Facts and Figures

Nationally

• An estimated 11 million adults and 770,000 children in the UK, using the widest survey definition are 'disabled', equivalent to more than one-in-five adults, and around one-in-twenty children. However many do not claim disability-related benefits or use services aimed specifically at disabled people.
• Disabled people are more likely to achieve lower outcomes in terms of employment, income and education and are more likely to face discrimination and negative attitudes, and often experience problems with housing and transport.

• Individuals of Indian, Pakistani, Bangladeshi and Chinese origin remain less likely to report that they are disabled than people from other ethnic origins.
• The number of incapacity-related benefit claimants has tripled since 1979.
• Disabled people still earn 30% less than non-disabled people.
• 27% of households with one or more disabled adults of working age have incomes below 60% of median income, compared with 20% of individuals in households with no disabled adults.
• Many houses in England are physically unsuitable for people with mobility or other impairments. Around 181,000 households contain people 'with a serious medical condition or disability' whose accommodation is not suitable for them.
• Difficulties in accessing transport contribute significantly to social exclusion and disabled individuals use transport a third less than the general public.
• Nationally, only around 30% of buses are accessible to disabled people.
• 21% of respondents to a Disability Rights Commission poll experienced harassment in public in relation to their disability.
• 17% of disabled respondents to a Department of work and Pensions survey said they had experienced actual discrimination in the workplace because of their disability.
• The term 'Disabled' covers people who are wheelchair-reliant,  people who are wheelchair users, blind people, deaf people, people with long-term progressive conditions such as Multiple Sclerosis, HIV /AIDS or cancer from the point at which adverse effects emerge, as well as people with impairments such as back pain and mental heath problems.

Source: Improving the lives of disabled people, January 2005  NB: it must be remembered that this information is not specific to sensory impairment.

• There is a wide variety of long term neurological conditions and people have 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 (eg Duchenne's muscular dystrophy) or develop during adulthood (eg Parkinson's disease).
• Approximately 10 million people in the UK have a neurological condition and 20% of acute hospital admissions are due to this.
• Two 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.

Source: "The National Service Framework for People with Long-Term Conditions[1]" (March 2005)

Locally

• Individuals with acquired brain injuries represent the largest service user group, 70 individuals, who receive commissioned services or Direct Payments.
• Multiple Sclerosis (MS) represents the second biggest service user group in the physically disabled population in Newcastle.
  • There are an estimated 528 people with MS in Newcastle, based on population data from the 2001 census and DoH indicators.
  • 400 individuals with MS are known to the Community MS Team and approximately 10% receive direct care from Adult Services

[1] This primarily refers to neurologically caused disability rather than general physical disability

Trends

• Among adults, trends in impairment show that the number of people reporting physical impairments is decreasing.
• Between 1997 and 2003 there has been a 44% increase in the number of homeless households in priority need because a house hold member has a physical impairment.

Source: "Improving the Life Chances of Disabled People" (January 2005)

Table 1: People in Newcastle predicted to have a moderate or serious physical disability, projected to 2025

Figures may not sum due to rounding Crown copyright 2008

Notes:

This table is based on the prevalence data for moderate and serious disability by age and sex included in the Health Survey for England, 2001, edited by Madhavi Bajekal, Paola Primatesta and Gillian Prior.

The prevalence rates given in the survey for moderate physical disability are 4.1% for 18-24 year olds, 4.2% for 25-34 year olds, 5.6% for 35-44 year olds, 9.7% for 45-54 year olds and 14.9% for 55-64 year olds.

The prevalence rates given in the survey for serious physical disability are 0.8% for 18-24 year olds, 0.4% for 25-34 year olds, 1.7% for 35-44 year olds, 2.7% for 45-54 year olds and 5.8% for 55-64 year olds.

The prevalence rates have been applied to ONS population projections of the 18 to 64 population to give estimated numbers predicted to have a moderate or serious physical disability to 2025.

Table 2: People aged 65 and over in Newcastle with a limiting long-term illness, by age projected to 2025

Notes:

Figures are taken from Office for National Statistics (ONS) 2001 Census, Standard Tables, Table S016 Sex and age by general health and limiting long-term illness. The most recent census information is for year 2001 (the next census will be conducted in 2011).

Numbers have been calculated by applying percentages of people with a limiting long-term illness in 2001 to projected population figures.

Targets

Nationally

• National goals set out in "Improving the Life Chances of Disabled People", January 2005, are to achieve:
  • Active citizens with choice and control over how additional needs are met
  • Support for families with young disabled children
  • Smooth transition into all aspects of adulthood
  • Improved employability

Locally

• The number of people in receipt of Direct Payments to increase by 100 by the end of March 2009 from the March 2008 figure of 267 people.
• Increase the number of ILF users from 84 in March 2008 to 100 by March 2009

Performance

The following table refers to Adult Social Care Performance for Newcastle upon Tyne for the period 2006/07from the 2007 annual performance assessment (APA) by the CSCI.

Table 3: Adult Social Care Performance for Newcastle upon Tyne for the period 2007/08 from the 2008 annual performance assessment (APA) by the CSCI.

Source: CSCI Annual Performance Assessment 2007 -2008, summary assessment report of social care services for adult services in Newcastle upon Tyne.

Indicators

Relevant National Indicators highlighted in Newcastle's 'Physical Disability Team Service Plan' are:

• NI119 Self-reported measure of people's overall health and wellbeing
• NI124 People with a long-term condition supported to be independent and in control of their condition
• NI127 Self reported experience of social care users
• NI128 User reported measure of respect and dignity in their treatment
• NI129 End of life care - access to appropriate care enabling people to choose to die at home
• NI130 Social Care clients receiving Self Directed Support (Direct Payments and Individual Budgets)
• NI132 Timeliness of social care assessment
• NI133 Timeliness of social care packages
• NI136 People supported to live independently through social services (all ages)
• NI139 The extent to which older people receive the support they need to live independently at home
• NI140 Fair treatment by local services
• NI141 Number of vulnerable people achieving independent living
• NI142 Number of vulnerable people who are supported to maintain independent living
• NI145 Adults with learning disabilities in settled accommodation
• NI175 Access to services and facilities by public transport, walking and cycling
• NI179 Value for money - total net value of on-going cash-releasing value for money gains that have impacted since the start of the 2008-09 financial year

• The Newcastle Partnerships Local Area Agreement 2008 - 2011 contains the following relevant targets to Adult Social Care.

[1] Note: this is a new indicator – baseline and target will be set at first annual refresh when data becomes available from the new Place Survey 

[2] Note: draft targets for NI 136 are based on the new calculation (not lifted directly from previous ‘CAF’ indicator figures and trends) – the targets are therefore estimated from the newly calculated baseline and may be reviewed at first annual refresh.  

[3] Note: this is a new indicator – baseline and target will be reviewed at first annual refresh when up to date data becomes available

[4] Baseline based on quarter 4 of 2006/07 and quarters 1,2,3 of 2007/08

Local Views

Personal Social Services Physically Disabled and Sensory Impaired User Experience Survey (May 2004). This survey asked the views of physically disabled and sensory impaired Social Service users aged 18 - 64 (excluding those with learning disabilities) on services they received. 220 out of 347 individuals responded.

• Direct payments: 46% of respondents were told about direct payments by their social worker or care manager, however, 11% did not know about them. 22% of respondents stated they used direct payments and 73%of those respondents said overall, they were 'extremely' or 'very' well advised and supported in using them.
• Personal care and support: 69%of respondents said that their opinions and preferences were 'always' (32%) or 'usually' (37%) taken into account when decisions were made about services provide to them. 10% of respondents stated their opinions and preferences were 'never' taken into account.
• 83% of respondents strongly agreed (31%) or agreed (52%) that, 'The help I get from Social Services or using direct payments has made me more independent than I was'. 17% either disagreed (13%) or strongly disagreed (4%) with the statement.
• 95% of respondents either strongly agreed (56%) or agreed (39%) that, 'My life would be a lot worse if I didn't have help from Social Services or direct payments. 5% of respondents either disagreed or strongly disagreed with the statement.
• Of the respondents able to work 6%, were in part-time or full-time work and 24% of respondents were not in work.
• 55% of respondents would like to take part in further consultations to improve services.
• The majority of respondents identified the most important change to improve services as either to have more hours of care, help with adaptations and equipment, more information or help from same carer all the time.

A Home Equipment Survey 2007/8 was commissioned by the Performance and Improvement Unit, Chief Executive's Office, Newcastle City Council in May 2008, to explore the views of individuals who had been given equipment or had an adaptation to their home, and produced the following findings:

• 94% were satisfied with the overall service they had received.
• 95% said that the equipment / minor adaptation they had received had made the quality of their life either much better or a little better e.g. "After the equipment was installed my quality of life has been made much better. I can now shower in safety and comfort. Thank you to all who made this possible."
• Some users experienced difficulties with mobility in their home due to length of wait for equipment to be installed.
• 30% of respondents had not had a follow-up visit after equipment was been received.
• 76% of respondents said they either chose, or played a role in choosing, what equipment they received.

In accordance with recommendations in Direct payments guidance: community care, services for carers and children's services (direct payments) guidance England, (2003), Newcastle Direct Payments Focus group (January 2008) was run and produced findings on main aspects of Direct Payments including the following.

• The Direct Payments Support Service (DPSS): most services users have found the DPSS very helpful but it was noted that Support Service were not aware of the difficulties that service users may face as they are office based.
• The Paperwork: services users found there was initially a lot of paperwork but tend to only use the relevant pieces and contact the DPSS if advice is needed.
• Managing your own staff: Service users prefer employing their own staff rather than using a care agency as it reduces the number of people they have to deal with.
• Using an Agency: there is a disparity in quality of services between different agencies. Respondents were concerned about falling standards of care but recognised agencies were good for providing emergency care.
• Respite and Short Breaks: Service users said there is a lack of information provided social services about respite care and short breaks.
• Finance: most service users managed their finances without difficulty although they feel they need more funding for Personal Assistants. Some felt there were problems with the financial contribution process e.g. user's contribution is too high and there have been too many changes over the past three years.
• Audit: service users have a good relationship with the Finance Officer and the process is simple and straightforward.
• Contact with other Direct Payments Users: Opinions on setting up group meetings were varied. Some felt it would be useful to share experiences others could not understand what was happening in the group.
• General Comments: Most service users felt more in control with Direct Payments, especially due to the flexibility of worker's hours although the loss of service users usual social worker was distressing for a couple of respondents.

National and Local Strategies

• Putting people first: a shared vision and commitment to the transformation of adult social care. Dec 2007 outlines aims for creating a personalised, high quality, accessible and responsive to individuals' needs Adult Social Care system through partnerships between various statutory agencies and private sector providers.
• Your Health, Your Care, Your Say : Improving Community Health and Care Services Department of Health covered all aspects of the care people need in the community and in their own homes. 
• "The Improving the Life Chance of Disabled People, Jan 2005 sets out a vision for improving the life of disabled people: 'By 2025, disabled people in Britain should have full opportunities and choices to improve their quality of life and will be respected and included as equal members of society'. Future strategy for disabled people should seek to realise this vision through practical measures in four key areas.
  • Helping disabled people to achieve independent living
  • Improving support for families with young disabled children
  • Facilitating a smooth transition into adulthood
  • Improving support and incentives for getting and staying in employment
• "The National Service Framework for People with Long-Term Conditions" (March 2005) highlights 11 quality requirements (QRs) to be implemented by 2015.   

1.  
   1. A person centred service
   2. Early recognition, prompt diagnosis and treatment
   3. Emergency and acute management
   4. Early and specialist rehabilitation
   5. Community rehabilitation and support
   6. Vocational rehabilitation
   7. Providing equipment and accommodation
   8. Providing personal care and support
   9. Palliative care
   10. Supporting family and carers
   11. Caring for people with neurological conditions in hospital or other health and social care settings

Direct payments guidance: community care, services for carers and children's services (direct payments) guidance England, 2003 was produced to assist local councils in making direct payments in order to give recipients control over their own life. Giving people flexibility to look beyond services provided by local councils for certain housing, employment, education and leisure activities as well as for personal assistance to meet their assessed needs. This will help increase opportunities for independence, social inclusion and enhanced self-esteem.

• Supporting People is the government's long-term policy to enable local authorities to plan, commission and provide housing-related support services that help vulnerable people to live independently.  In Newcastle, Supporting People is managed by a partnership between Newcastle City Council, the Probation Service for Northumbria and North of Tyne Primary Care Trust. The partnership commissions services for people of all ages and with a wide range of different support needs, to help them live independently in the community.

Supporting People Five year strategy 2005/6 - 2009/10 Newcastle City Council  2005

• Adult Services Service Plan
• Physical Disability Team Service Plan: sets out planned actions and targets for the 2008-2009 period covering four main areas within the Sustainable Community Strategy
  • Direct payments: Implementation of 3 new staff training programmes and an aim to increase uptake of Direct Payments/ Individual Budgets to enable choice and control for service users
  • Independent Living Fund: Increase the uptake of ILF monies by developing better infrastructure for the service and ensuring existing funding is continued.
  • Transport: to establish a baseline of service users who can travel independently and to engage service users in the process.
  • NHS Continuing Health Care: Adult Services to work jointly with NHS partners to achieve targets from the NHS National Framework Continuing Care Criteria 2007.
• Newcastle Partnerships Sustainable Communities Strategy. Relevant themes highlighted in the Physical Disability Team Service Plan are:
  • Ensuring that every adult is enabled to have a good quality of life
  • Ensuring that every adult is able to exercise choice and control
  • Ensuring that every adult is enabled to be free from discrimination or harassment
  • Increasing levels of participation in cultural activities, and the community involvement in development and delivery of cultural services
  • Ensuring that every adult is enabled to make a positive contribution
  • Ensuring that every adult is enabled to be healthy
• ILF uptake work plan

Current Activity and Services

What investment is there?

• £20,000 available to devise and implement training for service users on employing Personal Assistants
• £65,000 available for an ILF officer and admin time offset by budget savings.
• £17,000 to joint-fund 8 vocational rehabilitation places for people with acquired brain injuries
• £96,000 to fund the Direct Payments Support Service

 

What are they key inequalities?

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.
• less likely to have educational qualifications - disabled people are more likely to have no educational qualifications.
• more likely to be economically inactive - only one in two disabled people of working age are currently in employment, compared with four out of five non-disabled people.
• more likely to experience problems with hate crime or harassment - a quarter of all disabled people say that they have experienced hate crime or harassment, and this number rises to 47% of people with mental health conditions;
• more likely to experience problems with housing - nine out of ten families with disabled children have problems with their housing;
• more likely to experience problems with transport - the issue given most often by disabled people as their biggest challenge.

(Improving the life chances of disabled people, Prime Minister's Strategy Unit, 2005)

What are they key gaps in knowledge/services?

It is unclear where Newcastle measures up to with regards to national indicators.  Further data collection work is required to bench-mark services against these indicators.

What are the risks of not delivering our targets?

The National Service Framework for People with Long-Term Conditions (2005) identifies some of the economic impacts associated with disability.

Table 2.2: Costs of high rates of economic inactivity amongst disabled people

 

Is what we are doing working?

The Adult Social Care Performance for Newcastle upon Tyne for the period 2006/07from the 2007 annual performance assessment (APA) by the CSCI identified a number of areas where social care services are performing to a good standard.  The following were identified as the key strengths of the service:

• Joint working between the council and health partners to promote healthy lifestyles.
• Effective and wide range of programmes that engage people and their carers.
• The provision and support for advocacy services for most people who use services.
• The number of people in receipt of direct payments.
• Disability Equality Scheme published on council's website.
• Arrangements in place to make decisions and agree continuing care and shared care funding arrangements.
• Comprehensive arrangements in place to maximise uptake of benefits.
• Independent provider commissioned to deliver independent mental health capacity advocacy.
• The number of council staff trained in addressing work with vulnerable adults.
• The availability of single rooms.
• Multi agency safeguarding arrangements in place and are embedded.
• Relaunch of adult safeguarding policies.
• The council has set out key challenges for all service user groups which reflects both the national and local agendas and priorities.
• The percentage of staff where ethnicity not stated.
• Appointment of a Director of Adult Social Care.
• Working with key partner agencies and the Acting Director of Public Health to develop strategic commission.
• Joint commissioning arrangements involve the PCT, housing, people who use services and their carers.
• Priorities are linked to the councils Regeneration Strategy and the Local Area Agreement and drawn up in consultation with service user groups.
• More robust and frequent financial monitoring meetings and systems.

The following areas have been identified as requiring improvement:

• The development of self assessments.
• The full implementation of the Single Assessment Process (SAP and eSAP).
• Full implementation of the 5 equality standards for local government.
• Continue to improve recording of adult safeguarding referral patterns and completion rates.
• Appointment of permanent senior management team.
• Ongoing planning with the residential sector to introduce new methodologies to monitor physical environment and quality outcomes in registered provision.

The feedback from various service user consultations has been generally positive.  However certain aspects regarding obtaining information and contacting social services have been less positive:

• Social Services provides me with all the information I need? A quarter (27%; 55) either disagreed (21%; 43) or strongly disagreed (6%; 12) with the statement.
• I can always contact Social Services easily if I need to. 14% (28) either disagreed (7%; 19) or strongly disagreed (4%; 9) with the statement.
• Do you know how to make a complaint about Social Services? 7% (15) of these respondents said that although they knew they felt they could not complain if they wanted to. Another third (32%; 68) said they did not know how to complain.

Further negative feedback has been noted with regards to equipment:

• Social Services have provided me with the adaptations and equipment that I need. 19% (34) either disagreed (12%; 22) or strongly disagreed (7% 12) with the statement
• The majority (83%) of respondents said that they had not had problems whilst they were waiting for their equipment. However, some respondents commented that they had faced serious problems because of the waiting period. In particular, difficulties in bathing and severely limited mobility whilst waiting were mentioned, for example:
• Follow-up after equipment has been received: A relatively high percentage of respondents, 30%, said that they had not been contacted after they received their equipment to see if everything was okay.
• Several respondents did not seem to be clear about who had provided their equipment - whether it was Newcastle Adult Services or Newcastle PCT - and about how to contact them.

However:

• 94% were satisfied with the overall service they had received.
• 95% said that the equipment / minor adaptation they had received had made the quality  their life either much better or a little better (PAF indicator D83).
• 95% of people surveyed in 2004 felt that their lives would be a lot worse without help from Social Services.

What is coming on the horizon?

The Action Plan for Physical Disabilities 2008-2009 is in the process of being implemented.  Within this programme are the following three main work-streams:

• Implement 3 new training programmes to increase uptake of Direct Payments and sustain existing packages.
• Devise and implement robust infrastructure to increase uptake of Independent Living Fund (ILF) monies and sustain existing funding agreements.
• Implement new outcome of independence in travel for service users with long-term conditions as part of assessment and care-planning process.

What should we be doing next?

• There is the need for a programme of data collection to ensure that Newcastle is achieving national targets regarding a range of services for people with physical disabilities.
• In consultation with service users the problem of communication arose. There should be a dedicated work programme to rectify any issues around communication. Further work is required to ensure all service users are appropriately informed.