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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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)
An efficiency, improvement and transformation review of all services is being undertaken which will highlight service gaps and areas in need of development.
2. What commissioning priorities are recommended?
No additional commissioning priorities identified following review in 2016.
3. Who is at risk and why?
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).
Disabled people tend to earn at a lower hourly rate (£11.78) than non-disabled people (£12.88) (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).
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.
(Source: Department of Health, 2005).
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).
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).
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.
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:
Stockton Independent Living Centre (SILC)
Home Care Service
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.
Teesside Ability Support Centre (TASC)
Tees Valley Counselling Trust
Home Improvement Agency
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.
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.
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.
8. What evidence is there for effective intervention?
National Institute for Health and Clinical Excellence (NICE)
The National evaluation of the Individual Budget pilots notes that -
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:
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.
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.
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.
Name: Liz Boal
Job Title: Strategic Commissioning Manager
phone: (01642) 524553
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.
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