8.1 Introduction

Measuring the numbers of disabled people and their impairment was recognised by the West Midlands Regional Observatories Population and Society topic group as a gap in the Regional evidence base. This chapter is an attempt to map our knowledge of disability across the region and identify where gaps exists. The Regional Disability Network http://www.rdn-wm.org.uk/ has provided guidance on both use of language and some sources of data. The networks goal is to be the voice of disabled people in the West Midlands and sees publications such as Key Health Data as important in raising the understanding of disability issues in the public sector.

In this chapter we have reviewed quantitative data on physical and sensory impairments, mental illness, learning difficulties (disabilities) and social disabilities, There is much existing qualitative ‘needs’ evidence in the public domain which reflects the challenges faced by Disabled people in today’s society but these were beyond the scope of this chapter.

8.2 Definition of Disability

Before embarking on any work on disability it is important first to address the language and scope of the work.  The Disability Discrimination Act (DDA) defines a disabled person as ‘someone who has a physical or mental impairment that has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities’.¹ We propose to use the DDA definition in this chapter.

Definition of Impairment and Disability

• Impairment is an injury, illness, or congenital condition that causes or is likely to cause a long-term effect on appearance and/or limitation of function of the individual.
• Disability is the loss or limitation of opportunities to take part in society on an equal level with others due to social and environmental barriers

8.3 Models of Disability

There are a number of models that can be used to view and discuss disability, the two most common being the ‘social model’ and the medical model’. The Office of Disability Issues (ODI) and organisations in the Disability sector use and encourages others to use, the social model.  It is important to be aware of these two differing views as they lend differing interpretations to how we interpret the data we have available to us and the gaps that remain. 

The Social Model

Impairments and chronic illness often pose real difficulties for disabled people but they are not the main problems. It is the 'barriers' which exist in society that create the main problems. The three main areas of barrier are:

• environment (including inaccessible buildings and services)
• attitudes (stereotyping, discrimination and prejudice)
• organisations which operate inflexible procedures and practices

The Medical Model

The medical model is sometimes also known as the ‘personal model’. This is the traditional view that the inability of disabled people to fully participate in society is a direct result of having a disability, not a result of physical features of society.  The individual is 'impaired' and the impairment is the problem to be overcome. This model relies on a strong notion of what is ‘normal’, thereby emphasising the ‘abnormality’ of impaired people.

This model is more likely to lead to the targeting of special welfare benefits, and the provision of segregated services for disabled people.

The focus of the medical profession is to alleviate the effects of impairments, and disabled people need to be treated and rehabilitated to enable them to participate more fully.  This model suggests that disabled people should try, wherever possible, to live in the norms and patterns of mainstream society. ²

8.4 Measuring and Mapping Disability across the West Midlands

The aim is to map out the prevalence of disability by type across the region, and where possible the age, sex and ethnic distribution.  The chapter will look at the data sources available, present the data where available and indicate the biggest gaps.  The main content for this chapter is taken from the Office of Disability Issues. ³   For each area covered by the ODI we have highlighted where regional or lower level data is available.

8.5 Data Sources

There are two major types of data on impairment: Surveys; and administrative data.  There is no single register of disabled people and their needs or services provided.  In many regards this is probably the initial gap.  Disability services are not the sole remit of a single agency.  The challenges in using this data is that there is a lot of double counting and the data collected is still very medically orientated and focussed on individual disabled person’s limits rather than barriers which prevent full inclusion in society. 

Currently surveys use different wording to define disability resulting in different statistics on numbers of disabled people and exclusion of certain groups who may have rights under the Disability Discrimination Act (DDA). Furthermore, current survey questions often adopt a medical model approach to defining disability, without considering the social barriers that restrict people’s life opportunities.

ODI and Office of National Statistics (ONS) have continued to consult other government departments and disabled people on how to revise the questions used. It is anticipated that a recommended set of standard disability questions will be available before the end of 2010.⁴

On the KHD website  (http://www.bham.ac.uk/keyhealthdata) there is a downloadable data set of all measures of disability uncovered in producing this chapter.

8.6 General Demographics

• It is estimated that there are over 10 million people with a limiting long term illness, impairment or disability in the UK (Department of Work and Pensions 2010 )
• The most commonly reported impairments are those that affect mobility, lifting or carrying. 5
• The prevalence of disability rises with age. Around 1 in 20 children are disabled, compared to around 1 in 7 working age adults and almost 1 in 2 people over state pension age.5

Regionally there were 993,458 people with a limiting long term illness in the 2001 Census.  However, we are unable to count how many people have each type of limiting long term illness or disability. The data we do have on the types of disability people have is listed in Table 8.1. However within this table there will be much double counting.  This is evident from the data provided by the National Health Information Centre on those people who are either blind or partially sighted with an additional impairment (Table 8.2). 

Table 8.1: People with a disability living in the West Midlands, and the source of data

Table 8.2: Blind or partially sighted people with more than one disability, March 2008

In Table 8.3, the counts of people in receipt of benefit are listed by the condition for which they qualify.  This is the best data we have on the types of impairment in the population; however it should be noted that not all of these people would fall under the DDA definition.  There are three key data issues with using this information:

1. There are differences in the categorisation used for the different benefits.  Incapacity Benefit uses ICD 10; where as the other 3 use a Department of Work and Pension (DWP) specific classification. that does not match ICD 10.  A key concern is the inability to properly allocate the musculoskeletal conditions and injuries in the DWP classification. 
2. There will also be double counting across benefit groups as people are often in receipt of more than one benefit.   
3. The data for Attendance Allowance, Disability Living Allowance and Income Support are based on 5% samples and therefore are unreliable below counts of 500, and therefore unreliable below West Midland level in all but the largest local authorities. 

Table 8.3: People in receipt of benefits by medical condition, across West Midlands, November 2009

There is some data available on the age profile of people living with impairment.  For those registered as blind (Figure 8.1) and those in receipt of Disability Living Allowance (Figure 8.3) show an increasing number as age increases, however the rate of deafness is more u-shaped with a distinctly younger cohort of people (Figure 8.2) 

Figure 8.1: People registered as blind by age

Figure 8.2: People registered as deaf, rate per 1,000 population

Figure 8.3: People in receipt of Disability Living Allowance, November 2009

People in receipt of Disability Living Allowance, November 2009

8.7 Living Standards

• 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

• 23 per cent of individuals in families with at least one disabled member live in relative income poverty, on a Before Housing Costs basis, compared to 16 per cent of individuals in families with no disabled member ⁶

• 29 per cent of children in families with at least one disabled member are in poverty, a significantly higher proportion than the 20 per cent of children in families with no disabled member ⁶

This data is based on the Households below Average Income survey for which we have not been able to resolve to below National level. 

8.8 Employment

• The employment rate gap between disabled and non disabled people has decreased from around 36% in 2002 to around 30% in 2009 ⁷

• However, disabled people are far less likely to be in employment. Although there have been significant improvements in the employment rates of disabled people in the last decade, the employment rates of disabled people are around 47%, compared with around 77% of non-disabled people ⁷

This data is based on the Labour Force Survey some of which is available at a sub-regional level on the NOMIS website (www.nomisweb.co.uk), however this data is not on that site. 

8.9 Education

Between 2005/06 and 2008/09, the percentage of pupils at the end of Key Stage 4 achieving 5 or more GCSEs at grades A*-C has

• increased from 66.3 per cent to 80.2 per cent for students without Special Educational Needs (SEN)
• increased from 19.8 per cent to 40.3 per cent for students with SEN without a statement
• Increased from 8.7 per cent to 14.9 per cent for students with SEN with a statement. ⁸

This data is based on National Pupil Database.  This should be available locally through local authority education departments. 

8.10 Post-19 Education

• Disabled people are around twice as likely not to hold any qualifications compared to non disabled people, and around half as likely to hold a degree level qualification
• 24.3 per cent of working age disabled people do not hold any formal qualification compared to 10 per cent of working age non disabled people
• 11.4 per cent of working age disabled people hold degree-level qualifications compared to 21.8 per cent of working age non disabled people ⁷

This data is based again from the Labour Force Survey some of which is available at a sub-regional level on the NOMIS website (www.nomisweb.co.uk), however this data is not on that site. 

8.11 Independent Living

• Over a fifth of disabled people say that they do not frequently have choice and control over their daily lives 8

This is one area where data is collected and available, at least partial sub-regionally.  National Indicator NI136 gives information on the number of adults that are assisted directly through social services assessed/care planned, funded support to live independently, plus those supported through organisations that receive social services grant funded services.  The information is broken down by primary client (adults with a learning disability, a physical disability, a mental health problem, a substance misuse problem and vulnerable people) and by age group (adults aged 18 - 64 and older people aged 65 and over).

Table 8.4 lists the breakdown of people aged 18-64 with a learning disability helped to live independently.  The problem with this indicator is we do not know the population of the West Midlands with a learning disability to know what proportion of people are being assisted.  This data is available sub-regionally.

Table 8.4: People aged 18-64 with a learning disability

However for those people aged 65, the breakdown by impairment is not provided despite it being report under NI136.  What we have is the number of adults all ages per 100,000 population that are assisted directly through social services assessed/care planned, funded support to live independently, plus those supported through organisations that receive social services grant funded services.  The indicator is age standardised and adjusted for likely needs for social care services using needs-weighted population data produced from Relative Needs Formula (RNF) allocation calculations. 

Figure 8.4: People aged over 65 helped to live independently, standardised rate per 1,000

People aged over 65 helped to live independently, standardised rate per 1,000

8.12 Discrimination

Although there is very little data available at regional level about discrimination there are several studies by voluntary organisations working in this sector which provide qualitative information on the impact of discrimination on the lives of Disabled people. Some studies focus on disabled people with a single impairment and evidence the different barriers experienced by different impairment groups

• Disabled people are significantly more likely to experience unfair treatment at work than non disabled people. In 2008, 19 per cent of disabled people experienced unfair treatment at work compared to 13 per cent of non disabled people¹⁰
• Around a third of disabled people experience difficulties, related to their impairment or disability in accessing public, commercial and leisure goods and services¹¹

These data come from the Fair Treatment at Work Survey, and Taking Part Survey and are not found at a regional level.

8.13 Leisure, social and cultural activities

• Disabled people remain significantly less likely to participate in cultural, leisure and sporting activities than non disabled people. In 2008/2009, 51.8 per cent of disabled people engaged in cultural, leisure and sporting activities compared to 69.7 per cent of non disabled people¹²

These data come from the Citizenship Survey and again they are not found at a regional level.

8.14 Participation

• Disabled people are just as likely to have engaged in civic involvement as non disabled people. In 2008/09, 60 per cent of disabled people undertook at least one activity of civic involvement in the last 12 months compared to 62 per cent of non disabled people
• However, disabled people are significantly less likely to engage in formal volunteering. In 2008/09, 21 per cent of disabled people engaged in formal volunteering at least once a month compared with 27 per cent of non disabled people¹²

These data come from the Citizenship Survey and are not found at a regional level.

8.15 Transport

• Around a fifth of disabled people report having difficulties, related to their impairment or disability, in accessing transport 9
• Between 2005/2006 and 2007/2008, the percentage of buses with low floor wheelchair access increased from 50.4% to 62% ¹³

These data come from the Opinions Survey and the Annual Sample Survey of Bus Operators and are not found at a regional level.

8.16 Communications

• Around half of households with a disabled member have access to the internet compared to over two thirds of households with no disabled members ¹⁵

These data come from the British Social Attitudes Survey and are not found at a regional level.

8.17 Justice System

• Across all age groups, disabled people are significantly more likely to be victims of crime than non disabled people. This gap is largest amongst 16-34 year olds where 42 per cent of disabled people reported having been a victim of crime compared to 32 per cent of non disabled people
• Disabled people are also less likely than their non disabled peers to think the Criminal Justice System (CJS) is fair. This gap is largest amongst 16-34 year olds where 53 per cent of disabled people think that the CJS is fair compared to 64 per cent of non disabled people ¹⁶

These data come from the British Crime Survey and again that are not found at a regional level.

8.18 Housing

• Although the gap in non-decent accommodation has closed over recent years, 1 in 3 households with a disabled person still live in non-decent accommodation 16
• 1 in 5 disabled people requiring adaptations to their home believe that their accommodation is not suitable ¹⁷

These data come from the English House Condition Survey and the Survey of English Housing and again that are not found at a regional level,

8.19 Life Opportunities Survey

The Life Opportunities Survey (LOS) is a new national survey sponsored by ODI. It aims to collect information on people’s life opportunities, covering areas such as work, education, social participation and the use of public services. The survey also aims to identify the reasons why people do not take part in work or leisure activities that they would like to, or why people experience difficulties with using public services. There are specific questions which examine daily living through the lens of discrimination encountered.

8.20 Data archives

The Economic and Social Data Service  (http://esds.ac.uk) stores record level data for the surveys listed below and used in this chapter, and is free to access for public sector and non-commercial organisations. It was beyond the resources available to this study to undertake any detailed analyses of these surveys.

• British Crime Survey
• Citizenship Survey
• English House Condition Survey
• Fair Treatment at Work Survey
• Family Resources Survey
• House Below Average Income
• Labour Force Survey
• ONS Opinions Survey
• Survey of English Housing
• Taking Part Survey

The British Attitudinal Survey can be accessed through a dedicated website at the National Centre for Social Research (http://www.britsocat.com).

8.21 Conclusion

There remains an on-going paucity of data on disability, even filling the data gaps proves challenging without trying to look at the social model.  The most comprehensive data set remains the benefits data.  The registers of people who are blind or deaf are perhaps role models for other impairments, but there remain deficiencies in terms of equalities with no data on ethnicity, deprivation or sexuality.  Until these areas are addressed commissioners will lack the appropriate data to design services to fit the needs of their populations

References:

1. Office of Disability Issues 2010 http://www.officefordisability.gov.uk/research/definitions.php Accessed July 2010
2. Office of Disability Issues 2010a: http://www.officefordisability.gov.uk/resources/models-of-disability.php  Accessed July 2010
3. Office of Disability Issues 2010b: http://www.officefordisability.gov.uk/research/definitions.php Accessed July 2010
4. Office of Disability Issues 2010c: http://www.officefordisability.gov.uk/research/facts-and-figures.php Accessed July 2010
5. Statistical sources were quoted by Office of Disability Issues, the links provided here are to the survey websites, not necessary the actual data reported. 
6. Department of Work and Pensions 2010 Family Resources Survey 2008/09 http://statistics.dwp.gov.uk/asd/frs/ Accessed July 2010
7. Department of Work and Pensions 2010a Households Below Average Income 2008/09 http://statistics.dwp.gov.uk/asd/hbai/hbai_2009/index.php?page=chapters Accessed July 2010
8. Office of National Statistics 2010: Labour Force Survey 2009 http://www.ons.gov.uk/about-statistics/user-guidance/lm-guide/sources/household/lfs/index.html Accessed July 2010
9. Department for Children, Schools and Families 2010: National Pupil Database: Attainment Tables 2005/06-2008/09 http://www.dcsf.gov.uk/performancetables/ Access July 2010
10. Office of National Statistics 2010a Opinions Survey 2009 http://www.ons.gov.uk/about/who-we-are/our-services/omnibus-survey
11. Department for Business, Innovation and Skills 2010:  Fair Treatment at Work Survey 2008 http://www.bis.gov.uk/files/file52809.pdf  Access July 2010
12. Department for Culture, Media and Sport 2010: Taking Part Survey 2008/09http://www.culture.gov.uk/what_we_do/research_and_statistics/4828.aspx Access July 2010
13. Department of Communities and Local Government 2010: Citizenship Survey 2008/09 http://www.communities.gov.uk/publications/communities/citizenshipsurveyaprmar08 Access July 2010
14. Department for Transport 2010: Annual Sample Survey of Bus Operatorshttp://www.dft.gov.uk/pgr/statistics/datatablespublications/public/bus/latest/bus2010q01.pdf Access July 2010
15. National Centre for Social Research: British Social Attitudes Survey, 2006 http://www.britsocat.com/Body.aspx?control=HomePage Access July 2010
16. Home Office 2010: British Crime Survey 2008/09 http://rds.homeoffice.gov.uk/rds/bcs1.html
17. Department of Communities and Local Government: 2010a: English House Condition Survey 2007/08 http://www.communities.gov.uk/housing/housingresearch/housingsurveys/englishhousecondition/  Access July 2010
18. Department of Communities and Local Government: 2010b: Survey of English Housing 2007/08http://www.communities.gov.uk/housing/housingresearch/housingsurveys/surveyofenglishhousing/ Access July 2010