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Annex B
HEALTH AND WELLBEING
EXECUTIVE SUMMARY
INTRODUCTION
This report covers the Health and Wellbeing portfolio. This portfolio includes a number of significant aspects regarding disability equality which impact directly on disabled people's lives and wellbeing such as access to healthcare, and availability of community care. To this end seven key focus areas were selected for in-depth consideration and reporting: access to healthcare, independent living, housing, aids and adaptations, community care, sports and tackling poverty.
FOCUS AREAS
Access to Healthcare
The research shows that all the area and special heath boards have published disability equality schemes and over three quarters (18 out of 22) have published annual reports. A review of action plans and annual reports shows that the disability equality duty has served to help move progress forward on disability equality amongst health boards and on access to health care for disabled people, by comparison with a survey of baseline activity which was undertaken in 2004 1. Across the health boards, there appears to be a strong intention to take action to improve access to healthcare for disabled people, eliminate discrimination and promote equality of opportunity with some notable initiatives to meet disabled people's needs, though there is more that some boards could do to make their schemes and reports accessible.
Areas of progress include the assessment of policies, procedures and functions on disability equality, and the development of action plans to enhance service use and accessibility by disabled people of NHS services. A number of actions to improve the quality and accessibility of services, information, staff training on disability awareness, and the development of employment policies have been undertaken, and plans exist for further activity. There are some strong examples of information gathering to assist service development. There appears to be lesser activity from the health boards to take forward disability equality in relation to employment than in service delivery- in nearly half of all boards, baseline disability employment data was absent, though some boards now have plans in place to develop such data and to review policies.
For those with good provision already, the development of schemes and action plans has helped direct and shape their approach, and ensured that practice has been more related to disabled people's direct needs. For those with less developed programmes, the duty has served to ensure that disability equality is more on their agenda.
Housing
Housing is a key issue for many disabled people with both accessibility and adaptability of properties being key issues. Housing issues in relation to disability assume significant importance given that roughly a third of all households include a disabled person. Thehousing profile of disabled people in Scotland is different to that of non-disabled people with more disabled people renting (mainly from social housing providers), by comparison with non-disabled people who are more likely to own their properties. There is a need in many cases for aids and adaptations to make houses useable and suitable for disabled people.
In regard to evidence of progress on housing and disability equality two-thirds of local authorities in Scotland (22 authorities out of 32) made reference to actions on housing for disabled people within their disability equality schemes, action plans and annual reports. There was also evidence of progress from Communities Scotland 2 on developing the regulatory framework for social housing for disabled people and in standard setting for new built accommodation. Actions by local authorities ranged widely and covered a multitude of issues including:
- attention by some authorities to inclusive design and adaptations policies;
- Impact assessment of housing allocation policies by several authorities
- reviews of housing strategies by a significant number of authorities
Progress on housing and disability equality appears to have been less evident in a minority of local authorities which made no mention of housing issues in their disability equality schemes. Overall there was little data and evidence provided on housing and disability equality in disability equality schemes and annual reports. Only a minority mentioned tenant participation and support.
Sport
Sport was selected as a research focus area, as it can be a significant contributor to people's health and well being and previous reports had shown that there was a need for progress in the access to and participation by disabled people in sport. The research showed that there appears to have been progress made in the area of sport and disability equality, influenced in particular by the actions of sportscotland.
Some progress had been made by local authorities, particularly in respect of some steps with regard to access to and participation by disabled children and young people. However, a third of local authorities did not make reference to disability equality in sports in their disability equality schemes and in several there was little detail. A number, however, had clearly recognised the importance of the issue and were reviewing or developing strategies to take work forward, and some were looking to put standards and quality assurance frameworks in place.
Sportscotland had developed equality information and training material for staff and partner organisations, as well as a set of criteria for sports governing bodies and the development of equality targets for the Active Schools scheme. The Equity standard for sports appears to be a useful method of moving progress on disability equality forward. A number of the local authorities had taken forward work on the inclusion and participation of disabled children. However, only a minority of authorities specifically mentioned improving access to facilities for disabled people in sport in their schemes and annual reports and there were fewer mentions of disabled adult participation in sport, than for disabled school children.
Independent Living
Independent living as a concept has emerged over the past few years as a key issue for disabled people's equality. Independent living has been defined as 'disabled people having the same choice, control, and freedom as any citizen - at home at work and as members of the community' 3. It is an important issue therefore for local authorities and health boards, as they contribute towards policy and service provision in areas such as community care, aids and adaptations and housing.
The research found evidence that independent living is becoming a more evident area of focus both in policy and in practice terms by many public authorities. A review of local authority disability equality schemes, indicates that independent living for disabled people/or actions to take independent living forward is referred to in a majority of schemes by local authorities, though there was considerable variance in the extent to which the schemes made reference to it explicitly. For a few local authorities and health boards independent living appeared to be a key feature of their approach towards disability equality. Local authority disability equality schemes showed few mentions of activity with disability organisations on progressing independent living.
Local authorities appear to have a definite concern with and attention to take forward issues connected with learning disability and independent living. A minority of local authorities (8) are prioritising methods of encouraging greater take-up of self directed support. It was also noticeable that all the area heath boards make reference to the provision for communication and interpretation services for disabled people and nearly half to advocacy services, but there is lesser evidence of this by local authorities.
Community Care
Community Care Services are important services for many disabled people as they can assist not only the provision of support towards disabled people living in the community but also towards independent living. As a consequence the findings in this section need to be also read with those on independent living and on aids and adaptations.
The research findings indicate that Community Care and disability equality is an area that has received significant attention and consideration by public authorities. A majority of local authorities refer to it in their disability equality schemes as well as a minority of area health boards. In addition there have been a range of impairment specific initiatives, particularly in the case of people with learning difficulties and for people with sensory impairments. A third of local authorities and just over a half of health boards, however, do not refer to community care within their schemes. It would appear that there has been significant underreporting in disability equality schemes of activity and planned activity in this area.
Key activity in regard to taking forward disability equality in community care at a local authority level appeared to be training and awareness development for staff, as well as the development of user satisfaction and involvement methods and protocols for user involvement for people with learning disabilities, mental health problems and physically disabled people. Whilst it was noticeable that there had been some encouraging development work reported by a number of authorities on self-directed support, this still applied to a minority of authorities and those which had plans already had the most developed approaches.
Equipment and Adaptations
For many disabled people the provision of aids and adaptations can be vital to removing barriers and to assist in independence at home, in daily life and in work. Progress towards the overall provision and availability of aids and adaptations by local authorities, health boards and other key public authorities was looked at as well as in regard to the provision of wheelchairs.
The literature review and two reviews undertaken by Audit Scotland and also for the then Scottish Executive suggest that there has been an increase in provision over the past few years, though availability of information, statistics, policies and approaches by local authorities varied. Just under half of all local authorities referred to the provision of aids and adaptations in their schemes, despite all local authorities in Scotland having programmes to issue aids and adaptations. A number of authorities used the opportunity of the development of disability equality schemes to review their policies and approach towards aids and adaptations and some had put new processes in place and widened eligibility criteria. It was noticeable that of those local authorities mentioning aids and adaptations a number were placing attention to adaptations to houses.
In regard to the provision of wheelchairs - progress has been made via the introduction of a Review 4 process which had developed data and information on which future changes could be based. The Review process has travelled a significant distance over the past three years and has completed a systemic appraisal of processes in order to focus the wheelchair service in the future on becoming a service based on national standards.
Tackling Poverty
Poverty was selected as a focus area for the research, as poverty is often linked to inequality and can have a major impact on life chances. It was therefore felt important to look at examine data and evidence showing the extent to which disabled people in Scotland face poverty and progress made by public authorities to overcoming it. This latter aspect proved to be complex and difficult to report on -a significant absence of specific data regarding disabled people and poverty was found at both a national and at local authority level. The data that does exist shows that poverty is a significant factor for many disabled people and that disabled people are significantly more likely to live in poverty by comparison with non-disabled people, and that this is particularly so in the most deprived parts of Scotland.
A considerable number of local authorities have identified poverty amongst disabled people as a key issue - with 24 authorities listing actions to reduce poverty amongst disabled people. Several authorities have developed data about the position of disabled people and poverty in their localities and some had also developed anti-poverty strategies. Key measures that local authorities listed to tackle poverty in their localities were actions to increase employment by disabled people within their authorities, and via supported employment schemes, welfare benefit take up campaigns and in a few cases working on joint initiatives with health boards.
CATEGORIES OF IMPAIRMENT GROUPS
Key references by health boards to various categories of disabled people in disability equality schemes and annual reports were made particularly in regard to people with sensory impairments, people with mental health problems and people with learning disabilities, as well as people with physical impairments. There was also considerable reference to similar impairment groups in regard to community care, but there were less frequent mentions of people with physical impairments. The same sets of groups were mentioned in regard to independent living, along with people with mental health issues. The impairment category most referred to within disability equality schemes regarding housing and aids and adaptations was physical disability. There was also some reference in regard to equipment and aids to people with sensory impairments. The focus areas where impairment categories were least referred to were sport and poverty.
INVOLVEMENT AND CONSULTATION OF DISABLED PEOPLE
The research looked at the involvement of disabled people by health boards in the development of disability equality schemes, and by local authorities in regard to the key focus areas. It shows some commendable examples of involving disabled people by a number of health boards. A few boards showed little by way of involvement, and in a few cases appeared to see the involvement process more as a consultation exercise. In regard to local authority approaches towards involvement of disabled people over the various focus areas there was a considerable variance with some very developed approaches in some schemes and little specific mention in others.
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