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Topic on a Page - Physical Disabilities & Sensory Impairment

Data Sources:

Public Health England (PHE):

Public Health England: Public Health Profiles

Neurology data and analysis: a guide for health professionals Published: May 2017

Local action on health inequalities, Evidence papers, Briefing 5c: Increasing Employment opportunities and retention for people with a long-term health condition or disability Published: September 2014

Neurology services: hospital activity data

Royal National Institute of Blind People (RNIB):

Data Profiles: Sight loss data tool

NHS Digital:

Registered Blind and Partially Sighted People, England 2016-17

Further data sources:

Scroll to the bottom of the page to view and compare further datasets

Supporting Information:

Public Health England (PHE):

Eye Health Needs Assessment: East Midlands and East of England Published: May 2018

National Institute for Care and Health Excellence (NICE):

Challenging Behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges [NG11] 2015

Mental health problems in people with learning disabilities: prevention, assessment and management [NG54] 2016

Diabetic foot problems: prevention and management [NG19] 2015

Learning Disabilities: challenging behaviour [QS101] 2015

Glaucoma Overview

Hearing Loss in Adults: assessment and management [NG98]

Serious Eye Disorders [QS180] Published March 2019

Hearing loss in adults [QS185] Published July 2019

NHS Evidence:

Bells Palsy

Cerebral Palsy

Cystic Fibrosis

Physical Disability

Sight Loss

Hearing Loss

Deafblindness

Sensory Impairment

NHS England:

What Works Guides – Action Plan on Hearing Loss

Vision UK

UK Vision Strategy

Royal National Institute of Blind People (RNIB):

RNIB Outcome Framework: Seeing it my way

Demonstrating the impact and value of vision rehabilitation Published: Aug 2017

Social Care Institute for Excellence (SCIE):

Physical Disabilities

Hearing Loss

Sight Loss

Sensory Impairment

HM Government Policy

Office for Disability Issues

Action on Hearing Loss

Supporting older people with hearing loss in care settings

Linked Topics:

Topic last reviewed: Sept-19

JSNA Topic: Physical Disabilities & Sensory Impairment

Background

Defining disability is complex and contentious. The “social model” and the “medical model” highlight two distinct approaches to disability. The Government encourages the use of the social model which states that disability is created by barriers in society including the environment, people’s attitudes and organisations. The medical model, in contrast, is based on a belief that disability is caused by an individual’s health condition or impairment (Source: HM Government, 2015). Most analysis tends to use limiting long-term illness as the core definition although it should be recognised that limiting long-term illness covers limitation at any level on activities of any kind whereas disability covers a specified set of activities, therefore the prevalence of long-term limiting illness is higher than disability (Source: Public Health Action Support Team, 2011).

The definition of disabled as defined in the Equality Act 2010 includes those who have a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on their ability to do normal daily activities. The term ‘disabled’ is used interchangeably in this chapter to include both those with physical and sensory impairments.

The term ‘physical impairment’ refers to one or more conditions or limitations which may be congenital or acquired at any age, be temporary, long-term, or fluctuating. People with physical impairments may often have unique and multi-dimensional requirements. They therefore require tailored services to address them all in a person-centred holistic fashion.

The term ‘sensory impairment’ encompasses visual impairment (including those who are blind or partially sighted), hearing impairment (including those who are profoundly deaf, deafened or hard of hearing) or with dual sensory impairment (deaf-blindness).

Sensory impairments may, like physical impairments, be congenital or acquired at any age. They are more prevalent with age along with additional sensory or other impairments. Most sensory impairments develop gradually and are often secondary to other disabilities.

Context

National Strategies, Policies & Guidance:

The following information is relevant to people who have or provide support to others with Physical Disabilities and Sensory Impairment:

Department of Health and Social Care
There is a wealth of government policy and initiatives which support disabled and vulnerable adults, including those with sensory impairments. Details can be found on the Department of Health website.

NHS England: Accessible Information Standard
The Accessible Information Standard aims to make sure that people who have a disability, impairment or sensory loss can access and understand information in accessible formats. Mandatory standards are described for providers of NHS care and publicly funded adult social care to make their services accessible for people with disabilities and sensory loss.

The Care Act
The Care Act puts the individual at the centre of the decisions about their care, their health and how they live their lives. It offers disabled people greater choice and control; enhancing independence through self-care and self-management, increasing access to employment and education and offering disabled people opportunities to play an active part in their families and community.

Think Local Act Personal (TLAP)
TLAP is a National Partnership of more than 50 organisations committed to transforming health and social care through personalisation and community based support.

Incontrol
Incontrol is a national charity working for an inclusive society where everyone has support that they need to live a good life and make a valuable contribution.

Fulfilling Potential: making it happen for disabled people
This report and action plan explains how the government will help disabled people fulfil their potential.

Making it real for people with sensory loss
'Making it real' is a TLAP guide, for measuring progress towards personalised care and support. This information is aimed at local authorities, provider organisations, and individuals who provide specific and general sensory impairment services.

Royal National Institute of Blind People (RNIB) Outcome Framework - Seeing it My Way
'Seeing it my way' works to ensure that blind and partially sighted people can access the support and information services needed for independent living.

UK Vison Strategy
Vision UK works in collaboration with partners across the eye health and sight loss sector to deliver positive change for blind and partially sighted people.

The Department of Health and NHS England: Action Plan on Hearing Loss
Hearing loss is a major public health issue that requires urgent action across Government. The purpose of the Action Plan on Hearing Loss report is to encourage action and promote change across all levels of public service. It identifies how hearing needs can be met and improved for children and adults.

NHS England: Commissioning Framework
This framework contains important guidance for CCGs on how to commission cost-effective services that meet the needs of people with hearing loss.

Action on Hearing Loss (AoHL)
The AoHL website contains a wealth of resources to assist and guide both professionals and individuals.

Sense
This resource provides guidance explaining how local authorities should act in relation to care and support for adults and children who are deafblind.

Guidance for residential care homes
This guidance provides a comprehensive guide to caring for those with hearing loss in residential care homes including sign-posted resources.

Local Strategies & Plans

Adult Frailty and Long Term Conditions Commissioning Strategy
This strategy demonstrates Lincolnshire County Council's approach to commissioning social care and support for people with a physical disability or with a sensory impairment.

The key commissioning intentions focus on supporting people to live in their own homes for as long as they wish by developing high quality, personalised services that are flexible, responsive and give people choice and control over how their care and support is provided. The strategy and associated activities support people with eligible needs as outlined by the Care Act. The customer groups supported by this strategy are older people, people with physical disabilities and people with sensory impairments.

What is the picture in Lincolnshire?

What the data is telling us

It was estimated that in 2018 there were 47,246 adults aged 18 to 64 living in Lincolnshire with a long-term illness or physical disability (using Impaired Mobility and personal care conditions on PANSI: note that some clients may be duplicates if they have both impaired mobility and personal care conditions); this represents 6.23%% of the population. (Source: PANSI 2018)

For older people, even more of the county population have a limiting long-term condition or physical disability. It is estimated 40,856 older (over 65) people living in the county in 2018 with a long-term condition or disability that limits their day-to-day activities a lot, with a further 46,683 people having a lesser impact on their day-to-day activities. When the two are combined (87,539), this equates to just under half of the older adult population of Lincolnshire (Source: POPPI 2018).

  • Currently it is estimated that 47,246 working age (18-64) adults and 87,539 older people, living in Lincolnshire have a long term illness or physical disability. (Source: POPPI and PANSI)
  • During 2018/19, Lincolnshire County Council Adult Care supported a total of 1,191 adults aged 18 to 64 with a physical support need (including a sensory impairment). 132 (11%) people were supported in permanent residential care; the remaining 1,059 (89%) were supported in the community with a personal budget. (Source: SALT LTS001a)
  • 6,938 people aged 65 or over with a physical or sensory support need were also supported by the council. (Source: SALT LTS001a)
  • In 2018/19 there were 8,045 new requests for support from people aged 18-64, and 24,143 new requests from people aged 65 or over. (Source: SALT STS001)

This data is supplied to the government as part of the Short and Long Term (SALT) annual statutory return. The 2018/19 data is provisional and has not been published.

People who need some support to live their lives can have equipment to support their mobility needs. The Lincolnshire Integrated Community Equipment Service (ICES) provide equipment to people of all ages including children, with a physical disability to assist with their mobility.

In Lincolnshire 15,886 (2.1% of the total population) adults currently have a moderate or severe visual impairment, this is projected to rise to 20,281 (2.7% of the total population) by 2030. 5,222 adults aged 75 and over have a registrable eye condition as defined by the RNIB (approximately 51% of all people aged 75 and over who have a visual impairment). (Source POPPI and PANSI)

In April 2018, 4,544 people in Lincolnshire were recorded on the Visual Impairment Register and were supported by the Lincolnshire Sensory Services (LSS). Over the last 5 years, there has been an average of 249 new registrations per year.

In Lincolnshire, there are an estimated 164,000 people with hearing loss. (Source: Action on Hearing Loss).

Trend

Emerging trends for people with physical disabilities
The future needs of the population with respect to physical disabilities can be seen mainly from the increase in general population expected over the next 16 years. This increase is predicted by the Office for National Statistics, based on the 2011 census data.

The working age population is expected to remain fairly static; projections suggest a small reduction in young adults aged 24-34.

However, the number in older people is projected to increase by 33.5 % from 2019 to 2035, with the biggest increase amongst the over 90 age group, with a projected 90% increase. The chances of suffering a physical disability increases with age. Therefore this age group are more likely to require help with day to day activities.

Within this group, the number of people in Lincolnshire aged 90 and over is expected to almost double over the same period – from 8,000 to 15,200. The 2011 census also reveals this is particularly acute in East Lindsey which currently has the highest proportion of over 65s compared to anywhere else in the country – a predicted rise from 1,600 to 3,500 people.

Population forecasts based on ONS population projections show that the overall population of Adults aged 18-64 living with a sensory impairment will rise by 1% by 2030. However, this is below the increase that is predicted across the East Midlands (3.1%) and nationally (5%), for the same period (Source: PANSI & POPPI)

Emerging trends for people with sensory impairment
National statistics show that the prevalence of sensory impairment increases with age. In 2019, 11.6% of people aged 65 and over were estimated to have a moderate or severe visual impairment. In Lincolnshire this currently equates to 20,828 people, this is predicted to rise to over 29,620 by 2035 (12.36% of people aged 65 and over) (Source: POPPI).

Age related damage to the cochlear is the single biggest cause of hearing loss. Over 70% of people over 70 have hearing loss, and due to the ageing population, the number of people with hearing loss is set to grow (Source: Davis, 1995). By 2035, Action on Hearing Loss estimates there will be approximately 15.6 million with hearing loss across the country.

Key Inequalities

The Department for Work and Pensions have concluded that more people who live in families with disabled members live in poverty, compared to individuals who live in families where no one is disabled. Of individuals in families with at least one disabled member 19% live in relative income poverty, before housing costs are included, compared to 15% of individuals in families with no disabled member. 21% of children in families with at least one disabled member are in poverty, a significantly higher proportion than the 16% of children with no disabled member.

National research from the Department for Work and Pensions shows that:

  • Disabled people are significantly less likely to be in employment than people without a disability. In 2012, figures from the Labour Force Survey showed that the gap in employment between disabled and non-disabled people was 30.1% (approximately 2 million). However, this figure has reduced by 10% over a 14 year period.
  • People living with a disability are three times less likely to hold a post-19 educational qualification as people who are not disabled.
  • People with a disability are less likely to engage in sporting, cultural and leisure activities and volunteering opportunities than people who do not have a disability.
  • In 2011, fewer people with a disability (61%) lived in a household with access to the internet, compared to 86% of non-disabled people.
  • A fifth of people living with a disability report having problems accessing public transport. For further information please refer to the JSNA topic Access to Transport

(Source - Office for Disability Issues (2014); Disability facts and figures)

People who are deaf and use British Sign Language (BSL) are a linguistic and cultural minority who require culturally sensitive care and support to ensure they can communicate effectively; including the provision of communication support and specialist care.

Current Activity & Services

Lincolnshire County Council provides social care support for people with a physical disability and sensory impairment. People who have an eligible social care need as identified in Care and Support Statutory Guidance can choose appropriate support from a range of services.

At the end of March 2019, there were 2,137 adult care clients with a direct payment, which is a 4% decrease on the previous year. Of these, 530 were younger adults, and 549 older people with a physical disability and sensory impairment. (Source: SALT 1819 LTS001b table 1a/1b) In October 2015, LCC commissioned Penderels Trust to provide a range of support to Direct Payments clients. Challenges remain around older people being able to express the same level of choice and control as younger adults. However, LCC have introduced prepaid cards to support people to be able to manage their Direct Payment, which simplifies the process for the person.

Lincolnshire Sensory Services
The Sensory Impairment Support Service in Lincolnshire provides integrated sensory impairment support, and is provided by Lincolnshire Sensory Services. The service focuses on helping adults and children with sensory impairment to maintain their independence through providing enablement and rehabilitation support, reducing social isolation, encouraging better use of technology and working with health organisations, professionals and families to deliver a holistic approach to care. The key aims of the service are:

  • To deliver advice, advocacy and liaison
  • To assess need, produce support plans and review progress
  • To support home management and life skills
  • To set up and maintain homes/tenancies
  • To provide general support and promote well-being

Additional local services for people who are have a visual impairment
The Specific Needs Library Service provides a range of alternative format books – this includes over 13,000 titles in CD or tape format for people with a visual impairment.

The RNIB is a national organisation that supplies advice and support for those affected by sight loss, this includes; a comprehensive library service in a variety of formats, newspapers and magazines, physical adaption equipment and practical and emotional support to help those affected come to terms with sight loss and 'to live life again'.

Lincoln & Lindsey Blind Society and South Lincolnshire Blind Society (SLBS) are independent voluntary organisations whose aim is to enhance the quality of life for blind, partially sighted and visually impaired people whatever their age or personal circumstances in life. They offer practical help, advice and assistance.

The United Lincolnshire Hospital Trust has a Lincolnshire Eye Clinic Liaison Officer (ECLO) located within the hospital. The service acts as a bridge between health and social care services for people with sight loss and supports people to navigate and access the community and statutory support available to them, as well as providing emotional support with the impact of sight loss, and so improves independence and wellbeing outcomes.

Additional local services for people who have a hearing impairment
Deaflincs is a local sign language interpreting service.

Disabled Facilities Grants
Disabled Facilities Grants enable district councils to provide funding that assists vulnerable homeowners or private sector tenants to repair, improve, maintain or adapt their home. Homeowners may need assistance because they are older, disabled or on low income. Adaptions can include stair lifts, level access showers and extensions. The provision of DFGs is mandatory, and local authorities must consider this when assigning budgets to housing provision.

Disabled Facilities Grants are subject to means testing and an assessment needs to be completed by an Occupational Therapist. They consider whether an adaptation is necessary and appropriate. Further details on Disabled Facilities Grants can be found in the JSNA Housing and Health topic.

The Wellbeing Service
The Wellbeing Service (WBS) is a generic service, available to individuals aged 18 years and over across Lincolnshire. The service delivers equitable service provision to eligible residents throughout Lincolnshire. The aim of the WBS is to promote independence and support the trend towards independent living in an individual's own home through the delivery of community based support and facilitation within care and health settings. The Wellbeing Lincs website gives further information on the service.

The WBS consists of the following six components:

  • Assessment;
  • Generic support – providing up to a maximum of 12 weeks support based on the needs established in the assessment;
  • Hospital and care in-reach – a promotion function to develop the referral pathway into urgent healthcare better;
  • Small aids and adaptations – installation of aids and adaptations that the service user purchases, based on their needs assessment;
  • Resettlement – a resettlement service which meets individuals at home, post a stay in hospital or care facility, ensuring needs are assessed and planned for upon returning home; and
  • Telecare Response – a 24 hour response service to telecare alerts where the individual registers and pays for the service. This service also has the ability to provide falls assessment, lifting, and emergency personal care where required.

Unmet Needs & Gaps

Data showing unmet need at a lower geographical level should be sourced to help to identify any unmet needs or gaps across the county. Qualitative information from people with a physical disability could be used to identify where these unmet needs are located. The gap between the number of people currently estimated to be living in the county with a long-term condition aged over 65 (n=87,539), people who have a personal care disability aged 18-64 (n=22,056), and all people predicted to experience impaired mobility (n=57,355) along with those who are supported by council-arranged social care services (n=8,806) is sizable. However this indicates that people with a physical disability are self-managing or looking to arrange their own support and care. (Source: POPPI, PANSI & SALT LTS001a)

Local Views & Insights

The annual user survey of people who use social care allows the council to know what people think and feel about the care they receive or do not receive. In 2019 1,058 people were surveyed and there was a return rate of 40% (423 people); of the respondents, 265 people had a physical disability or sensory impairment. The results outlined that:

  • 15% of respondents reported that their general health was bad or very bad (up from 13% in 2018) and 34.4% felt their general health was fair. 51% said they were in good or very good health (up from 38% previous year).
  • 52% are able to get around indoors (except steps) easily by themselves (up 4% from 2017-18).
  • 53% can easily get in and out of a chair, or bed, easily without assistance.
  • 78% of service users are able to easily feed themselves without help.
  • 30% are able to bathe or shower easily without assistance (up 2% from 2017-18).
  • 42% of service users easily manage to dress and undress themselves (up 5% from 2017-18).

(Source: ASCS 18/19)

Risks of not doing something

The predicted increase in people with a physical disability or sensory impairment over the next few years will require a proportionate increase in services available to meet this need.

Physical and sensory impairments can have a substantial effect on a person's ability to carry out normal day-to-day activities. People with physical or sensory impairments are more likely to live in poverty and experience problems with housing, transport, hate crime and harassment as well as a lack of support to access opportunities to improve the quality of their life.

People with Physical Disabilities
In 2014, 10% of people aged 18 to 64 were estimated to have a moderate or serious physical disability in England. This is just over 3.3 million people across the country. (Source: Office for Disability Issues (2014))

People with a visual impairment
Approximately 10% of UK blindness registrations are attributed to glaucoma. Around 2% of people aged over 40 years have Chronic Open Angle Glaucoma (COAG), rising to almost 10% of people aged over 75 years who are white Europeans. Prevalence may be higher in people of black African or black Caribbean and Asian descent or in people who have a family history of glaucoma. With changes in population demographics the number of people affected is expected to rise (Source, NICE).

People with a hearing impairment
In 2015, Action on Hearing Loss stated that 11 million people across the UK were identified as having hearing loss, about one in six of the population. Hearing loss is a serious health condition that can have an adverse impact on a person’s health and quality of life. People with hearing loss or deafness may find it difficult to communicate and are at greater risk of isolation and other health problems such as anxiety and depression.

A significant body of evidence shows that hearing loss can have an adverse impact on a person’s health and quality of life, and studies have found that hearing loss is independently associated with:

  • Increased use of health services
  • Increased burden of disease amongst adults
  • Increased risk of mortality
  • More frequent falls
  • Diabetes
  • Stroke
  • Sight loss

Evidence suggests people with learning disabilities are more likely to develop hearing loss earlier compared to the general population and are at greater risk of associated health problems.

In Healthcare settings, people with hearing loss may struggle to hear what is being said due to poor deaf awareness and the lack of communication support. This may lead to confusion over diagnoses – and ineffective care. Action on Hearing Loss Access All Areas research showed that, after attending an appointment with their GP, more than a quarter of survey respondents (28%) had been unclear about their diagnosis and approximately a fifth (19%) had been unclear about their medication.

People who use British Sign Language (BSL) can experience inequality of support. Research by the Our Health in Your Hands campaign demonstrates:

  • 68% of survey respondents who asked for a sign language interpreter for their GP appointment didn’t get one,
  • 41% felt unclear about their diagnosis because they couldn’t understand the sign language interpreter.

Prevalence data suggests that at least 70 people in every 100,000 over the age of 60 are Deaf-blind. 'Deaf-blindness' is a distinct impairment, which can be congenital, or acquired. It is a unique impairment with specific impacts upon the lives of individuals. The difficulties that it creates for communication, mobility and access to information are vast. The impact upon an individual of dual loss is significantly different from that of a single loss; as an individual’s ability to compensate is reduced. The age of acquisition of deaf blindness is a significant factor in the scale of its impact.

What is coming on the horizon?

Lincolnshire County Council has re-confirmed its commitment to personalising social care for people with a physical disability or sensory impairment.

Lincolnshire County Council's Strategic and Commissioning Objectives for 2018-2021 include:

  • Working with providers to offer flexible support services for people with complex physical disabilities both at home and in residential settings, focusing on individualised and creative approaches, for example introducing Individual Service Funds (ISFs) and increasing the uptake of Direct Payments.
  • Offering opportunities for organisations who would like to provide community supported living for people with learning disabilities and physical disabilities.
  • Working in partnership with district councils and independent providers to support the development of extra care housing across the county to meet estimated demand over the next 20 years that will not only support older people, but also ensuring these schemes are multi-generational enabling them to support working age adults with care and support needs.

What should we be doing next?

There are a number of data sources which, once captured and analysed, will allow a more accurate picture of need for people living with a physical disability or sensory impairment in the county. The topic owner will take steps to update this JSNA topic with the data / information missing from this section, as it becomes available.

  • Discussions with key stakeholders to ascertain whether any new services have emerged or any gaps in service provision have been identified.
  • Details about Health initiatives to support people with a physical disability or sensory impairment. Health partners and key stakeholders will be consulted on the gaps.
  • The number of Care and Support needs met by non-commissioned community-provided support.

 

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