Physical and sensory impairment

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Living and working well

Physical and sensory impairment

Introduction

This chapter of the JSNA includes an overview of long-term limiting illness and disability and the levels of physical and sensory impairment within Wokingham. There is no authenticated disability data source and no single definitive measure of disability, so estimates of disability prevalence vary between surveys according to the definitions of disability that are chosen and the motives of the collector. This chapter therefore provides a variety of information from different sources which may be relevant for future commissioning priorities.

The term ‘Physical Impairment’ refers to people who have one or more physical impairments which may be congenital or acquired at any age, be temporary, long-term, or fluctuating. People with physical impairments often have unique and multi-dimensional requirements; so they require tailored services to address their needs provided in a person-centered holistic fashion.

The term ‘Sensory Impairment’ encompasses visual impairment (including sight impaired or severely sight impaired), hearing impairment (including those who are profoundly deaf, deafened and hard of hearing), and dual sensory impairment (deaf blindness). Sensory impairments may, like physical impairments, be congenital or acquired at any age. They are more prevalent with age, as are additional sensory and other impairments. Most sensory impairments develop gradually and are often secondary to other disabilities.

Information on some of the specific long-term health conditions which could result in disability, such as cardiovascular disease, is included in other chapters. Similarly, information on learning disabilities, autism, and mental health are also included elsewhere.

Disability affects all age groups and all parts of the population, although some communities have a higher incidence of certain chronic conditions. Many impairments and illnesses are particularly associated with ageing, whilst some people have a lifetime disability; additionally some other disabilities are acquired by either accident or disease. Some people have multiple long-term conditions which can lead to complex health and care needs.

There are two main models that have been developed to conceptualise disability - the medical and social models. The medical model focuses on the individual and regards disability as being caused by the impairments that prevent an individual from living a normal life.

The Disability Discrimination Act definition of disability is based on the medical model. The social model turns the cause of disability around and proposes that the inability of those with impairments to undertake social activities is caused by “the erection of physical or attitudinal barriers by the non-disabled majority that constrain the lives of people with impairments”.

Much of the data on disability prevalence that is collected in the UK is based on the medical model. The social model is, however, becoming increasingly important within the social policy context. It is acknowledged there is a gap in having sufficient information to quantify the effect of the environment on an individual’s experience of disability, particularly at a local level.

Nationally, through work from the Office for Disability Issues, it is understood that 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. 19% of household with a disabled member live in poverty (on a housing cost basis) compared to 15% where no member is disabled. 21% of children in families with a disabled member are in poverty, compared to children in other households where 16% live in poverty.
Less likely to have formal, recognised, educational qualifications
More likely to be economically inactive – only 50% of disabled people of working age are currently in employment, compared with 80% of non-disabled people
More likely to experience problems with hate crime or harassment – 25% of all disabled people say that they have experienced hate crime or harassment, and this percentage rises to 47% for people with mental health conditions
More likely to experience problems with housing – 90% of families with disabled children have problems meeting their housing needs
More likely to experience problems with transport; this issue is raised most frequently by disabled people as their biggest challenge
More likely to experience problems with access to information and guidance relating to their condition and care#
More likely to have difficulties in accessing health and care services

Also of relevance nationally are the following areas, originally highlighted in the National Service Framework for People with Long-term Conditions in 2005:

There is a wide variety of long-term neurological conditions, with people having very different experiences. Conditions may be present at birth (e.g. cerebral palsy) and some of these may be associated with varying degrees of learning disability. Other conditions appear in childhood (e.g. Duchenne’s muscular dystrophy) or develop during adulthood (e.g. Parkinson’s disease)
Approximately 10 million people in the UK have a neurological condition and 20% of acute hospital admissions are due to this
2 people in every 100,000 experience a traumatic spinal injury every year
Approximately 350,000 people across the UK require support with daily life because of a neurological condition and 850,000 people are carers for people with neurological conditions

Some Black and Minority Ethnic (BME) groups are at higher risk of developing eye conditions than the UK average:

African and African Caribbean ethnic groups are four times more likely to develop Glaucoma and are also at higher risk of developing age-related macular degeneration under the age of 60
People of South Asian ethnicity are at a higher risk of developing cataracts
African, African Caribbean, and Asian ethnic groups are at a higher risk of developing Diabetic eye disease

Our website contains details of services available to children, young people and adults with disabilities or long-term conditions.

The Office for Disability Issues (2014 estimates) estimated there were 11.6 million people in Great Britain with a longstanding illness, disability or infirmity who have a significant difficulty with day-to-day activities:

0.8 million children
5.7 million adults of working age
5.1 million over pension age

Based on disability prevalence it is estimated that, in 2011/12 there were:

6.5 million with mobility difficulties
6.3 million with difficulties in lifting or carrying
2.8 million with manual dexterity difficulties
1.8 million with continence problems
2.2 million with communication difficulties
2.5 million with difficulties with their memory, concentration or learning skills
0.8 million who have problems recognising when they are in danger
2.7 million experiencing difficulties in physical co-ordination

The 11.6 million people with a longstanding illness, disability or infirmity who have a significant difficulty with day-to-day activities, mentioned earlier, have at least one of the impairments above.

In 2014 the “Projecting Adult Needs and Service Information” team estimated that 10% of the working age population had a moderate or serious disability; just over 3 million people.

The percentages of working age people with a sensory impairment were estimated at:

3.8% with moderate or severe hearing impairment
0.03% with a profound hearing impairment
0.07% with a serious visual impairment

Sensory impairment increases with age, for people aged over 65 these estimates rose to:

41.9% with moderate or severe hearing impairment
1.1% with a profound hearing impairment
8.8% with a moderate or severe visual impairment

As the definition of disability differs dependent on context, there are no firm estimates for the numbers of people in Wokingham living with a disability.

When commissioning services for people with disabilities, it needs to be remembered that around 600 people (with disabilities which impact a lot on their lives) live in villages, hamlets or rural areas. The difficulty of accessing suitable transport to services in urban areas might limit their ability to use centralised services.

Wokingham had 426 people claiming Personal Independence Payments as at October 2015.

National disability benefits are still in transition from Disability Living Allowances to Personal Independence Payments, so aggregated data is hard to find and, potentially, includes some duplication.

The Care Act 2014, ich is being phased in over the period 2015 to 2020, pulls together legislation on assessments and service provision for people with disabilities leading to social care needs. It also covers the transition arrangements for children with special educational needs into Adult Services. The Care Act also introduces a common eligibility threshold for access to services, replacing the FACS guidance and the ability of each local authority to set its threshold “in relation to the budget available”.

The Department for Work and Pensions (2013) Fulfilling Potential: Making it Happen outlines specific actions to improve outcomes for disabled people (education, employment, income, health and wellbeing, inclusive communities, choice and control), timelines and how progress will be monitored.

Department of Health (2010) A Vision for Adult Social Care: Capable Communities and Active Citizens sets out the principles of personalisation and putting outcomes at centre stage.

Research has indicated that there are significant numbers of people who have not been identified as having a long-term condition (either because they have not contacted the health service or they are unaware of their condition) and are therefore not receiving any treatment. People with long-term conditions tend to be more intensive users of health and care services and these conditions are a major contributor to health inequalities. National strategies aim to improve prevention and management of long-term conditions through their early identification, promoting self-care and providing effective treatment.

The Equality Act 2010 defines a disabled person as anyone with an impairment that has a long-term adverse effect on his or her ability to carry out day-to-day activities.

If you need help in your home there are personal care and support services that can help you.

There are different types of homecare and support services that can help with various aspects of your home life:

Personal care, such as help with washing or dressing
Companionship and befriending
Preparing and cooking meals
Household chores, such as cleaning and vacuuming
Help with your garden
Household repairs and maintenance

Preparing for adulthood

Preparing for adulthood means preparing for:

Higher education and/or employment - this includes exploring different employment options, such as support for becoming self-employed and help from supported employment agencies
Independent living - this means young people having choice, control and freedom over their lives and the support they have, their accommodation and living arrangements, including supported living
Participating in society, including having friends and supportive relationships, and participating in, and contributing to, the local community
Being as healthy as possible in adult life

For every child or young person with an Education, Health and Care Plan, preparing for adulthood should be discussed from day one, and support provided to help them to develop skills that will help them to be as independent as possible in adult life.

Between the ages of 14 and 25 is a time of many changes for all young people. For those with Special Educational Needs and Disabilities and their families, these changes can seem daunting. They may involve the following:

Leaving school
Starting college, or employment
Change of health providers, who you may have known for a long time
Change of social care providers
Moving out of the family home

A consultation event carried out by BADGE on behalf of the Office for Disability Issues in 2012 highlighted the importance of supporting disabled people to access employment and learning, including individual support to find a job, work with employers and improved transport options.

As the population ages, more people have to live with long-term conditions and disabilities. National projections show:

People aged 18-64 predicted to have a moderate or serious physical disability in Wokingham

Welfare reform will impact on disabled people of working age and carers through the reassessment for Disability Living Allowance and the move to Personal Independence Payments, and through the shift to Universal Credit and the tie in of Carers Allowance. Disabled people will also be impacted by other welfare changes such as withdrawing the spare bedroom subsidy and Council Tax Credit. Some disabled people will be impacted by multiple changes to their benefits. As these changes are currently being implemented, it is unclear to what extent the reduction in income for disabled people will impact on their ability to live independently and requirement for support from health and care services.

Wokingham projection from Projecting Older People Population Information (POPPI)

To find out more download limiting long term illness (PDF document).

The Projecting Adult Needs and Services Information System uses Office for National Statistics population projections and the number of people registered with a sensory impairment to project how many people aged 18 to 64 will have a visual or hearing impairment from 2012 to 2020. Around 3,900 adults in the Wokingham Borough are estimated to have moderate or severe hearing impairment in 2012 with 34 estimated to have a profound hearing impairment. These figures are estimated to rise to around 4,300 and 38 by 2020. 63 adults are estimated to have a serious visual impairment.

National Demographics from the Office for Disability Issues show that there are 11.2 million disabled people in Great Britain. 5.2 million are working-age adults, 5.2 million are over State Pension age and 0.8 million are children. The Family Resources Survey 2010/11 shows that the most commonly-reported impairments are those that affect mobility, lifting or carrying.

According to the Labour force survey 2012, disabled people are now more likely to be employed than they were in 2002, but disabled people remain significantly less likely to be in employment than non-disabled people. In 2012, 46.3% of working-age disabled people are in employment compared to 76.4% of working-age non-disabled people. There is therefore a 30.1% gap between disabled and non-disabled people, representing over 2 million people. The gap has reduced by 10% over the last 14 years and has remained stable over the last two years despite the economic climate.

The Citizenship Survey 2010/11 shows that disabled people remain significantly less likely to participate in cultural, leisure and sporting activities than non-disabled people.

The Projecting Adult Needs and Services Information System estimates that in 2012 around 7,700 people aged 18 to 64 had a moderate physical disability in the Wokingham Borough. 2,300 were estimated to have a serious physical disability. These figures are estimated to rise to around 8,400 and 2,525 by 2020.

Current activity and services - assessment and brokerage

Wokingham Borough Council’s Adult Social Care Assessment Teams carry out assessments of needs. This will establish whether a period of reablement or the provision of equipment or adaptations will be sufficient to support the person. If a person with a physical disability is assessed as having on-going needs that are eligible for social care services, an amount of money (a personal budget) is allocated to meet these needs (this is also subject to a financial assessment). This can be taken as a Direct Payment or can be managed by the council.

Safeguarding

The Care Act puts Adult Safeguarding on a legal footing. Safeguarding is defined as “protecting an adult’s right to live in safety, free from abuse and neglect. The Adult Social Care teams respond to concerns of abuse harm and neglect by carrying out investigations under section 42 of the Care Act 2014. We work closely with our partners such as the police, fire service and health colleagues and the providers of services to ensure good outcomes for our customers.

The Council’s traded company, Optalis, provides brokerage services for people with personal budgets. Optalis also manages a number of support services such as day care, employment services, home care, supported housing services and sensory needs services. All services are tailored to meet the individual needs of social care customers.

Sensory Needs Service (Optalis)

The Wokingham-based Sensory Needs Service serves Wokingham Borough Council and is managed by Optalis, which is the Council’s traded company. The service provides statutory specialist assessments, registration duties and operates with strong emphasis on their social care and reablement functions. Although working mainly with adults, they also carry out registration and transitional work with children and young adults.

Services for people with visual impairments include:

Advice, training and equipment
Independent living skills, orientation and mobility
Referrals to other services e.g. Occupational Therapists
Advice on accessing personal budgets
A Braille Printing Service
A Communicator Guide Service for Deafblind people

Services for deaf people include:

Support from a social worker
Advice, guidance and assistance on a wide range of issues, to help support positive independent living
Information about essential equipment to assist and improve daily living in the home
Information on deaf issues
Information on deaf clubs and where to meet other people
Information on interpreters

Day care opportunities

Personal budgets offer great flexibility for choosing support and care services. People with physical disabilities have access to day care services in specialist day care settings, such as Westmead, but can also take part in community based activities, such as trips out, leisure and sports activities, lunch clubs and pursue specialist hobbies. In 2012/13, 210 people with physical disabilities aged 18 to 64 and 180 people with physical disabilities aged 65 and over were using day care services.

Home care

Home care services are predominantly used by people with physical disabilities who are over 65 (505 in 2012/13) as opposed to people aged 18 to 64 with physical disabilities (85 in 2012/13). Personal budgets enable social care customers choose the providers of their home care services.

Employment support

Specialist employment support service for people with all disabilities is provided by Optalis. Services include interviewing skills, job searching and job coaching and one-to-one employment support. Job Centre Plus and Connexions also provide employment support services locally.

Physical activities

Wokingham Borough Council funds a sports activities programme (SHINE+) for people with disabilities and carers. Activities include swimming, physical exercises, massage and ball games.

Advocacy services

Just Advocacy provides advocacy services to social care customers and carers in Wokingham Borough, when required.

Voluntary sector organisations

Activities, support, advice and information for people with physical disabilities and sensory impairments is provided by a number of local organisations. Involve is an umbrella organisation supporting and empowering the voluntary and community sectors across Bracknell Forest and Wokingham providing a central support organisation for volunteers, communities and faith groups. Activities can range from gardening opportunities offered by centres such as Thrive, Riding for the Disabled or sailing offered by Burghfield Sailability as well as smaller, more focussed groups providing friendship and reducing social isolation.

Blind and visually impaired people are supported by the Berkshire County Blind Society which offers trips out, advice on equipment, visiting services and social activities. Similar services are offered by the Reading Deaf Centre for people who are deaf or hard of hearing.

Signposting to services

Wokingham Borough Council website has a directory that provides information and advice on local and national support groups, clubs and organisations, including services for people with physical disabilities and sensory impairments.

Local views

A group of nine physically disabled social care customers with personal budgets were trained as Choice Champions to provide support to people new to personalised services and represent their views.

There are a wide range of activities and support for people with physical disabilities and sensory impairments. However, there is not a lot of local data about specific or unmet needs of people with physical disabilities and sensory impairments. Moreover, there is not a lot of co-ordination across services.

People with physical disabilities find it more difficult to find and sustain employment. The Employment Service provided by Optalis supports people with physical disabilities, but in the current financial climate, employment opportunities are few and far between.

In addition, people with physical disabilities that live in rural areas, experience difficulties with transport as public transport (for example accessible buses) is limited or unavailable. This, in turn, limits access to other services such as health, support and leisure.

What are the unmet needs/ service gaps?

Lack of appropriate housing, in particular for those with a learning disability
Accessible and affordable transport in rural areas is limited
Low level of awareness of sports and leisure activities and support services
Lack of support services for people with physical disabilities who do not use health or social care services (for example specialist health advice, self-support groups and clubs)
Lack of apprenticeship and volunteering opportunities

Recommendations for consideration by other key organisations such as: CCG’s, General Practices, Local Authority department e.g. housing and other providers:

Review accessibility of transport for disabled people
Promote Wokingham Information Network across services
Record more detailed information about the local needs of people with physical disabilities and sensory impairments , particularly among BME communities and deprived areas
Work with local employers to create apprenticeship / volunteering opportunities as a step into permanent employment