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.

This topic is most closely linked with:

 

Last updated: 2014-06-05 13:44:36
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1. What are the key issues?

Personalisation: Better outcomes for the individual and more cost-effective support services can be achieved through increased choice and control in the provision of support.

Equality: People with physical disabilities are subject to inequalities in housing and employment.

Enablement: Early access to information and support can assist people to gain and maintain independence.

 

Last updated: 05/06/14

2. What commissioning priorities are recommended?

2012/01
Continue to support the uptake of individual budgets and use of direct payments
by people with a physical disability.

2012/02
Improve the completeness of local information
about people with physical disabilities that includes the support that is provided and intended outcomes. There is a gap in information on the use and outcomes from Individual Budgets and a lack of specific information from local people about their experiences that can be used to inform strategic planning.

2012/03
Ensure that current commissioned services and support through Individual Budgets meet the diverse needs of people
in the community, including support for people from ethnic minorities.

2012/04
Develop further the role that Telecare and Telehealth
have in the development of support for people with physical disabilities in promoting privacy, dignity and independence.

2012/05
Continue to support and develop third sector organisations
that will maintain support for people in the community when eligibility for statutory services is not met.

2012/06
Continue to develop the range of services that can be accessed through individual budgets
that meet the support needs and preferences of people with physical disabilities. The market for recruitment of personal assistants requires particular development.

 

Last updated: 05/06/14

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: 05/06/14

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

There are estimated to be nearly 6,800 people aged 18-64 with a moderate physical disability and over 2,000 people aged 18-64 with a serious physical disability living in Redcar and Cleveland. This includes an estimated 4,100 people aged 18-64 who require personal care in connection with a moderate or serious disability.

  • 6,480 people are in receipt of Incapacity Benefit and 810 people are in receipt of Severe Disablement Allowance.
  • 5,130 people have been in receipt of Incapacity Benefit/Severe Disablement Allowance for over 5 years.
  • 4,880 people aged 18-64 are in receipt of Disability Living Allowance.

Social care service provision for people aged 18-64 in 2011/12 is summarized in the table below.  The total number of people cannot be obtained accurately as some people may use more than one service type.

 

Number of service users by type of service, Redcar & Cleveland, 2011/12

Provision

Physical Disability Service Users 18-64 in

RAP Returns, 2011/12

Direct Payments

194

Residential Care

30

Care at Home

196

Day Care

23

Other

1015

Source: RAP data, www.hscic.gov.uk

The number of clients receiving services has increased from 4,200 in 2005/06 to 5,700 in 2011/12, a 36% increase over 7 years.  The rate of service provision in Redcar & Cleveland is above both England and the North East and is increasing where national and regional rates are decreasing (Source: NASCIS; RAP P1)

Clients with physical disabilities receiving services, Redcar & Cleveland, 2005/6 to 2011/12

The data on service provision provides an indication of what types of services have been provided.  In Redcar & Cleveland, 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).

Clients with physical disabilities by service type, Redcar & Cleveland, 2008/9 to 2011/12

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 Redcar & Cleveland, one-third 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 two in every three of those with physical disabilities currently don’t receive services in Redcar & Cleveland.

Tees estimated number of adults with disability

 

 

Last updated: 05/06/14

5. What services are currently provided?

Adult social care
The local authority undertakes supported self-assessment through three locality teams following referral. For people who meet Fair Access to Care Services (FACS) eligibility criteria, the provision of support is through resource allocation and use of Individual Budgets, where people choose to manage their own support arrangements.

There are 55 care home beds within Redcar & Cleveland in two establishments that provide specialist support. Of these, 20 are occupied by Redcar & Cleveland residents, 27 are occupied by people from outside the borough, 5 are for respite provision and 3 are currently vacant (Nov 2012).

There are several domiciliary care agencies contracted to work in Redcar & Cleveland or people have the option to employ a personal assistant.

Redcar Real Opportunity Centre (ROC) currently provides an Information & Shopmobility service and an Independent Living Resource Service in Redcar that is open to people with physical disabilities.

 

Distribution of spend on physical disabilities, Redcar & Cleveland, 2011/12

Provision

Spend (£thousands)

Percentage of Total Spend %

Direct Payments

1,981

50%

Residential Care

1,088

28%

Care at Home

659

17%

Day Care

134

3%

Other

60

2%

Total

3,922

100%


 

Last updated: 05/06/14

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 9% by 2016, and in 2025 the number will be 25% higher than in 2012 and continuing to increase further by 2030.

Forecast number of people with physical disabilities, Redcar & Cleveland, 2012 to 2030

 

Last updated: 05/06/14

7. What needs might be unmet?

Independent assistance with support planning has been used in the past but is no longer widely available. This may be needed to maintain the continued high levels of uptake of direct payments.

Arrangements for the choice and support in the recruitment and employment of Personal Assistants could be improved.

There is an under supply of accessible single person and shared accommodation in suitable locations.

 

Last updated: 05/06/14

8. What evidence is there for effective intervention?

National Institute for Health and Care 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: 05/06/14

9. What do people say?

Working Together for Change
This is a process that uses person-centred information taken directly from individual reviews, support plans or person-centred plans to inform strategic planning and commissioning. A series of events has resulted in the following feedback:

 

What is not currently working for people:

What is currently working for people:

Transport

Person-centred services

Lack of quality support / care

Choice and control

Support information and advice

Information

Feeling overwhelmed

Rights and entitlement

Communication

Connecting people to communities

Systems are disjointed

Personal growth

Not enough support

Work and volunteering

 

Independence

 

What is important to people for the future?

Emotional Wellbeing

Employment & Volunteering

Good Information & Communication

Planning

Dignity

Staying in Control

Skills

Opportunities

Person-centred care

Home & Housing

Health

Relationships

Transport

Rights & Entitlement

Feeling and Staying Safe

Independence

Family & Friends

Support

 

Families of young disabled people comment on the difficulties they face in the transition from children’s services to adult life.

 

Last updated: 05/06/14

10. What additional needs assessment is required?

There is a gap in information on the use and outcomes from Individual Budgets and a lack of specific information from local people about their experiences.

 

Last updated: 05/06/14

Key Contact

Name: Derek Birtwhistle

Job Title: Commissioning Lead - Disabilities

e-mail: Derek_Birtwhistle@redcar-cleveland.gov.uk

phone: (01642) 771500

 

References

Local strategies and plans

Redcar & Cleveland Borough Council (2013). This is our plan

 

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