State of HealthOur people Our place Our approach Our strategy Resources

Supporting Independent Living

also known as: Disabled people, Physical disability.

This page provides information on the need to support people with long term conditions to be more independent and have full choice and control over their lives.

One of the five key priorities in the Health and Wellbeing Strategy focuses on supporting people with long term conditions to be independent and have control.

Developing a co-ordinated, effective and personalised response to the needs of adults with disabling long-term health conditions is a central challenge for the health and social care system, and for wider public services. We will concentrate, in particular, on:

  • developing reablement and rehabilitation services to reduce people’s long-term support needs.
  • integrating co-ordination of community support for people with long-term conditions.
  • developing a system of personal budgets for long-term health and social care.
  • making telecare and telehealth available to those who can benefit from them.

Why has this been identified as a priority?

The JSNA has identified that adults with long-term health conditions are now the predominant users of NHS services. Almost all of the users of adult social care have disabilities or disabling long-term conditions. In addition:

  • The numbers of adults with disabilities or long-term health conditions are projected to increase. This includes people with conditions associated with old age, due to increased life expectancy, and young adults with complex disabilities, due to improved medical care increasing survival rates.
  • There are relatively high levels of usage of institutional forms of service to support disabling conditions. A risk-averse culture in many services has resulted in forms of support that can undermine people's independence.
  • Organisational and financial arrangements have often prioritised responding to health and social crises over effective continuing support and monitoring to prevent crises from arising.
  • There are rising expectations about the extent to which disabled people should be supported to be in control of their own lives, and to have the same choices as others.

What will be done differently?

Commissioning arrangements for health and social care support for people with long-term conditions need to be fully integrated, to ensure that people get more coherent, and therefore more effective and accessible, support. There will also be a greater emphasis on understanding carers’ needs, and making sure that they are able to play a full part in designing support arrangements. Funding mechanisms will be redesigned to remove unnecessary obstacles to transferring resources from crisis response into forms of support which maintain people's independence. We will work to change the risk adverse culture among professionals and in the wider community so that people are not over-protected in a way that undermines their independence. These changes will require resources to be shifted from hospitals to the community and from treatment episodes to long-term coordinated support.

What impact will be made?

  • People with long-term conditions will feel more in control of their support, will be clearer about who they need to talk to when there are problems, and be less likely to experience emergency hospital admissions or institutional care.
  • Disabled people will become more widely visible in the community and community attitudes to risk and independence will evolve.

Key Documents & Links

  • Commissioning Documents- These plans sets out the shared commissioning intentions for supporting disabled adults and those with a long-term illness. They are shared between Northumberland Care Trust, Northumberland County Council and the Northumberland Commissioning Group.
  • Market Position Statements- From April 2015 local authorities will have a strengthened duty under the Care Act 2014 to facilitate and to shape the market for adult care and support in their area. Market Position Statements will be a key part in this extended role helping to ensure: an appropriate choice of different types of service and providers; high quality, personalised and outcome-focused services; a supply of such services sufficient to meet the demand for them; a stable and sustainable market.

Northumberland has collaborated with regional partners, with government-appointed advisors and in consultation with users and service providers to develop four Market Position Statements following a format shared with other North Eastern councils to address the needs groups for whom we have agreed Joint Health and Social Care Commissioning Strategies: older people, people with learning disabilities, working age adults with a physical disability or illness; and people with mental health issues.

The Statements cover for each group: supply and demand of services, future resources for council-commissioned services, key messages from policy, users and providers, the priorities for new service development. They give a sense of the direction we would like the market to take; and form part of continuing engagement with stakeholders. They are available on this link.

The following information and priorities are taken from the baseline JSNA and update (2012). The content of this section is currently being updated therefore some of the data and documents may be out of date.

Statistics on this topic on the People and Disabilities page

Key Documents

Key messages

Priorities for this group of people include
  • better information and advice about services and facilities
  • increasing the use of assistive technology to support people in the community
  • recognising the role of carers
  • developing services to maximise independent living, inlcuding making the best use of housing-related support
  • increasing personal control over resources and developing self-directed support
  • involving people with a disability in the planning and delivery of services
  • using a new phone service to signpost people who are not emergencies
  • working with children's services for a seamless transition to adulthood

The views of people with a disability or long-term illness and their carers are drawn from a wide variety of sources, including user forums for people with a long-term condition, and for people who receive direct payments, carers’ forums organised by Carers Northumberland, surveys of service users and carer, and specific consultations about key developments such as the personalisation of social care. The key messages coming out of these consultations include:

  • People want services that fit into their lives and do not want to change their lives to fit the service delivery schedules and capacity of care agencies that sometimes cannot for a variety of reasons provide support when they want it
  • The current care management service is valued as a way of having needs assessed and support services arranged, but is also felt to be bureaucratic, with many forms having to be completed to access these services
  • People want to feel that they are listened to and want to be in control of the care planning and care arrangement processes.

Statistics on this topic on the People and Disabilities page

Key documents

Statistics on this topic on the People and Disabilities page

Key documents

People receiving social care services

People receiving social care services in Northumberland were surveyed as part of the Adult Social Care User Survey in England 2010-11. Overall views were very positive: overall satisfaction with the care and support people were receiving was 93% - either extremely (31%) satisfied, very satisfied (32%) or quite (30%) satisfied.

This is reflected in the view that some key aspects of quality of life were mostly in place:

  • People described their personal care positively: 53% feeling able to present themselves in the way that they liked; 41% feeling adequately clean and presentable.
  • 64% of people felt they got all the food and drink they liked when they wanted it; 30% felt their food and drink adequate.
  • 60% felt their home was as clean and comfortable as they wanted; 35% felt it was adequate.
  • 62% of people felt as safe as they wanted; 30% felt adequately safe.

However, views on overall quality of life suggested that people would like to see improvement: 47% of people felt extremely, very or quite satisfied. Possible issues include:

  • 72% of people felt they had as much control as they wanted over daily life and 47% felt they had adequate control.
  • 39% felt they had as much social contact as they would like, and 36% had adequate social contact.
  • 61% of people thought information and advice very easy or fairly easy to find, 20% found it fairly difficult or very difficult to find.
  • Perhaps understandably in a county such as Northumberland, satisfaction with getting around outside the home was an issue: with 30% of people feeling able to get to all the places in their area that they want; 27% acknowledging that at times this was a challenge; 24% unable to get to the places they want and 19% unable to leave their home.

Short term support services

People with many different needs use this service, which provides initial assessment and support with a view to quickly restoring people’s independence and maintaining their ability to live in their own homes. Their views were sought in summer 2012.

Overall views were very positive

  • High levels of overall satisfaction: 97% rating the service either excellent (73%) or very good(24%).
  • Most people felt the service offered helped them to do things for themselves (93% either agreed with this or agreed strongly)
  • Most people the treatment they received was polite and friendly (99% agreed or agreed strongly); and respected their dignity and privacy (99% agreed or agreed strongly).
  • Information about the service was understood fully (57%) or partially (28%); and timing of visits was convenient always (65%) or most of the time (32%).

There were some areas where comment was negative or suggested improvement was possible – 24% of people felt their ability to do housework or laundry had reduced after receiving the service; 25% of people felt the same in respect of shopping.

In-house services (mostly for people with learning disability)

The users of these services made the following points.

  • People liked going to the day services, felt safe there; were happy with the staff; had friends there; but views about meals and information provided by the service were mixed.
  • People using the horticultural services also liked going there; felt safe there; were happy with the staff; and had friends there. They reported that they got the chance to learn about new things; they knew how to use tools and equipment safely; but some people felt they were not consulted about how the service was run and others also wanted to see better information.
  • People from residential care services liked living there; were happy with the building; felt safe there; were happy with the staff; and felt able to keep in touch with family and friends. Some people said they wanted more things to do and to go out more: some people did not feel able easily to make their own drinks and snacks.

Autism is a lifelong developmental disorder which affects the way people interact with the world around them. The three main areas of difficulty which all people with ASC share, relate to 'social communication', 'social interaction. and 'social imagination'. Some people with ASC can live relatively independantly, while others require a lifetime of specialist care.

There is a tendency to think of autism as a condition affecting only children, and it can be under-diagnosed in older people, as suggested in research by the National Autistic Society (NAS) charity, published in Getting on? Growing Older with Autism (2013). Improvements to the diagnostic pathway for adults should take account of the needs of older people as well as those of working age adults. Further research is required to improve understanding on how the condition develops in older age and the most appropriate forms of support required for older people with autism.

Statistics on this topic on the People and Disabilities page

Key Documents

A carer is someone who provides un-paid help to a person who depends upon them because of frailty, mental or physical health problems, illness or drug/alcohol misuse. They may not live in the same house and do not have to be related to the person who they care for.The amount and type of care that carers provide varies considerably.

Key messages

The geographical isolation of many people in Northumberland increases this risk and rural carers are not only less likely to recognise themselves as carers and exercise their rights, but they may also experience greater difficulty in getting the help they need.

Caring is still predominantly a role carried out by women. The 2001 census showed that about 42% of carers are male and 58% of carers are female; fewer male carers may seek support.

A number of different groups of carers require support and there is no single group or stereotypical relationship, e.g.

  • People providing support to someone with an enduring mental health problem often fail to recognise their eligibility for support as the care does not always involve practical help.
  • Young carers (under 18) are often not recognised by professionals as having a substantial caring role and can be extremely isolated.
  • Black and ethnic minority carers tend to be hidden largely due to assumptions made with regard to the closeness of facilities and the role of woman.

Combinations of disadvantage including caring responsibilities often lead to a cycle of worklessness and ill health, e.g. a person who becomes a carer whilst still a child is more likely than average to be economically inactive and still a carer as a young adult.

Many carers juggle work with caring and view their work as a vital part of their lives. People who give up work to care face an immediate reduction in income and the loss of companionship at work may lead to social exclusion.

Carers’ health is an issue as carers are more likely than others to suffer from health problems. Caring can be demanding physically, emotionally and mentally. Helping to keep carers healthy is crucial if they are to continue in this essential role.

Statistics on this topic on the People and Disabilities page

Key Documents

More information about carers can be found on the Council's Carers webpage here.

Guidance on working with carers

Statistics on this topic on the People and Disabilities , and Older People pages

Key Documents

The Ex-Service Community

Although service in the armed forces is generally associated with good health, there has been increasing research and media attention on service-related Post Traumatic Stress Disorder (PTSD), other mental disorder including mild traumatic brain injury and links to alcohol abuse, homelessness and crime.

In addition, more servicemen survive injuries that would have caused death years ago, due to advances in military health services. Therefore, the physical health needs of those people surviving injuries during military conflict present significant challenges for health and social care services during servicemen's recovery before they return to service or adapt to civilian life if medically discharged.

Key Messages

  • The North East provides a disproportionately high number of recruits to the armed forces, many of whom will return to settle in the area upon discharge.
  • Advances in military medicine mean that more of the ex-service community may be returning to civilian life with complex and long term needs, which require significant levels of expertise and financial resource to meet.
  • There is a strong body of evidence to indicate that the ex-service community have worse health outcomes than the general population.
  • The transition for those leaving the forces, into the civilian NHS is patchy and variable in its effectiveness; the link between defence medical services and the local NHS needs to be much tighter and more systematic.
  • Earlier intervention from other civilian services such as Job Centre Plus and Housing would also facilitate a smoother transition for ex servicemen.
  • Better information about size, geographical spread, age profile, employment status and health and social needs of the ex-service community in Northumberland is required to support the planning and commissioning of services; this information gap applies to the whole of the North East of England.

Renewed commitment includes

  • A guarantee that all those seriously injured will receive an early and comprehensive assessment of their long term needs before they leave the Armed Forces;
  • High quality care for life for those with continuing healthcare needs based on a regular review of their needs overseen by an NHS case manager
  • Grant funding with Combat Stress (that they are matching) to work directly with mental health trusts to ensure that the services they provide are accessible to and appropriate for military veterans;
  • Closer NHS links with a full range of third sector partners and charities with extensive experience of working with veterans, to share advice, knowledge and best practice to improve services for veterans;
  • Entitlement for all veterans who have lost a limb whilst serving in the Armed Forces to receive, where clinically appropriate, the same standard of prosthetic limb from the NHS that they received or would receive today from Defence Medical Services as a result of major technological advances.
  • Responsible Directors within each Strategic Health Authority, together with Primary Care Trust champions, to ensure the needs of the armed forces, their families and Veterans, fully reflected in local plans and service provision; and
  • Improved transfer of medical records to the NHS on retirement from the armed forces, including greater GP awareness of veteran status of new patients to ensure veterans receive their entitlement to priority treatment for any injuries or illness attributable to their time serving in the Armed Forces.

Key documents

Future Plans

People who are homeless

People who are homeless or living in temporary accommodation suffer from high levels of health inequality which may include: high mortality rates; higher rates of depression and anxiety and some major mental disorders; higher prevalence of bronchitis, tuberculosis, arthritis, skin diseases, and infections, problems related to alcohol and substance misuse; and higher rates of hospital admissions.

A general definition is that someone is homeless in law, if:

  • They do not have accommodation that they have a legal right to occupy.
  • They have accommodation that is not accessible and/or physically available to them (and their household).
  • They have accommodation but it would not be reasonable for them to continue to live in it.
  • It would not be reasonable for someone to continue to live in their home, for example, if it was likely to lead to violence against them (or a member of their family) or if the property was in such a state of disrepair that it was not habitable.

Key messages

The Housing Options and Homelessness Service continues to work toward achieving successful outcomes against the housing performance indicators for homelessness which are:

  • Number of successful outcomes for homelessness support and prevention funded through the homelessness grant
  • Average length of stay for occupants in the temporary accommodation owned, leased or accessed by a Service Level Agreement
  • The percentage of satisfied customers who have accessed the housing options and homelessness service
  • Average length of time to process a homeless application to decision. The target is currently 28 days.

Key documents

People Isolated and Excluded

Equalities and community cohesion are key cross cutting themes within the refreshed Commissioning Strategy. A cohesive society would seek to reduce isolation and social exclusion.

Key Messages

People who live in a rural setting can be quite isolated and excluded from normal every day activities and services throughout Northumberland. From lack of access to training events to lack of access to health and education services. Better transport links are key to enable people to access a universal range of services.

  • The relationship between better health and income could explain why fewer people in poorer rural areas such as Lincolnshire and the Fens, the North East, Cornwall, the Isle of Wight and East Kent report that their health is good.
  • Fathers are an important part of a child’s life and their needs can sometimes be overlooked by service providers. Countywide there has been an Including Men Network developed; this looks at best practice and emerging issues countywide. Sure Start Children’s Centres are actively involving fathers in their daily practice.
  • Sure Start Children’s Centres work closely with JobCentre Plus Lone Parent Advisors, to make sure they are receiving the services and benefits available to them. This will enable lone parents to return to or enter into education, employment or training.
  • Offenders can be isolated and excluded. A range of interventions have been deployed to reduce the number of young people re-offending, and becoming involved with the criminal justice system.
  • Within the contracts the Council has renewed there is a sharper focus around participation as it was felt that was a key area of need.

Statistics on these topics on the Other Vulnerable Groups page

There are 1.86 million people in the UK living with sight loss. By 2020 this number is predicted to increase by 22 per cent and will double to almost four million people by the year 2050. The increase can be mainly attributed to an ageing population; over 80 per cent of sight loss occurs in people over 60 years.

Age-related macular degeneration, glaucoma and diabetic retinopathy have all increased in England and Wales since 1990- 91 and the number of people with diabetic retinopathy among the over-65s has more than doubled.

Age-related macular degeneration (AMD)This commonly affects people over the age of 50 and is the leading cause of blindness in people over the age of 65. There are two main types: neovascular or exudative AMD commonly known as wet AMD; and atrophic commonly known as dry AMD. Early identification and treatment of wet AMD is vital. Treatment can halt the further development of scarring but lost sight cannot be restored. Dry AMD can develop slowly and take a long time to progress to its final stage. There is currently no treatment for dry AMD.

Glaucoma is a group of eye conditions in which the optic nerve is damaged due to changes in eye pressure. Damage to sight can usually be minimised by early diagnosis in conjunction with careful regular observation and treatment.

Cataracts is a common eye condition that can get worse over time, prevalent in older people, where the lens becomes misty or cloudy resulting in poor vision. Cataracts surgery can improve quality of life and reduce the number of falls (RNIB 2011).

Diabetic retinopathy can lead to permanent sight loss, therefore screening and early diagnosis with appropriate intervention is essential. A Department of Health screening process has been introduced. The uptake of screening services for diabetic retinopathy can be explored on the NHS Atlas of Variation .

Key messages

  • The prevalence of sight loss increases with age and the UK population is ageing. One in five people aged 75 and over and one in two people aged 90 and over is living with sight loss in the UK.
  • The four leading causes of sight loss are age-related macular degeneration (AMD), glaucoma, cataracts and diabetic retinopathy.
  • There is a wide range of impairment levels and it is important that services are tailored to meet individual specific needs.
  • There are a number of people with sight loss below registrable levels whose specific needs will need to be considered in service planning. These will include people identified as having low vision (sight loss that is not correctable by spectacles).
  • Groups at greater risk of sight loss also tend to be those most vulnerable to exclusion from services. Such groups include older people, people in the lower socio-economic groups, those in residential care, those with poor mobility, those with dementia, Black and Minority ethnic (BME) groups, those with multiple sensory loss/impairment, those with learning difficulties, the prison population, asylum seekers, refugees and travelling populations.

JSNA Guidance for Eye Health

Evidence (cited in JSNA Guidance for Eye Health, July 2012) shows:

  • There is a link between people on low incomes and living in deprivation and people living with sight loss; three out of four blind or partially sighted people are living in poverty or on its margins.
  • People from the Asian population are at a higher risk of developing cataracts. African, African Caribbean and Asian populations are at a higher risk of developing diabetic eye disease.
  • There is a high prevalence rate of visual impairment amongst adults with learning disabilities. An estimated one in ten adults with learning disabilities is blind or partially sighted and adults with learning disabilities are 10 times more likely to be blind or partially sighted than the general population
  • The links between sight loss and other health determinants include smoking, obesity and uncontrolled high blood pressure. Strokes can result in visual impairment (affecting 60% of stroke survivors).
  • As the population ages an increasing number of people will experience both dementia and sight loss.
  • Visual impairment is associated with a higher risk of suicide.
  • People registered with a sight impairment are distributed unevenly across the different localities in the county (April 2013 figures):
  • 32% are in the Central locality
  • 21% in the North
  • 23% in the South and
  • 23% in the West

More detail of the position in Northumberland is available here.

Sight loss data toolkit

The Sight Loss Data Tool provides information about blind and partially sighted people and those at risk of sight loss at a local level throughout the UK. By providing robust evidence on sight loss and those at risk of sight loss at a local level, the data tool can support a range of activities such as:

  • fundraising
  • influencing
  • marketing and communications
  • service and strategic planning

Statistics on this topic on the People and Disabilities page

Key documents

Additional policy and legislation

Key messages

The proportion of the population who have a learning disability falls with age, in part because some common conditions associated with learning disability also lead to a reduced life expectancy compared to the general population. People with learning disabilities are 58 times more likely to die before the age of 50 than the general population.

However, the health of people with a learning disability has been improving over the years in conjunction with improvements in health and social care, so that many people with a learning disability are living longer. This does, however, pose some health concerns for people with learning disabilities in older age. In particular, there is a higher risk of complex health problems and dementia in people with Down’s Syndrome or profound and multiple learning disabilities.

National prevalence data suggest there will be 1500-1600 people with a moderate or severe learning disability in Northumberland.

Key issues for people with learning disabilities in the next five years:

  • An increase in the number of older people with learning disabilities who have additional needs
  • Increased life expectancy of people with Down’s syndrome
  • An increasing number of younger adults who have additional needs
  • Increasing rates of physical disability associated with cerebral palsy
  • The need to personalise care of people with complex and challenging behaviour
  • Applying best practice in the care of people with mental health problems to people with learning disability with mental health needs
  • A larger number of young people in transition from children’s to adult services

Further information on promoting equality in Northumberland, and information on how we are meeting our duties under the Equalities Act 2010, can be found on the Equality and Diversity web page.

Statistics on this topic on the People and Disabilities page

Key documents

Key messages

National statistics confirm mental health as the largest single cause of disability

Both common mental health problems and diagnosable psychosis are associated with being separated or divorced, being unemployed or in an unskilled job, having physical health problems and living in an urban area. (In at least some of these cases, the direction of causation may not be one way.) The influence of mental health conditions is also associated with educational achievement and skills, health risk behaviours such as smoking and substance misuse, anti-social behaviour and criminality.

Key messages from users and carers in previous reviews and surveys are that although there has been significant progress in mental health (with the development of a range of different services) there needs to be:

  • More direct support for carers including short break care, especially for young carers, either through extra support into the home, or the person they care for being able to have short-break care in a suitable environment
  • Improved access to substance misuse and alcohol service for people with mental distress (including alcohol detox facilities)
  • Improved services for people with eating disorders
  • More recognition of the needs of people with Aspergers Syndrome
  • More access to crisis beds
  • Earlier intervention, including a 24 hour helpline for people experiencing mental distress but who don’t meet the criteria immediate risk of hospital admission
  • More emphasis on social inclusion and recovery, particularly the employment of service users, information to employers, and work to address stigma and discrimination
  • More intensive support for people who do would benefit from longer term support to help them live independently and support which can respond flexibly to changes in their mental health any time of day or night
  • More locally available services and more choice, including day opportunities which offer safe, supported facilities with mental health expertise as well as support to access opportunities in the wider community
  • Out of hours flexible services.

Copies of surveys from previous years are available below:

Key documents

Policy and legislation - Northumberland

Community Mental Health Profiles 2013,

Statistics on this topic on the People and Disabilities page