Physical disabilities and sensory loss

Introduction

There are over 11 million people with a limiting long term illness, impairment including sensory loss, or disability in Great Britain (Department for Work and Pensions, 2010). The demographics of our society are changing. People are living longer and coupled with the effects of lifestyles which can adversely impact on our health and well-being.

This will mean that over the next 20 years there is expected to be a significant increase in the number of people living with long term conditions. This presents a challenge to all of us to ensure that safe, effective and person-centred services are in place to support people with long term conditions. (Department of Health, Social Services and Public Safety, 2012).

What do we know?

The prevalence of disability rises with age. Some 6 percent of children are disabled compared to 16 percent of working age adults and 45 percent of adults over 65 in Britain (Department for Work and Pensions, 2010).

Macular Disease is the most common cause of visual impairment in the developed world and is most prevalent in people aged 60 and over. Whilst currently one in seven people in UK are deaf or hard of hearing (Action on Hearing Loss, 2013).

Whilst the vast majority of people with visual impairment within Bracknell Forest are older adults, there is small cohort of younger adults with inherited conditions, primarily Usher Syndrome and/or Retinitis Pigmentosa, who require life-long intervention.

Facts, figures and trends

Moderate and severe disability projections

The Health Survey for England has been used to estimate the prevalence of moderate and serious physical disability for adults aged 18-64 in local authority areas. In 2014, Bracknell Forest was estimated to have 5,716 people with a moderate disability (table 1) and 1,670 with a severe disability who were aged 18 to 64 (table 2). These numbers are expected to increase in line with the overall population growth in the Borough.

Table 1 shows people aged 18-64 in Bracknell Forest predicted to have a moderate disability projected to 2030.

2014	2015	2020	2025	2030
5,716	5,806	6,113	6,280	6,274

Table 2 shows people aged 18-64 in Bracknell Forest predicted to have a serious disability projected to 2030.

2014	2015	2020	2025	2030
1,670	1,704	1,823	1,893	1,888

Source: Institute of Public Care – PANSI & POPPI databases + ONS

Disability Living Allowance

Disability Living Allowance (DLA) is provided to people of all ages and is the main benefit for people who are disabled. Annual figures show the number of claimants is falling:

In November 2015, Bracknell Forest had a higher percentage of the working population claiming DLA than the English average.

The number of children and young people claiming DLA is also high and is a useful indicator of future demand for adult social care services.

Source: Department fro Work and Pensions data via NOMIS web

Visual impairment

It is predicted that currently 48 people aged 18-64 in Bracknell Forest have a serious visual impairment (Institute of Public Care POPPI & PANSI databases).

It is also predicted that currently 1386 peopled aged 65+ in Bracknell Forest have a moderate or severe visual impairment. This is projected to rise to 2288 by 2030 (Institute of Public Care POPPI & PANSI databases).

Data from the Health & Social Care Information Centre shows that in Bracknell Forest in 2014 (year ending 31^st March 2014) 100 people were registered as blind. This is a rate of 86 per 100,000 population (based on mid year population estimates for 2013). This is lower than both the South East average rate of 252 per 100,000 and the England average rate of 266 per 100,000.

Although Bracknell Forest has fewer people registered blind than the South East or England as a whole, as previously noted, the numbers include younger adults, often with parenting responsiblities living with congenital sensory loss, for example Usher’s Syndrome and Retinitus Pigmentosa, who may require substantial support to remain independent.

Hearing impairment

People with moderate to severe deafness may have difficulty in following speech with or without a hearing aid and may rely on lipreading. For some Deaf people, BSL may be their first or preferred language.

It is estimated that the number of people aged 18+ living in Bracknell Forest that have a moderate or severe hearing loss is currently 9,459. This is projected to increase to 14,268 by 2030 (Institute of Public Care- PANSI database).

It is also estimated that the number of people aged 18+ living in Bracknell Forest  that have a profound hearing impairment is currently 196. This is projected to increase to 321 by 2030 (Institute of Public Care- PANSI database).

The number of people registered deaf or hard of hearing in Bracknell Forest in 2010 (year ending 31^st March 2010) was 210. This equates to a rate of 180 per 100,000 population (based on mid year population estimates 2010). This is far lower than both the South East average of 401 per 100,000 and the England average of 408 per 100,000 (Health and Social Care Information Centre)

National & local strategies (current best practices)

DH Policy Guidance on Long-term Conditions suggests that

• people will be supported to stay healthy and avoid developing a long term condition, where possible
• people will have their conditions diagnosed early and quickly
• services will be joined up, and based around individuals’ biological, psychological and social needs
• people with long term conditions will be socially included, including succeeding in work and education
• people with long term conditions will be as independent as possible and in control of their lives (up to and including the end of life)
• people with long term conditions will be supported to stay as well as possible

The Association of Directors of Adult Social Services (ADASS) position on visual impairment rehabilitation in the context of personalisation sees rehabilitation as an early intervention should be an entitlement as part of the core offer. The increasing number of older people with sensory needs mean that this is likely to be a service in high demand. This statement reiterates ADASS’ previous advice on this subject that local authorities should consider securing  specialist qualified rehabilitation and assessment provision whether in-house, or contracted through a third party to ensure that people with sight loss in the area are able to maximise their independence in a timely manner.

Action Plan on Hearing Loss (NHS England and Department for Health) looks to tackle prevalence, costs and service quality associated with hearing loss through:

• Promoting prevention of hearing loss
• Improving both the commissioning and integration of services
• Providing innovative models of care
• Ensuring that people of all ages with hearing loss are actively supported and empowered to lead the lives they want for themselves and their families in the best possible health

Bracknell Forest Council Sensory Needs Clinic – This resource centre provides a wide range of advice and support to enable people with sensory loss to remain as independent as possible and will expand to be a resource for prevention in early 2014.

Integrated Care Teams – This initiative undertaken in conjunction with the Clinical Commissioning Group and Berkshire Healthcare Foundation Trust aims to provide a joint approach to supporting individuals with long-term conditions, particularly those with complex needs.

What are the key inequalities?

A substantially higher proportion of individuals who live in families with disabled members live in poverty, compared to individuals who live in families where no one is disabled (Department for Work and Pensions, 2010)

Although the gap in non-decent housing has narrowed over recent years, one in three households with a disabled person still live in non-decent accommodation.  (Department for Communities and Local Government, 2008)

What are the unmet needs/ service gaps?

Over a quarter of disabled people say that they frequently do not have choice and control over their daily lives. (Department for Work and Pensions, 2010) Appropriate housing, access to employment and support that enables the individual to maintain choice and control over their lives are goals that remain to be met.

Recommendations for consideration by other key organisations

• An expansion of integrated working would greatly benefit people with long-term conditions including those living with sensory loss.
• Joint personal health and social care budgets would support people to have greater choice and control.
• Greater access to suitable housing and direct support with education and childcare to enable people with long-term conditions to gain or return to employment would help to address the higher proportion of disabled people currently living in poverty.