Disability

1  Introduction

This is one in a series of needs assessments regarding protected characteristic groups to support compliance with the public sector Equality Duty (The Equality Act 2010).

The document is intended to raise awareness of the key public health, and health and social care considerations relevant to people with disabilities; and to provide a starting point to inform the development of Equality Impact Needs Assessments (EINAs).

Disability is a protected characteristic under the Equality Act 2010. A person with a disability can be defined as someone with a physical or mental impairment which has a substantial and long-term adverse effect on that person’s ability to carry out normal day-to-day activities[1].

Disabilities take many forms but are often classified into the follows main groups:

• Physical disability
• Learning disability
• Mental health problems
• Sensory disability
• Special educational needs.

A detailed needs assessment is in the process of being developed for people with Learning Disability and will be completed in 2014.

2  Background

People with disabilities are more likely to suffer a range of barriers, including:

• Social prejudice and discrimination.
• Unfair treatment at work and in the labour market.
• Potential difficulties accessing public, commercial and leisure services, and their particular needs been adequately met by generic services (including health and social care services).
• Difficulties with physical accessibility to buildings and transport.

Also, research suggests that people with disabilities are also at higher risk of other health problems, for example, almost a third of people with long-term physical conditions have a concurrent mental health problem such as depression and anxiety[2]. Furthermore, surveys of people with disabilities report that they enjoy lower levels of life satisfaction and mental wellbeing (e.g. anxiety)[3].

Consequently, it is important that health and social care services are able to provide effective specialist services to meet the needs of disabled people, and ensure that other universal services (e.g. primary care, health improvement and disease prevention initiatives) are accessible to people with disabilities and sensitive to their needs.

3  Local picture

Information on people with disabilities in Richmond is available from a variety of sources, which focus on particular disabilities and measure different aspects of disability. Together they help to form the overall picture of disability in Richmond.

• 21,447 (11.5%) of people in Richmond report that they have some form of disability or health problem that affects their day-to-day activities a lot or a little. This compares to 17.6% in England as a whole[4].
• 2802 (2%) of people in Richmond aged 16-74 years consider themselves to be economically inactive due to a permanent sickness or disability, compared to 4% in England as a whole.
• Population estimates based on Census data and research suggest that among Richmond residents aged 18-64 years 9,180 people have a moderate physical disability and 2,673 a severe physical disability[5].
• Registration data for Richmond show that in 2011 370 people were blind, 260 were partially sighted[6], and in 2010 550 were deaf or hard of hearing[7].
• Estimates suggest the following numbers of people in Richmond aged 18-64 years (2011) have mental health problems[8]:
  • In total, 20,510 people with a common mental health problem
  • 9,155 have two or more psychiatric disorders
  • 1,526 have a serious mental illness (i.e. 574 borderline personality disorder, 442 anti-social personality disorder, 510 psychotic disorder).
• Estimates suggest the following numbers of Richmond residents aged over 65 years (2011) with mental health problems:
  • 2,254 people with depression
  • 716 with severe depression
  • 26 with probable psychotic disorder
  • 506 with 2 or more conditions.
• The number of older people living in with depression and severe depression is projected to increase by around 20% between 2012 and 2020[9].
• Estimates suggest that in 2011 Richmond 3,621 people aged 15-64 years have a learning disability, and that of these 770 have a moderate or severe learning disability[10].
• According to GP data 439 (2.76/1000) adults with a learning disability known to GPs in Richmond, compared to population rates of 3.44/1000 in London and 4.65/1000 in England[11].
• Also, according to other data 412 adults with a learning disability receive council services, of whom 169 live in a care home and 243 receive community services[12].
• A total of 4,344 school pupils have special educational needs (SEN) in Richmond (2013). Of these 731 have a SEN statement (2.28%) compared to 2.78% in England, and 3,616 do not have a SEN statement (11.25%) compared to 15.96% in England.

Within the Borough local variations in the geographic patterns of people disabilities are seen. This is exemplified below in terms of ward variations in the numbers and percentages of people who considered themselves to be permanently sick or disabled in the 2011 Census.

Table 1. People permanently sick or disabled: London Borough of Richmond, 2011

4    Service Provision

A comprehensive range of public health programmes[13], and health and social care services are designed, planned and delivered to meet the needs of Richmond’s population.

The following mechanisms are in place to ensure that consideration is given to the diverse population and individual needs of residents, including those of protected characteristic groups.

• Development of needs assessments to research local population health and wellbeing needs.
• Liaison with a range of local community organisations, tailoring of the design and delivery of services to maximise their appropriateness and accessibility to all residents, including the targeting of services and initiatives at populations with diverse needs, including protected characteristic groups. For example:
  • Richmond’s NHS Health Checks programme targets people with learning disabilities and severe mental health problems, and carers as priority groups. In addition, further efforts to target people with disabilities are underway, including increases in incentives for GPs and other providers to undertake health checks for people with disabilities, a pilot outreach service, and promotional events with Carers Hub, and local disability charities and service providers.
  • The Richmond LiveWell healthy lifestyle service has been asked to increase its efforts to engage with people with learning disabilities.
  • Richmond’s National Child Measurement Programme (NCMP) has recently been extended to include special school units and special schools to ensure that children with disabilities can benefit.
• Audits, reviews, and evaluations of existing services including consideration of equality and diversity issues.
• Equality Impact Needs Assessments (EINAs) of new services and changes to existing services.
• Monitoring of service use by key population characteristics, including some protected characteristic groups.
• Adoption of equality requirements in service specifications and monitoring processes as part of contracting requirements for services and their providers.
• Annual reviews of compliance with the Public Sector Equality Duties.
• Implementation of the NHS Equality Diversity System by local NHS commissioners and providers.
• The council has undertaken an audit of provisions for protected characteristic groups in public health programmes, and the findings are under consideration.

5    Conclusion

A number of further actions are underway or being considered by Richmond Borough Council, including:

• Development of a detailed Equalities Profile for the Borough based on the results of the 2011 Census. This will further support general consideration of protected characteristic group equality issues across council responsibilities and beyond.
• Work to support Richmond CCG in their planned update of their Public Sector Equality Statement and implementation of the NHS Equality Diversity System.
• Consideration of the extension of routine consistent equality monitoring of all protected characteristic groups, including use by people with disabilities, across public health programmes, in addition to those groups most frequently routinely covered by standard data collection systems (i.e. age, sex/gender, ethnicity).
• Review of service specifications for the commissioned services included in public health programmes, to ensure an adequate and consistent approach equality issues relating to the protected characteristic groups.
• Review of access to data essential to undertake adequate equality monitoring of key public health services, particularly immunisation and screening.

6    References

[1] Source: Equality & Human Rights Commission (EHRC) www.equalityhumanrights.com Accessed 10/03/2014

[2] Department for Work & Pensions (2013). Fulfilling potential: Building a deeper understanding of disability in the UK today.

[3] Source: 2012 Annual Population Survey, ONS.

[4] Source: 2011 Census data, ONS.

[5] Source: DataRich www.pansi.org

[6] Source: The Health & Social Care Information Centre, 2011

[7] Source: The Health & Social Care Information Centre, 2010

[8] McManus et al. (2009). Adult Psychiatric Morbidity Survey reported in Richmond Mental Health JSNA 2013

[9] Source: DataRich www.poppi.org

[10] Source: DataRich www.poppi.org

[11] Source: Health and Social Care Information Centre, 2013

[12] DataRich www.datarich.info/

[13] NHS Health Checks, LiveWell Richmond health lifestyle service, Kick It stop smoking service, School nursing and the National Child Measurement Programme, Sexual health and contraception services, Substance misuse services, Screening programmes, Immunisation programmes.

The Equality and Diversity pages of DataRich provide further data and analysis on each of the protected characteristics under the Equality Act 2010.

Document Information

Published: July 2014
For review: July 2017 
Topic Lead: Jane Bailey, Public Health Lead