Physical sensory and learning disability - Halton and St Helens PCT

Physical, sensory and learning disabilityIntroductionThe Disability Discrimination Act (DDA) 1995 defines a disabled person as someonewho has a physical or mental impairment that has a substantial and long-term adverseeffect on his or her ability to carry out normal day-to-day activities.It is recognized that disability can impact on individuals by: reducing their quality andlength of life; restricting access to public services; and make them vulnerable to abuse.This chapter will analyse the needs of adults with physical and sensory disabilities, andlearning disabilities – mental health is covered in a separate chapter.Other relevant chapters:Mental HealthVulnerable AdultsOlder PeopleSocial careEconomicHousingKey issues and gapsHalton has a aging population of people with learning disabilities known toservices – 20% are aged 56+Local support for people who challenge services to prevent them being sent todistant placements away from Halton.Earlier identification and planning with older families not known to services thatmay require support in response to changing family circumstances.Adults with learning disabilities generally suffer poorer physical health than thegeneral population, experience health inequalities through difficulties in accessinggeneric healthcare and screening programmes and have a shorter life expectancy.In Halton 3.7% of adults with learning disabilities are in employment. Nationally thefigure is 6.8% and regionally 5.2%.Nationally, 50-55% of people with learning disabilities live in the family home. InHalton the figure is 47%.Addressing the complex needs of young people with profound learning andphysical disabilities transferring to adult services.1

Physical, sensory and learning disabilityLevel of need in the populationPhysical and Sensory disabilityThe term ‘Physical Impairment’ refers to people who have one or more physicalimpairments. These impairments may be congenital or acquired at any age, betemporary, long-term, or fluctuating. People with physical impairments may often haveunique & multi-dimensional requirements. They therefore require tailored services toaddress them all in a person-centred holistic fashionThe term ‘Sensory Impairment’ encompasses visual impairment (including blind andpartially sighted), hearing impairment (including those who are profoundly deaf,deafened and hard of hearing) and dual sensory impairment (deafblindness). Sensoryimpairments may, like physical impairments, be congenital or acquired at any age.They are more prevalent with age as are additional sensory or other impairments. Mostsensory impairments develop gradually and are often secondary to other disabilities.Map 1: Halton Client Density: Physical and Sensory disabilitySource: Carefirst Database (31/03/09 – 01/04/10)The above map (map 1) highlights the location of clients with physical and sensorydisability, with the different quantities represented by the colours – The wards markedin red have the highest number of clients, whereas the darker green wards have lowernumbers.The table 1 shows that an estimated 5,968 people between the ages of 18 and 64have a physical disability. The majority of these (67%) are aged between 45 and 643

Physical, sensory and learning disabilitywith 26% aged between 25 and 44 and 7% between 16 and 24.Table 1: People aged 18-64 predicted to have a moderate or serious physicaldisability, by age, projected to 20302010 2015 2020 2025 2030People aged 18-24 predicted to have a moderatephysical disabilityPeople aged 25-34 predicted to have a moderatephysical disability529 465 427 436 480667 736 732 671 630People aged 35-44 predicted to have a moderatephysical disabilityPeople aged 45-54 predicted to have a moderatephysical disabilityPeople aged 55-64 predicted to have a moderatephysical disability1190 1051 1051 1182 11902108 2108 1947 1723 17363270 3167 3312 3333 3084Total population aged 18-64 predicted tohave a moderate physical disability7764 7527 7469 7345 7120Source: PANSI, 2010Table 2 shows that 3,117 people between the ages of 18 and 64 have a sensorydisability. The majority of these (89%) are aged between 45 and 64 with 10% agedbetween 25 and 44 and only 1% between 16 and 24.Table 2: People predicted to have a moderate or serious sensory disability, byage, projected to 20302010 2015 2020 2025 2030People aged 18-24 predicted to have a moderateor severe sensory impairmentPeople aged 25-34 predicted to have a moderateor severe sensory impairmentPeople aged 35-44 predicted to have a moderateor severe sensory impairmentPeople aged 45-54 predicted to have a moderateor severe sensory impairmentPeople aged 55-64 predicted to have a moderateor severe sensory impairmentPeople aged 65-74 predicted to have a moderateor severe visual impairment23 21 19 19 2079 86 86 79 74251 221 219 243 244958 951 882 782 7961,806 1,746 1,800 1,831 1,6862,392 2,938 3,280 3,244 3,4144

Physical, sensory and learning disabilityPeople aged 75 and over predicted to have amoderate or severe visual impairment6,016 6,581 7,725 9,575 11,077Total population aged 18+ predicted tohave a moderate or severe hearingimpairment11,525 12,544 14,011 15,773 17,311Source: PANSI and POPPI, 2010Learning disabilityThe current HM Government definition of ‘Learning Disability’ is set out in ValuingPeople, the 2001 White Paper on the health and social care of people with learningdisabilities, included the following definition of learning disabilities.‘Learning disability includes the presence of:• a significantly reduced ability to understand new or complex information, to learnnew skills (impaired intelligence), with;• a reduced ability to cope independently (impaired social functioning);• which started before adulthood, with a lasting effect on development.’The Public Health Observatory for Learning Disabilities [Improving Health and Lives:Learning Disabilities Observatory] is reviewing, with the Department of Health (DH)and the new Confidential Inquiry into premature deaths of people with learningdisabilities (CIPOLD), this definition and has published a document outlining a workingdefinition (http://www.improvinghealthandlives.org.uk/uploads/doc/vid_7446_2010-01WorkingDefinition.pdf).Adults with learning disabilities are one of the most vulnerable groups in society,experiencing health inequalities, social exclusion and stigmatisation. In general, adultswith learning disabilities have greater and more complex health needs than the generalpopulation, and often these needs are not identified or treated. The Quality andOutcomes Framework (QOF) includes a register of patients with a learning disability,which included 665 for Halton as at 1 st January 2010.Life expectancy of this group is shorter than the general population, though this hasincreased recently. In addition a number of national reports have highlighted thatadults with learning disabilities often experience barriers to accessing healthcareservices, and poor levels of care. Indeed, adults with learning disabilities are morelikely to die from a preventable cause than the general population.Patterns of health needs amongst adults with a learning disability are different to thegeneral population, and therefore current programmes that target health inequalitiesmay exclude this population group.5

Physical, sensory and learning disabilityMap 2: Halton Client Density: Clients with Learning DisabilitiesSource: Carefirst Database (31/03/09 – 01/04/10)Map 2 highlights the location of clients with learning disabilities, with the differentquantities represented by the colours – The wards marked in red have the highestnumber of clients, whereas the darker green wards have lower numbers.Nationally the numbers of adults with a learning disability is rising, and for the olderpopulation (65+) an 11% increase is predicted for those aged between 65-84 and a14% increase for those aged 85+ in the period to 2015. In Halton, the number ofadults with a learning disability is also rising, but at a steadier rate.Table 3: People predicted to have a learning disability, by age2010 2015 2020 2025 2030People aged 18-24 predicted to have a learningdisabilityPeople aged 25-34 predicted to have a learningdisabilityPeople aged 35-44 predicted to have a learningdisabilityPeople aged 45-54 predicted to have a learningdisability293 257 235 239 263361 398 396 364 341399 354 355 400 404395 397 369 328 3326

Physical, sensory and learning disabilityPeople aged 55-64 predicted to have a learningdisability358 347 364 366 339People aged 65-74 predicted to have a learningdisability209 255 289 286 301People aged 75-84 predicted to have a learningdisability116 124 139 179 201People aged 85 and over predicted to have alearning disability34 40 48 60 75Total population aged 18 and overpredicted to have a learning disability2,165 2,173 2,194 2,223 2,255Source: PANSI/POPPI, 2010Adults with learning disabilities in settled accommodation (NI 145 andVital Sign VSC05)The percentage of adults with learning disabilities living in settled accommodation inHalton is 86.7%. This is a significantly higher figure than either the regional (66.1%) ornational average (64.5%)Figure 1: Adults with learning disabilities in settled accommodationAdults with learning disabilities in settled accommodation - NI 145100.090.080.070.0% of Adults60.050.040.030.020.010.0HaltonNWEngland0.02008/09Source: Places Analysis Tool, NI 145 (2008/09)7

Physical, sensory and learning disabilityAdults with learning disabilities in employment (NI 146 and Vital SignVSC07)The percentage of adults with learning disabilities in employment within Halton is 3.7%.This is lower than the regional average (5.2%) and considerably lower than theaverage national rate (6.8%)Figure 2: Adults with learning disabilities in empolymentAdults with learning disabilities in employment - NI 1468.07.06.0% of Adults5.04.03.0HaltonNWEngland2.01.00.02008/09Source: Places Analysis Tool, NI 146 (2008/09)Current services in relation to needPhysical DisabilityCare management and assessment services.This service works with disabled people, their carers and families to assess need anddevelop appropriate support to maximise independence. Separate teams areestablished for physically and sensory disabled people and those with learningdisabilities.Located within assessment and care management services is the Visual ImpairmentRehabilitation Service offering individual assessments of need across all ages, takingfull account of any remaining vision and the impact of dual sensory loss. Identifiedpsychological and emotional needs associated with loss of vision are addressedthrough counselling and implementation of rehabilitation training programs. Anyindentified specialist communication needs (British Sign Language) or equipmentspecific for the individuals hearing loss are referred on to the specialist Deafblind8

service.Physical, sensory and learning disabilityHalton Home Improvement and Independent Living Services (HHIILS)Strategies promoting independence and enabling people to continue to live in thecommunity have led to a national increase in demand for home adaptations,equipment, housing support and preventative services to enable people to live athome.The HHIILS team is responsible for assessing the long-term needs of children, adultsand older people, resident in Halton, who have a permanent and substantial disabilityand providing permanent adaptations to their homes.Halton has reconfigured its Home Improvement and Independent Living service toimprove the response to Older and Disabled people through a partnership approachwith local registered social landlords to substantially increase the number ofadaptations within social rented stock and develop an Accessible Homes Register toprioritise disabled people when such properties are vacated.Day ActivitiesIn Halton day services have moved from the traditional large day centre to communitybased satellite centres offering meaningful activity and or learning and employmentopportunities.For many of those who access such support, this change has demonstrably increasedtheir confidence so they are now in a position to take full advantage of thePersonalisation Agenda and exercise greater choice in how they spend their time andwith whom.Using community facilities has identified issues of accessibility. Longer-term, anyimprovements in the accessible environment as a result of this initiative will bringbenefits to the wider community.Independent Living CentreThis facility is able to offer disabled people and carers advice on and the opportunity totry out equipment that will assist with independent living. Vision Support also has itsresource centre based here.Services provided by the third sectorHearing Impairment Services – Deafness Resource CentreDeafness Resource Centre is commissioned by the Council from April 2011 to offer specialist knowledge and communication skills to assess need of childrenand adults who are deaf or hearing impaired and their carers. Technical assessments for suitability of environmental equipment . Information in a range of formats on available support and signposting to otherservices as appropriate.Work is ongoing to raise community awareness of the issues faced by deaf childrenand adults and to further develop early intervention and preventative support .9

Physical, sensory and learning disabilityVisual impairment services - Vision SupportVision Support is commissioned by Halton Borough Council and NHS Halton and StHelens to provide a range of services to adults and older people with visual impairmentincluding:Access to a Resource Centre offering information, advice and small items ofequipment for purchase to help with daily living and improve their quality of life.Support Workers who visit people in their own home to demonstrate equipmentand assist with daily living tasks.IT Training in the use of speech and magnification software and advice is givenon the availability of free software that can be downloaded at home.Telephone befriending through volunteers to maintain contact and relieve socialisolation.User Led Organisation – Halton Disability PartnershipHalton Disability Partnership is a small local voluntary organisation, which aims to raiseawareness of the needs and wishes of people with disabilities and to help provideinformation and support to enable them to live independently.Learning DisabilitySafeguardingThe vision of Halton’s Safeguarding Adults Board is of a Halton where vulnerablepeople are safe from abuse and harm, whilst being empowered to make their ownchoices and to choose risks. This resonates with Halton’s vision for people withlearning disabilities of supporting them to achieve greater independence whilstensuring safeguards are in place to protect people from and prevent abuse.Model of careThe model is being reviewed to respond to the move away from specialist inpatientsupport to community focussed services and is based on the premise that all peoplewith learning disabilities can lead fulfilling lives in the community supported by‘ordinary’ learning disability services. They will sometimes have physical or mentalhealth problems and should be supported to access mainstream health services.Where they need more specialist support, including needs arising from challengingbehaviour, they will have access to skilled support staff and where necessary specialistprofessionals to assist assessment and help plan more effective support.HealthcareAll adults with a learning disability known to social care are being offered an annualhealth check and opportunity to develop a health action plan. Health passports havebeen introduced to aid hospital staff in understanding the individual e.g. aroundcommunication and improve the patient experience.Learning Disability Nurses are located in the integrated Care Management andAssessment Team. This team also acts as the gatekeeper to a range of specialist,community based support such as occupational and speech and language therapists.Short stay, in-patient, assessment and treatment interventions for people with learningdisabilities and associated challenging behaviour or mental health issues are availableat Hollins Park.10

Physical, sensory and learning disabilityPositive Behaviour ServiceThis specialist service, skilled in behavioural approaches, supports frontline servicesworking with adults and children with learning disabilities whose behaviour challenges.The aim is to improve outcomes for individuals and their families, and to support costeffectiveand local responses for people with complex needs, including autism.Support for CarersA number of actions have been targeted at older families, including completing aperson centred plan with the cared for and working with families to establish contactsand arrangements for the Community Learning Disability Team to act on should anemergency situation arise.Halton Carers Centre is actively working to identify hidden carers and encourage selfassessment of low level need and signposting to available support.Short BreaksHalton recognises the pressures placed on family members caring for a person withlearning disabilities and offers opportunities for breaks from caring. For learningdisabled adults with accompanying complex physical needs, residential respite supportis available at Bredon. A significant number of carers opt for direct payments to givethem full flexibility around when and how they receive support.Developing the Provider MarketIn 2010 the Council is positioning the provider market to move away from traditionalblock contracts for supported living services and encouraging more personalised,flexible and innovative support whether a person is purchasing this for themselves or itis commissioned on their behalf.EmploymentIn Halton the number of people with learning disability in employment at 3.7% is lowerthan both the National figure for England (7.5%) and Comparator Authority figure(4.1%). The Enterprise and Employment Division within the Council takes the lead onemployment for disabled people. Health and Social Care have an active role inpromoting employability amongst people with learning disabilities and their familiesparticularly targeting young people in Year 9 (age 14+) to raise their aspirations beforeleaving school and moving into adult services.Halton’s daytime and community support service continues to extend the number ofopportunities for people to train for, experience and gain employment, whilst theCommunity Bridge Builder Service is supporting people into paid or voluntary work.Services provided by the third sectorHalton Speak Out support adults with learning disabilities in voicing their views toinfluence improvements in local services. They also co-ordinate Person CenteredPlanning in Halton.11

Physical, sensory and learning disabilityEvidence of what worksOur Health, Our Care Our Say (Department of Health, 2006) this white paper sets thevision for Health and Social Care services by setting four goals to be achieved: Better prevention and early intervention for improved health, independence andwell-being More choice and a stronger voice for local individuals and communities Tackling inequalities and access to community based services More support for people with long term needs.High Quality Care For All (Department of Health, 2008) this report written by LordDarzi builds on the goals of the white paper and further highlights the need to improvepreventative services, deliver more health services locally and improve choicesavailable to people.Putting People First (Department of Health, 2007) the national concordat, set out thevision, aims and values that will guide the Transformation of Adult Social Care. Itsupports the need for universal access to low level preventative services that includeequipment and other home support services.National Service Framework (NSF) for Long Term Conditions (Department ofHealth, 2005) was published to raise standards for people with long-term neurologicalconditions requiring treatment to access to care and support across Health and SocialCare Services. Whilst the NSF is focussed on people with long term neurologicalconditions the principles underpinning the framework apply to all physically disabledpeople.The Social Policy Research Unit 1 have published a research paper identifying threetypes of service that promote continuity of care for people with long term neurologicalconditions: Community based inter-disciplinary neuro-rehabilitation teams Nurse Specialists Proactive holistic day opportunities.Prevention and early intervention (P&EI) Health and social care have developed ajoint strategy for P&EI in Halton aimed at promoting the independence of older peoplebut also transferring the learning to other disabled people. Emphasis is placed ontelecare and telehealth to support self management of long term conditions andenabling people to remain independent to avoid unplanned hospital admissions.Improving the Life Chances of Disabled People (2005)A further cross government policy to transform the life choices of disabled people sothat by 2025 they have full opportunities and choices to improve their quality of life andbe respected and included as full members of society.1 Bernard S., Aspinal ., Grindley K., Parker G (20101) Integrated Services for people withLong Term Neurological Conditions: evaluation of the impact of the NSF, Research Works2010-05, Social Policy Research Unit, University of York, York.12

Physical, sensory and learning disabilityKey contacts and further linkshttp://www.improvinghealthandlives.org.uk/ – Improving Health and Lives: LearningDisability Observatory.http://www.valuingpeoplenow.dh.gov.uk15