to independent living with some support) is not available to all those who would benefit.
  • The market is limited for people purchasing services with personal budgets.
  • More work is required on advanced planning (i.e. ageing carers) and planning future support opportunities at the right time.
  • There are further opportunities for assistive technology.

 

Last updated: 08/11/12

2. What commissioning priorities are recommended?

Middlesbrough Council’s commissioning intentions are based upon a number of factors including national policy, local demographic analysis and intelligence, corporate requirements including the ongoing efficiency programme and analysis of the impact of partner decisions and actions.

The department currently has a number of over-arching goals which we hope to meet by achieving a number of planned actions.

2012/01
Stimulate local markets to ensure the availability of choice and cost-effective provision which meets needs locally:

  • Provide intelligence to encourage the new development of provision to meet emerging needs.
  • Develop a model for extra care housing using private financing arrangements on the old St Paul site.


2012/02
Promote supported living, reduce dependencies and foster reablement resulting in a reduction of hospital admissions and a reduced reliance upon residential care:

  • Develop option for supported living within community settings for people with physical disabilities.
  • Review advocacy provision and determine future demands.
  • Progress proposals for delivering assisted living lifestyles at scale.
  • Agree strategy for improving health and wellbeing of people in care homes through development of “virtual wards” concept and the alignment of GPs to care home clusters.
  • Participate in and implement agreed actions from joint groups/meetings with South Tees Hospitals NHS Trust to improve discharge arrangements and reduce unnecessary admissions.


2012/03
Promote personalised systems which place the person at the heart of any process, provide information and advice and stimulate universal access to all services:

  • Establish a Physical Disability Partnership Forum to oversee and implement the Physical Disabilities Strategy.
  • Implement recommendations from the scrutiny process regarding stroke services.
  • Ensure that government targets for the implementation of personalised budgets are met.
  • Align services in conjunction with the introduction of personal health budgets.
  • Introduce a Universal Information, Advice and Advocacy service.


2012/04
Promote health and well-being including early intervention, to prevent/reduce reliance on service provision:

  • Introduce personal budgets for carers.
  • Improve the public health of residents within residential care settings through improved nutrition, hydration and social inclusion.


2012/05
Ensure that the principles of quality, equality and value for money are embedded within processes and service provision:

  • Seek to renegotiate home care contracts and/or conduct market testing on service provision and cost.
  • Scope the re-provision of day services as part of the community building review.
  • Review and re-provide services from the current deaf centre site.
  • Undertake a review of the departments ‘Fairer Charging’ policy.
  • Review all out of area placements, developing local services where possible and renegotiating placement costs. This should be carried out in conjunction with NHS Tees to agree risk share on high cost placements and plans for move on.
  • Rationalise day service provision for individuals in residential care settings.
  • Implement a single resource allocation system.

 

Last updated: 08/11/12

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: 08/11/12

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

The number of clients receiving services has decreased slightly from 4,260 in 2005/06 to 4,170 in 2011/12.  The rate of service provision in Middlesbrough is above both England and the North East (Source: NASCIS; RAP P1).

Middlesbrough trend adult physical disabilities reveiving services

 

The data on service provision provides an indication of what types of services have been provided.  In Middlesbrough, a slightly higher than average proportion of services are community-based.  Over four years, the number of people receiving residential care services has increased slightly, nursing care is broadly stable and community-based services have decreased (numbers are rounded to the nearest 5).

Middlesbrough adult physical disabilities by service 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 Middlesbrough, 30% 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 7 in 10 of those with physical disabilities currently don’t receive services in Middlesbrough.

Tees predicted physical disability and number receiving services

 

In Middlesbrough, there are 293 people with a physical disability recorded as being in receipt of a service based upon a personal budget.  There are likely to be significantly more who receive a “virtual” personal budget (that is to say, they are presented with the options but elect to receive local authority managed provision). Of the 293, 46% are aged 18 to 64 and 54% are aged 65 and above.

Overall, there were 435 provisions recorded against people with a personal budget in this group, of these 60% were related to the provision of personal care with 52% of these being the employment of a personal assistant. There are slightly more personal assistants employed by older people (74) than people aged 18-64 (64). The following chart shows the distribution of service provision by type.

Personal budget service provision, Middlesbrough, 2011/12

Middlesbrough personal budget service provision

 

Last updated: 08/11/12

5. What services are currently provided?

Personal budgets
A personal social care budget allows a person to select services designed to meet their identified needs from a wide range of providers in the public and private sectors. For instance, personal care needs may be met by a traditional domiciliary care agency or a person can opt to employ an assistant to meet these needs.

Care homes
There are eleven care homes contracted to Middlesbrough Council that provide residential and nursing care to people with physical disabilities.

Day care
Middlesbrough Council provides day-care services directly to service users at The Orchard. This service caters for up to twenty-six people with complex needs. In addition, the Teesside Ability Support Centre (TASC) provides up to 92 places on a block contract basis and has 26 users accessing the service on a spot basis.

Personal care, enablement and support
There are a number of providers in the Middlesbrough area who can provide support for a wide range of needs, from low-level housing-related support to high care needs including personal care.

There are two providers of supported accommodation and housing-based support services. The Holyrood supported accommodation service currently assists six clients and Habinteg Housing Related Support Service assists up to 52 people at any time.

Middlesbrough Council delivers domiciliary care via four agencies, supporting the varying level of needs with service users, typically within their own homes.

The Middlesbrough Intermediate Care Centre (MICC) provides a number of services which are aimed at maximising independence, preventing unnecessary hospital admission or long-term care need and facilitates early discharge from hospital. The service currently has capacity for 21 people in its residential reablement service.

The Independence Team based within MICC delivers a reablement service in the homes of service users and a rapid response service to handle crisis situations.  The service supplies about 585 hours of reablement and rapid response assistance per month.

Other and generic services
The Staying Put Agency assists older, vulnerable and disabled people to remain independent and in their own home by offering a range of financial and practical support services including Disabled Facilities Grants, equipment repairs and minor adaptations.

Middlesbrough Council operates a team who work with people of working age with disabilities who want to work. They deliver tailored support with a view to the person gaining access to sustainable jobs paying a living wage.

The Tees Community Equipment Service provide equipment and adaptations on behalf of local authorities in the Tees Valley area.  People with physical disabilities represent 85% of active users.

 

 

Last updated: 08/11/12

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 fall slowly.  In contrast the number of people aged over 65 with a limiting long-term illness is forecast to increase by 6% by 2016, and in 2025 the number will be 24% higher than in 2012 and continuing to increase further by 2030.

Middlesbrough forecast number of people with disabilities

 

Service users
Estimating change in service user numbers to the end of the 2015/16 financial year based upon the average rate of change since 2005/06 indicates an increase from 4,203 in 2011/12 to 4,411 in 2015/16.  This would be a 5% increase in four years, but below the projected increase in need.


Services
Applying the same method to the uptake of services, it is estimated that community-based services, such as domiciliary care, will see an increase of 7% in utilisation to 2015/16 whilst nursing and residential care may see a decline of 6% and 73% respectively.

The significant drop in utilisation of nursing care is not unprecedented.  Between 2005 and 2011, usage dropped from 201 to 105 in the over-65 age group. It is also probable that the increase in community-based services will reduce as more people begin to employ personal assistants.

 

Last updated: 08/11/12

7. What needs might be unmet?

  • Services for people with physical disabilities and complex needs.
  • Services for people with acquired brain injuries.
  • Specially adapted housing in the right locations.
Last updated: 08/11/12

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: 08/11/12

9. What do people say?

Middlesbrough’s Physical Disabilities Strategic Plan includes feedback from people with disabilities on a range of subjects:

Transport

  • An audit of current and future transport needs taking into account future demographic changes in Middlesbrough should be undertaken.
  • Enforcement of disabled parking should be stricter.
  • Disability awareness training should be provided to all staff dealing with customers.
  • The range of community and voluntary transport needs to be enhanced to improve service delivery for people who are unable to use conventional services.
  • More information should be provided about taxis and buses which are fully accessible for disabled people.


Housing

  • Improve availability of a range of accessible and adaptable housing that promotes independent living.
  • Improve access to equipment.

Wellbeing and activity
Provide a directory of sports facilities, clubs and events.
Disability awareness training should be provided to enhance understanding of disabled customers’ needs.
Fitness facilities or arranged classes should include equipment suitable for wheelchair users.

Access and support to employment

  • Develop employment and training services that promote access for disabled adults of working age.
  • Raise awareness and improve information for individuals about employment and support.

Community safety

  • Improve street lighting to make the environment safer.
  • Deploy CCTV in known “trouble-spots”.
  • Increase the level of community policing.
  • Provide support for disabled people who are victims of hate crime.

Education and learning

  • Ensure equality of opportunity for all disabled people who want to participate in formal and informal learning.
  • Increase access to support for people who have a disability and wish to participate in further education.
  • Provide lifelong learning opportunities that will develop skills and knowledge.
  • Provide an access centre which offers advice and supports prospective learners.

Active citizenship and partnership

  • Promote the participation of disabled people in the planning and delivery of services.
  • Develop more public forums to share and exchange information.
  • Ensure that dialogue with people who use services is taken into account to ensure that services are operated for their benefits rather than that of the provider.

 

Last updated: 08/11/12

10. What additional needs assessment is required?

  • Housing needs and demand forecast.
  • Profile of ageing carers without services at home.
  • Planning using transitions data.
  • Detailed analysis of the potential for reablement services.
Last updated: 08/11/12

Key Contact

Name: Erik Scollay

Job Title: Assistant Director, Social Care

e-mail: erik_scollay@middlesbrough.gov.uk

phone:

 

References

Local strategies and plans

Middlesbrough Borough Council (2009). Inclusion Health & Independence: physical disability strategic plan 2009-2019.

 

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