Predicting Need – Physical and Sensory Disability
Disabled people in Barnet are a significant proportion of the population in Barnet who we know
experience poorer life chances and outcomes than non-disabled people. The definition of
‘disability’ here is taken from the Disability Discrimination Act 1995: “A physical or mental
impairment that has a substantial and long term impact on the ability of a person to carry out
normal day to day activities. Included within this definition in Barnet are adults aged 18 plus
affected by physical disability, long term illness/ conditions and sensory impairment.”
In Barnet we can expect:-
• 13,785 households in Barnet that have support needs due to a physical disability
• 1890 people with a neurological condition requiring help with daily living
• 4590 carers of people with a neurological condition
• 745 people with acquired brain injury
• 820 registered blind and 730 partially sighted people
• 1485 people who are registered deaf or hard of hearing
• 40% of people with a learning disability also have a hearing impairment
There a wide variety of long term neurological conditions and people have very different
experiences. The time course of conditions also varies widely. The average time between
diagnosis and death for someone with motor neurone disease is 14 months, while someone
with multiple sclerosis may live with the condition for decades. Even within specific conditions,
the needs of individuals, for example for social care support, vary widely. The diagnosis or
onset of these conditions generally marks the beginning of profound changes in the life of the
person and the lives of their carer, family and friends. It may affect relationships, career
prospects, income and expectations for the future. Nationally neurological conditions account
for 20% of acute admissions and are the third most common reason for seeing a GP. It is
therefore essential that health and social care organisations work within a long term conditions
model to provide effective support to enable people to live as independently as possible in their
According to the Housing Needs Survey, people with physical disability make up the largest
group who has support needs (74%).
There has been an annual increase in initial contacts to social services, progressing through to
assessment from around 150 in 2004/5 to nearly 600 in 2007. The demand is affected by
earlier discharges from hospital, general demographic growth and accommodation need which
impacts upon the demand for services for younger adults with physical and sensory disabilities.
The factors that affect health outcomes and independence affect disabled people
disproportionately. 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 that
earned by non-disabled people
• less likely to have 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 problems with housing – nine out 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
• As well as a predicted increase in the adult population which will affect demand in the future,
age is the single most common reason why someone might be hard of hearing and the
increases in the numbers of older people will increase the demand for specialist sensory
impairment services. Increases in demand are also being affected by:
• A rising increase in the prevalence of disability among children, partly due to the increase
survival of pre term babies
• The increase in drug and alcohol use, resulting in disability or cognitive impairment
• Rising public expectations
• Ethnicity has an impact on demand in Barnet as population estimates set out in the earlier
sections show the growth in the younger age groups and this affects health in particular
ways. For example
• High blood pressure and stroke is more common in people from Africa and the Caribbean
• The prevalence of Deafness within the Asian community is 4-5 times higher than the national
average across the population the incidence of diabetes is especially high in people from
Africa the Caribbean and South Asia and Hepatitis B is especially prevalent in people from
South East Asia.
• Sickle cell disorder is commoner in those of African-Caribbean descent and thalssaemia in
Asia and Mediterranean communities.
Responding to changing demand
Barnet has adopted the social model of disability. This recognises that many of the difficulties /
barriers that arise for disabled people, notwithstanding the fact of their disability, are largely
attributable to attitudes and structures in society. The six priorities for action identified in the
commissioning strategy are focused on an agenda for change which focuses on inclusion,
rights and choice, moving away from specialised service provision towards facilitating access to
mainstream services with a strong focus on addressing inequalities. A cornerstone of this is the
development of individualized budgets. Another is partnership with housing agencies.
There are specific initiatives and targets which rely on partnership between social care and the
NHS including improved access to rehabilitation for individuals with a long term neurological
condition to achieve the best possible outcomes, including a reduction in wait times for
individuals to specialist facilities in line with national guidance and to increase access to
specialist therapists in the community and to vocational rehabilitation in the community. There
are specific targets to improve the balance of those people who live in registered care and
those supported intensively to live in their own homes.
The service structures are starting to change; the equipment service has been changed to
provide a more responsive service with improved coverage and response times.
Currently Barnet has the highest number of service users overall receiving Direct Payments.
The most recent review of the Direct Payments Advisory Service highlights improved
performance and the relatively high number of people from black and minority ethnic
backgrounds in receipt of direct payments. The report also shows that the Direct Payments
Advisory Service is highly valued by service users evidenced by 98% customer satisfaction.
The service has targets including increasing service user involvement in the management and
implementation of direct payments and facilitating change and delivery of individual budgets as
part of the Delivering Choice and Independence Programme. The outcomes for people using
this increased flexibility of care arrangements are clearly demonstrated in the user survey. The
high level of Direct Payments and the high value placed on this method by service users are
helping to promote the cultural and organisation change required to deliver the overall vision of
independence and choice in Barnet.
Barnet is committed to facilitating access to paid work for younger adult service users with a
physical disability. Daycare is gradually being transformed from being focused on buildings
providing segregated services so that investment can be made into improving access to
activities in the community including leisure facilities, libraries and education which improves
the physical fitness of people, improve choices and enhance life opportunities. Key local
service developments in the borough include the transition of the Flightways Resource Centre
into becoming a Centre for Independent Living for adults with physical or sensory disability.
Barnet is developing an enablement process which provides more intensive help when people
first get referred for assessment as part of its core remodelling. This also includes transforming
homecare services to provide more intensive short term support which maximises people’s
independence and reduces reliance on long term care. For those who do need longer term
services they will be encouraged to have direct control in how their care and support needs are
met through support planning and brokerage. These options will need to continue to develop to
effectively offer viable alternatives to residential / nursing care, in accordance with preference
of people to remain living within community settings. This will support admission avoidance and
contribute to reduction in overall emergency bed days used.
• The disability is predominantly whole community agenda, focused on rights inclusion and
choice moving away from specialist provisions towards facilitating access to mainstream
services and to the community in general with a strong focus on addressing inequalities.
• Health and social care organisations are developing a commissioning system which supports
personalised care. The different agencies working across the health social care and
voluntary sector will work need to work in effective partnership to continue to develop
seamless services and to effectively target local resources to best effect.
• Access to suitable housing and opportunities for paid employment is key areas for continued