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: 2017-01-11 14:52:25
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1. What are the key issues?

People with physical disabilities should be supported to enable then to live as independently as possible and achieve their full potential.

With the predicted older population increase of around 4,000 every five years to 2025 and a predicted further increase of 5,000 to 2030 (Source:POPPI)  there will be a proportionate increase in physical disabilities as a result of the aging process.

Many people with a physical disability also have a learning disability. Appropriate support needed to help the person cope with their physical disability should be addressed equally.

People with physical disabilities are more prone to mental health problems due to the problems they face as a result of their disability and the barriers caused by society.

Prejudice, hostile or benevolent, still exists towards people with a physical disability.

Services, facilities and training / education should be easily accessible to people with a physical disability.

The number of people aged 18-64 who have a moderate physical disability in 2015 is not  predicted to rise from 2011 levels but by 2020 there is a predicted rise of 1.5% on 2011 levels. The levels are then predicted to fall again by 3% from 2020 to 2030.

The number of people aged 18-64 who have a severe physical disability is predicted to fall slightly by 0.6% in 2015 but rise again by 2020 by 2.1% on 2011 levels. There is then a predicted fall of 3% from 2020 to 2030.

There is concern that services for adults with physical disabilities will come under considerable pressure due to the current economic climate and budget deficit measures particularly when there is no predicted increase of number of people with physical disabilities in the next few years.

Key outcomes have been identified in ‘Fulfilling Potential: making it happen' (2014)

Education

Disabled people told us that education is fundamental, not just in school but in higher and further education, and in lifelong learning.

Employment

Being in employment is a key life outcome, but also a driver for many of the other strategic outcomes.

Income

Disabled people are more likely than non-disabled people to experience material deprivation.

Health and well-being

Health outcomes are very important for everyone. Disabled people can experience poor health outcomes either as a direct or indirect result of their condition. Well-being presents an overarching indication of how satisfied disabled people feel with their life overall.

Inclusive communities

Communities that are inclusive to all people enable everyone to participate in and access all aspects of society. Particularly important to disabled people are transport; housing; social participation; friends and family; information and access; and attitudes.

Choice and control

To achieve independent living, disabled people should have the same choice and control in their

 

An efficiency, improvement and transformation review of all services is being undertaken which will highlight service gaps and areas in need of development.

Last updated: 11/01/17

2. What commissioning priorities are recommended?

No additional commissioning priorities identified following review in 2016.

2012/01
Implement the goals set out in “Our health, our care, our say” to help people with a physical disability live fulfilling lives and achieve to their full potential by receiving the support they need.

2012/02
Stimulate the local market to provide more innovative and cost-effective ways of providing support and meeting the needs of people with physical disabilities.

2012/03
Involve people with physical disabilities fully in the planning of future services to ensure services meet their needs.

2012/04
Reduce prejudice against people with physical disabilities in the community and workplace.

2012/05
Continue to improve access to services, facilities, training and education for people with physical disabilities.

2012/06
Ensure the rise in the older population and associated increase in physical disability is taken into account when commissioning services.

2012/07
Implement the recommendations of the efficiency, improvement and transformation review of all services.

2012/08
Ensure services are providing quality and value for money.

Last updated: 11/01/17

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: 11/01/17

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

The number of clients receiving services increased from 5,700 in 2005/06 to 6,300 in 2010/11, but dropped to 5,700 in 2011/12.  The rate of service provision in Stockton-on-Tees is above both England and the North East (Source: NASCIS; RAP P1).

Stockton trend adult physical disability receiving services

 

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

Stockton adult physical disability by servce 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 Stockton-on-Tees, 30% of those with severe physical disability (age 18-64) or with a limiting long-term illness (age 65+) receive services, compared with 23.1% 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 Stockton.

Tees estimated number of adults with physical disability

 

Last updated: 11/01/17

5. What services are currently provided?

A range of services is provided to support people with a physical disability and their carers in Stockton-on-Tees.  These include:

  • assessment of needs and person-centred action planning;
  • adaptations to the home and equipment to make managing everyday tasks easier;
  • benefit entitlement advice;
  • advice on independent living in the community;
  • advice on local support groups, education and employment;
  • direct payments which give people the option to arrange their own services specific to their personal situation;
  • support and rehabilitation, provided though the Intermediate Care Service, to help people regain their functioning resulting from illness, disability or injury;
  • self-directed support through personal choice by either accessing services that the council provides, through approved services provided by an independent organisation or through the offer of a direct payment.

Stockton Independent Living Centre (SILC)
An equipment demonstration centre based in Hardwick, where people can try disability equipment so that they can decide which things are right for them before buying.  It provides a stroke clinic to support victims of strokes and their carers.

Home Care Service
This helps people to maintain their independence in familiar surroundings at home.

Extra Care
Stockton Borough Council provides opportunities for people who are older and / or have a physical disability to live in ‘Extra Care’ accommodation. There are currently three schemes in Stockton-on-Tees, providing over 100 housing units.

STEPs
The STEPs service was established in 2001 by Stockton Borough Council; it provides direct employment support to residents of Stockton and has a broad engagement with employers across the Teesside area. 

The service provides support to access vocational training and employment opportunities for disabled people with a diverse range of needs, including physical disabilities, mental health, learning disabilities and sensory disabilities.

STEPs seek to build on individuals’ aims and interests to support them in developing skills and to achieve realistic employment goals. A ‘stepping stone’ approach is used with all clients to ensure progression is at their pace. The service supports individuals with initial one to one support, practical advice and guidance and in identifying and accessing opportunities, overcoming barriers to employment and in building self-confidence.
Additionally the STEPs Employment Service provides support, advice and guidance to employers, including disability awareness guidance, support around retention, advice on aids and adaptations and ongoing support for as long as is needed.

Teesside Ability Support Centre (TASC)
TASC provides social care and life skills learning opportunities for disabled adults in a day centre setting.  Activities are carried out both in-house and externally at local colleges of further education, with a variety of courses being offered. A wide range of sports and leisure activities is available. Service users are trained in basic skills thereby creating work placement and work experience for the members. The emphasis of the training is to increase self-confidence and to maximise potential to live as independent a life as possible.

Tees Valley Counselling Trust
This is a free, specialised counselling service to meet the needs of people who have a physical disability, chronic illness, or are the carers of such a person. Counselling is provided to adults aged over 16 and play therapy is used, where appropriate, for children aged 5 to 16.

Telecare services
These provide a range of sensors to detect potentially dangerous situations.

Home Improvement Agency
This is a low-cost essential adaptations scheme which provides for minor works at home. These facilitate hospital discharge or reduce the risks of accidents occurring in or around the home.

Shopmobility
This service allows hire of electric scooters, electric and conventional wheelchairs and walking aids.  For those who cannot manage alone or prefer not to go out alone, trained escorts are available.  Long-term hire of the equipment (for example, for holidays) is available.

Information and guidance on welfare benefits, social care, and consumer issues, as well as a wide range of information covering disability related topics, such as choosing equipment and services is provided.

A large range of disability equipment is supplied, including servicing, repairs and maintenance.

Training and guidance on the safe use of mobility scooters and on the legislation for particular classes of vehicle can be provided.  Funding has been reviewed for this service with the EIT recommendation being that the service should move to a sustainable self funding model. The aim is that this will be in place by April 2018.

Personal budgets
The provision of personal budgets allows individuals to purchase services to meet their needs in innovative ways.

 

Last updated: 11/01/17

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 10% by 2016, and in 2025 the number will be 35% higher than in 2012 and continuing to increase further by 2030.

Stockton forecast physical disability numbers

 

Last updated: 11/01/17

7. What needs might be unmet?

More appropriate accommodation to promote independent living is required.

There are insufficient placements for young people with physical disabilities.

There is insufficient / ineffective support to assist individuals in taking part in community life.

Individuals feel they are subjected to effects of prejudice in the community and workplace.

There is limited access to training, education and employment.

Mental health issues are often not identified at an early stage.

 

Last updated: 11/01/17

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: 11/01/17

9. What do people say?

A survey of public perceptions of disabled people showed that since 2005, attitudes towards disabled people have improved, overall (Office for Disability Issues, 2010).

However, the table below shows how more people with a disability feel there is a lot of prejudice than they did in 2005. The survey included all disabilities.

How much prejudice people feel there is against disabled people, by disability status and year

 

A lot

A little

Hardly any

None

Disabled 2009

36%

38%

19%

6%

Disabled 2005

33%

42%

16%

8%

Non-disabled 2009

24%

56%

14%

5%

Non-disabled 2005

23%

51%

17%

8%

Source: Office for Disability Issues, 2010


 

Last updated: 11/01/17

10. What additional needs assessment is required?

There is a need for increased service user feedback to enhance commissioning needs assessments. Feedback should provide good quality data around satisfaction levels and patterns of uptake.

A clearer indication of service uptake could be achieved by clearer disability classifications.

An assessment of current services could promote social inclusion by identifying areas where improved services are required.

 

Last updated: 11/01/17

Key Contacts

 

Name: Liz Boal

Job Title: Strategic Commissioning Manager

e-mail: elizabeth.boal@stockton.gov.uk

phone: (01642) 524553

 

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 (2014). Fulfilling Potential: making it happen

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