Disabilities In England Research Articles

Social care for adults with learning disabilities in England: trends over time

Purpose The purpose of this paper is to examine trends over time in social care usage and expenditure for adults with learning disabilities in England. Design/methodology/approach Returns from councils with social services responsibilities in England concerning social care usage and expenditure were analysed to examine the national picture and trends over time for adults with learning disabilities. Findings In 2017/2018, 147,915 adults with learning disabilities were receiving long-term social care, an increase of 5.7 per cent from 2014/2015. Social care expenditure increased by 10.2 per cent from 2014/2015 to £5.54bn in 2017/2018; adjusted for inflation this was a 2.7 per cent increase. For adults with learning disabilities who receive social care, increasing numbers of people are living with families or in supported accommodation/living, with gradual declines in the number of people living in residential or nursing care. The number of adults with learning disabilities in temporary accommodation is small but increasing. Social implications While councils appear to be attempting to protect social care for adults with learning disabilities in the face of cuts to council expenditure, social care expenditure and coverage are not keeping pace with likely increases in the number of adults with learning disabilities requiring social care. Originality/value This paper presents in one place statistics concerning long-term social care for adults with learning disabilities in England.

Evaluating the quality of outcomes defined for children with Education Health and Care plans in England: A local picture with global implications

Recently, the Children and Families Act 2014 was introduced in England to regulate provision for children with disabilities. According to this policy, statements of special educational needs were replaced with education, health and care plans, which should include high-quality, holistic and participation-focused outcomes to regulate provision; this change aligns with international recommendations regarding provision for children with disabilities.This study aimed to evaluate the outcomes defined for children with education, health and care plans in England.236 Education Health and Care plans were included in the analysis, providing 2813 outcomes to be examined, which came from 11 local authorities and 42 schools and belong to 69 girls and 167 boys from 4 to 21 years of age.The outcomes were independently rated by two experienced researchers using a Goal Functionality Scale. Inter-rater agreement was calculated for 10% of the outcomes.Most outcomes were considered not to be functional or high-quality; differences in quality were found between local authorities, types of school, type of outcome, and the children’s main need.There are important quality concerns regarding the outcomes that have been designed for children with disabilities in England, which should be addressed through standardised training and guidelines on procedures.

Development and implementation of the Steps to Successful Palliative Care programme in residential care homes for people with a learning disability.

For health and social care services to meet the needs of a growing and ageing population they need to respond appropriately. This response is only going to be possible if attention is paid to the individuals within it. This includes those people living with a learning disability (LD). To develop and implement a palliative care programme that would meet the needs of people with a LD, their families and care home staff. A palliative care programme and resource folder was created following a literature review and meetings with LD and specialist palliative care experts, organisations and care home managers. This folder was further developed collaboratively throughout the programme's implementation. 39 homes were recruited and 86% completed the programme. This programme enabled the identification, assessment and management of the health and social care needs of people living and dying in a care home with a LD.

An observational study of the use of acute hospital care by people with intellectual disabilities in England.

Providing safe, high-quality admitted-patient care for people with intellectual disabilities (IDs) requires consideration for their special needs particularly in relation to communication and consent. To make allowance for these special requirements, it would be helpful for hospitals to know how often they are likely to arise. This study set out to identify the amount and patterns of use of acute, non-psychiatric hospital admitted-patient care in England by people with ID. Patterns are considered in relation to clinical specialties, modes of admission (emergency or planned) and life stages (children and young people, working age and older adults). In each case, patterns for people with ID are compared with patterns for those without. Descriptive observational study using a major general practitioner (GP) research database (Clinical Practice Research Datalink GOLD) linked to routine national statistical records of admitted-patient care. Overall people identified by their GP as having ID had higher rates of admitted-patient care episodes and longer durations of stay than those without. Differences varied considerably between clinical specialties with rates more elevated in medical and paediatric than surgical specialties. Admitted-patient care rates for women with ID in obstetrics and gynaecology were lower than for other women, while rates for admitted-patient dental care were much higher for both men and women with ID. In an average English health administrative area with a local population of 250000 people, at any time, there are likely to be approximately 670 people receiving acute admitted-patient care. Approximately six of these are likely to have been identified by their GP as having ID. At 0.9% of hospital in-patients, this is just under twice the proportion in the population. Our figures are likely to be an underestimate as GP identification of people with ID is known to be far from complete. However, they indicate that the number of people with ID in acute hospital settings is likely to be substantially more than a recent survey of English health services indicated they were aware of. The study is intended to help guide expectations for acute hospitals seeking to audit the completeness of their identification of people with ID and to indicate their likely distribution between clinical specialties.

Impact of changes in tobacco smoking prevalence on death, dementia and disability in England and Wales, 2017–2040: A modelling study

Background There is considerable morbidity and mortality associated with smoking globally and in the UK. We aimed to estimate the impact of two scenarios for reduction of smoking prevalence on numbers of deaths, life expectancy and incidence of dementia and disability to 2040 in England and Wales. Methods A probabilistic Markov model, IMPACT-BAM, was developed to integrate calendar trends in incidence of cardiovascular disease (CVD), dementia, disability and mortality to forecast future prevalence of these conditions in addition to numbers of deaths from cardiovascular and non-cardiovascular causes in the population of England and Wales. Disability is defined as the inability to independently conduct one or more basic activities of daily living. Data from the English Longitudinal Study of Ageing (ELSA) and Office for National Statistics were used to inform the model. Systematic reviews and meta-analyses of published literature provided relative risks of CVD, dementia, disability and mortality for smokers versus non-smokers, by age and sex. These estimates were used to modify model parameters and forecast the impact of smoking on mortality, dementia and disability to 2040 under three scenarios: S1. Prevalence of smoking remains at 2017 levels, 19% in men and 17% in women, up to 2040 (baseline scenario); S2. Prevalence of smoking is reduced to 9% by 2020 and 5% by 2025 (taper scenario); S3. Smoking is eliminated by 2020 (elimination scenario). Results If prevalence of smoking remains at 2017 levels (S1), there will be an estimated 952,000 (95% Uncertainty Interval 808,000–1153,000) deaths from cardiovascular causes and 10,624,000 (9,562,000–11,776,000) deaths from non-cardiovascular causes between 2017 and 2040. If prevalence of smoking declines gradually to 2025 (S2) 35,000 (29,000–43,000) CVD deaths and 408,000 (373,000–443,000) non-CVD deaths could be prevented or postponed. If smoking is eliminated (S3), the corresponding figures are 84,000 (68,000–105,000) and 843,000 (764,000–907,000) deaths. If prevalence of smoking remains constant (S1), cumulatively between 2017 and 2040, 5,073,000 (95%UI 4,868,000–5,256,000) persons are estimated to develop dementia and 6,690,000 (95%UI 6,483,000–6,869,000) persons are estimated to develop disability. 34,000 (22,000–40,000) incident cases of dementia and 57,000 (47,000–73,000) cases of disability can be prevented or postponed under the taper scenario S2. A tot l of 56,000 (17,000–88,000) cases of dementia and 113,000 (52,000–160,000) cases of disability can be prevented or postponed under the elimination scenario S3. Under the stable smoking prevalence scenario (S1) LE at 65 will increase from 21.8 years (95% UI 21.7, 22.0) in 2017 to 26.4 years (95%UI 23.8, 29.9) by 2040. LE at 65 in 2040 is estimated to increase by an additional half a year under S2 (26.9 (24.2, 30.6)) and an additional year under S3 (27.4 [24.5, 31.1]). Half the increase in LE will be free of dementia and disability. Conclusion Public health programs targeting tobacco smoking can potentially have a considerable effect on postponing deaths from cardiovascular and non-cardiovascular causes and yield gains in life expectancy free of dementia and disability.

“The Legacy Element . . . It Just Felt More Woolly”: Exploring the Reasons for the Decline in People With Disabilities’ Sport Participation in England 5 Years After the London 2012 Paralympic Games

This article explores why sports participation of people with disabilities in England has declined since the London 2012 Paralympic Games (LPG). Thirty semistructured interviews were conducted with staff employed in a variety of sports and disability-specific organizations. Our preliminary findings suggest that the decline is a result of a complex interplay between multiple factors. A competency gap and a lack of relevance between Paralympians and the rest of the community of people with disabilities might have limited the impact of the legacy. In addition, an absence of coordinated leveraging of the LPG, and a decline in the media coverage of disability sport in the aftermath of the LPG, might also have dulled the legacy. Finally, our data show that austerity and negative media coverage of people with disabilities deterred some people from participating in sport.

The Learning Disabilities Mortality Review (LeDeR) programme

BackgroundSince the 1990s reports have consistently highlighted health inequalities faced by people with learning disabilities. Data from the Primary Care Research Database suggests an all-cause standardised mortality ratio for people with learning disabilities of 3.18, and that people with learning disabilities die approximately 20 years sooner than people without learning disabilities.AimThis presentation will provide an overview of the Learning Disabilities Mortality Review (LeDeR) programme. LeDeR aims to contribute to improvements in the quality of health and social care for people with learning disabilities in England through retrospective mortality reviews.MethodInitial reviews are undertaken of all deaths notified to the LeDeR programme of people with learning disabilities aged 4 years and over. Where indicated, a full multiagency review is conducted. Deaths of young people aged 18–24, and of people from Black and Minority Ethnic communities are subject to priority themed review; each of these receive a full multiagency review.ResultsThe LeDeR programme will be fully rolled out across England by the end of 2017. In this presentation we will share some of the learning from reviews that are particularly pertinent to GPs, and some of the service improvements that have resulted.ConclusionTo our knowledge, this is the first national programme of mortality reviews of people with learning disabilities in the world. Its focus is service improvement: it is about learning lessons and making changes to improve the lives of, and support for people with learning disabilities.

Paid employment amongst adults with learning disabilities receiving social care in England: trends over time and geographical variation

Purpose The purpose of this paper is to examine trends over time and geographical variation in rates of paid employment amongst working age adults with learning disabilities receiving long-term social care in England. Design/methodology/approach Data were drawn from NHS Digital adult social care statistics examining paid/self-employment for working age (18-64 years) adults with learning disabilities known to social care (2008/2009 to 2013/2014) or receiving long-term social care (2014/2015 to 2016/2017). Findings In 2016/2017, councils reported that 5.7 per cent of working age adults (7,422 people) with learning disabilities receiving long-term social care were in paid/self-employment, with higher employment rates for men than women and most people working less than 16 hours per week. Paid employment rates seem to be slightly declining over time, and there is wide variation across councils in reported paid/self-employment rates. Social implications Despite good evidence for the cost effectiveness of supported employment support, employment rates for adults with learning disabilities receiving long-term social care remain extremely low. Originality/value This paper presents in one place statistics concerning the paid employment of working age adults with learning disabilities in England.

Mapping staff perspectives towards the delivery of hospital care for children and young people with and without learning disabilities in England: a mixed methods national study

BackgroundChildren and young people (CYP) with learning disabilities (LD) are a vulnerable population with increased risk of abuse and accidental injury and whose parents have reported concerns about the quality, safety and accessibility of their hospital care. The Care Quality Commission’s (CQC) view of best practice for this group of patients includes: access to senior LD nurse provision; a clearly visible flagging system for identifying them; the use of hospital passports; and defined communication strategies (Glasper, Comp Child Adolesc Nurs 40:63-67, 2017). What remains unclear is whether these recommendations are being applied and if so, what difference they are making. Furthermore, what we do not know is whether parental concerns of CYP with LD differ from parents of other children with long-term conditions. The aims of this study were to 1) describe the organisational context for healthcare delivery to CYP with LD and their families and 2) compare staff perceptions of their ability to identify the needs of CYP with and without LD and their families and provide high quality care to effectively meet these needs.MethodsIndividual interviews (n = 65) and anonymised online survey (n = 2261) were conducted with hospital staff working with CYP in 15 children’s and 9 non-children’s hospitals in England. The majority of interviews were conducted over the telephone and recorded and transcribed verbatim. Health Research Authority was obtained and verbal or written consent for data collection was obtained from all interview participants.ResultsThe nature and extent of organisational policies, systems and practices in place within hospitals to support the care of CYP with LD differs across England and some uncertainty exists within and across hospitals as to what is currently available and accessed. Staff perceived that those with LD were included less, valued less, and less safe than CYP without LD. They also reported having less confidence, capability and capacity to meet the needs of this population compared to those without LD.ConclusionFindings indicate inequality with regards the provision of high quality hospital care to children and young people with LD that meets their needs.There is a pressing need to understand the impact this has on them and their families.Trial registrationThe study has been registered on the NIHR CRN portfolio 20461 (Phase 1), 31336 (Phases 2-4).

To what extent are midwives adapting antenatal information for pregnant women with intellectual disabilities? A survey of NHS trusts in England

ObjectivesTo identify the existing antenatal information provision practices for pregnant women with intellectual disabilities in England. To identify how practices between and within local supervising authorities differed, and if midwives were adapting standard antenatal information for pregnant women with intellectual disabilities, including examples of accessible information being used. Study designCross-sectional survey. MethodsAll contact supervisors of midwives from acute trusts with maternity services were accessed via the local supervisor of midwives officers' databases and sent a questionnaire. Quantitative data were collated. Associations between trust size, geographical location, antenatal provision and National Institute for Health and Care Excellence guidelines alongside National policy were examined using Fischer's exact test of association. ResultsContact supervisors of midwives returned a questionnaire on behalf of their trust (74, 53%). The majority worked in maternity units with more than 4000 births a year (50, 66%). Few trusts had a specialist or lead midwife in post for pregnant women with intellectual disabilities (17, 22.9%) but over half (39, 52.7%) reported that their trust had a specialist learning disability nurse in post. Only 28.3% reported availability of post registration training and even fewer (8, 10.8%) had access to written protocols. Less than half reported extra time being offered at the booking (29, 39.1%) or routine antenatal appointments (30, 40.5%). Less than a quarter (17, 22.9%) reported that their trust had routine antenatal written information available in accessible formats. ConclusionReasonable adjustments to standard antenatal information for pregnant women with intellectual disabilities were not common practice. Most trusts did not have local guidelines in place or offer midwives post registration education to help support them in this requirement.

Moving on: Transitions out of care for young people with learning disabilities in England and Sweden

Accessible summary When young people with learning disabilities leave the care system, they can experience many problems. Here we describe some of these problems and what they do (or would like us to do) to improve things. Young people do not always want the same things that professionals or family carers want. We do not spend enough time listening to what young people can tell us. AbstractBackgroundYoung people with learning disabilities are frequently underrepresented in research accounts. This study describes the experiences of young people moving from the care system.MethodsWe scoped the English and Swedish literature for first‐hand accounts and interviewed four young people with learning disabilities leaving the English care system. We combined findings from both sources.Findings“Grey” and campaigning literature are more likely than academic studies to include the voices of service users, but even then, the voices tend to be those of professional or family carers. Both the literature and interviews demonstrate young peoples’ awareness and understanding of the social as well as financial benefits of work. Good foster care could be precarious, and young people in unhappy placements lacked direction. Exploitation around a young person's housing and finances could be problems. There was evidence of “threshold” difficulties in accessing services.ConclusionsDespite an NHS commitment to listening to users in the UK, and similar aspirations in Sweden, our search of the literature identified few studies reporting care leavers' with learning disabilities own words. Our data add to the voices of a group frequently silent or silenced. We found evidence of resilience and hope as well as difficulties and frustrations. The accounts in the literature and our interviews provide data on what it can be like to try to operate “the system.” The people we spoke with and those whose accounts we found in the literature were thoughtful and engaging. They provide an important source of knowledge for policy and practice.

The mental health of adolescents with and without mild/moderate intellectual disabilities in England: Secondary analysis of a longitudinal cohort study.

Children with mild/moderate intellectual disabilities are at greater risk for mental health problems, with socio-economic factors and adversity partly accounting for this. Fewer data are available for adolescents. Secondary analysis was undertaken of the Next Steps annual panel study following a cohort through adolescence into adulthood containing self-report mental health data up to age 16/17. Participants with mild/moderate intellectual disabilities were identified through data linkage with educational records. Adolescents with mild/moderate intellectual disabilities were more likely than non-disabled peers to experience socio-economic disadvantage and bullying. Incidence rates of mental health problems were generally not significantly different between adolescents with and without intellectual disabilities. These findings are consistent with higher rates of persistent mental health problems beginning earlier among children with intellectual disabilities. Greater attention needs to be paid to the timecourse of mental health problems, and the impact of socio-economic factors, family and peers on mental health.

Economic and ethical implications of improving access to health care for older people with intellectual disabilities in England: a cost-effectiveness modelling study of health checks

BackgroundAn increasing number of people with intellectual disabilities are reaching old age. Knowledge has emerged internationally about the complex and largely unmet health needs of this specific ageing population, and associated costs. Annual health checks, incentivised but not mandatory for primary care in England, seek to reduce health inequities for this population. However, their cost-effectiveness is unknown. Our study aimed to address this evidence gap. MethodsWe developed a decision analytical Markov model to compare a strategy in which older people with intellectual disabilities received annual health checks with standard care. The model, developed to inform a guideline for the National Institute for Health and Care Excellence (NICE), followed hypothetical cohorts of 1000 people in England from when they were 40 years old until they died. Outcome measure was cost per quality-adjusted life-year (QALY) gained. We calculated incremental cost-effectiveness ratios (ICER). Costs were assessed from a health provider perspective and expressed in 2016 British pounds. Costs and QALYs were discounted at 3·5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinions informed parameters. FindingsAnnual health checks led to a mean QALY gain of 0·072 (95% CI 0·069–0·113) and mean incremental costs of £4911 (4897–5133). For a threshold of £30 000, annual health checks were not cost effective (mean ICER £89 200, 95% CI 86 252 to 136 769). Costs of intervention needed to reduce from £258 to under £100 per year for annual health checks to be cost effective. InterpretationAlthough our findings need to be considered with caution since the model was based on assumptions to overcome evidence gaps, they suggest that providing cost-effective annual health checks is difficult. This immediately raises ethical questions about equitable access to health checks and health itself. Additional resources are needed if health systems are to contribute to a fairer society. FundingNICE.

Variation in rates of inpatient admissions and lengths of stay experienced by adults with learning disabilities in England

PurposeThe purpose of this paper is to analyse rates of inpatient admissions for people with learning disabilities in England and to identify factors associated with higher rates of inpatient admission.Design/methodology/approachSecondary analysis of data submitted as part of the Transforming Care programme in England.Findings2,510 people with learning disabilities in England were inpatients on 31st March 2016. Findings indicate that people with learning disabilities are at risk of higher rate of inpatient admission than can be explained by prevalence within the general population; this risk may be associated with areas where there are higher numbers of inpatient settings which provide assessment and treatment for people with learning disabilities.Research limitations/implicationsVariability in the quality of the data submitted by commissioners across the 48 Transforming Care Plan areas mean that greater attention needs to be paid to determining the validity of the common reporting method. This would improve the quality of data and insight from any future analysis.Practical implicationsThe study’s findings are consistent with the hypothesis that geographical variations in the risk of people with learning disabilities being admitted to inpatient services are not consistent with variations in prevalence rates for learning disability. The findings support the hypothesis that building alternatives to inpatient units should impact positively on the numbers of learning disabled people who are able to live independent lives.Originality/valueThis is the first study which examines the data which commissioners in England have reported to NHS England on the experience of people with learning disabilities who are admitted as inpatients and to report on the possible factors which result in higher rates of inpatient admission.

Preventable Emergency Hospital Admissions Among Adults With Intellectual Disability in England

Adults with intellectual disabilities experience poorer physical health and health care quality, but there is limited information on the potential for reducing emergency hospital admissions in this population. We describe overall and preventable emergency admissions for adults with vs without intellectual disabilities in England and assess differences in primary care management before admission for 2 common ambulatory care-sensitive conditions (ACSCs). We used electronic records to study a cohort of 16,666 adults with intellectual disabilities and 113,562 age-, sex-, and practice-matched adults without intellectual disabilities from 343 English family practices. Incident rate ratios (IRRs) from conditional Poisson regression were analyzed for all emergency and preventable emergency admissions. Primary care management of lower respiratory tract infections and urinary tract infections, as exemplar ACSCs, before admission were compared in unmatched analysis between adults with and without intellectual disabilities. The overall rate for emergency admissions for adults with vs without intellectual disabilities was 182 vs 68 per 1,000 per year (IRR = 2.82; 95% CI, 2.66-2.98). ACSCs accounted for 33.7% of emergency admissions among the former compared with 17.3% among the latter (IRR = 5.62; 95% CI, 5.14-6.13); adjusting for comorbidity, smoking, and deprivation did not fully explain the difference (IRR = 3.60; 95% CI, 3.25-3.99). Although adults with intellectual disability were at nearly 5 times higher risk for admission for lower respiratory tract infections and urinary tract infections, they had similar primary care use, investigation, and management before admission as the general population. Adults with intellectual disabilities are at high risk for preventable emergency admissions. Identifying strategies for better detecting and managing ACSCs, including lower respiratory and urinary tract infections, in primary care could reduce hospitalizations.

Deprivation of liberty applications concerning people with learning disabilities in England: trends over time and geographical variation

PurposeThe purpose of this paper is to analyse trends over time and geographical variation in Deprivation of Liberty Safeguards (DoLS) applications for adults with learning disabilities.Design/methodology/approachSecondary analysis of national- and local authority-level statistics collected and reported by NHS Digital.FindingsThere has been a sharp national increase in the number of completed and granted DoLS applications regarding adults with learning disabilities since the 2014 “Cheshire West” Supreme Court judgement, with a greater proportion of completed DoLS applications being granted. There is extreme geographical variation across local authorities in England in the rates at which DoLS applications are being made and granted.Practical implicationsThe extreme variation in DoLS applications regarding adults with learning disabilities is highly unlikely to be a function of differences in mental capacity and living circumstances experienced by adults with learning disabilities across local authorities, and urgent attention needs to be paid to this variation.Originality/valueThis is the first paper to analyse the geographical variation at local authority level for completed and granted DoLS applications regarding adults with learning disabilities.

Forecasted trends in disability and life expectancy in England and Wales up to 2025: a modelling study

SummaryBackgroundReliable estimation of future trends in life expectancy and the burden of disability is crucial for ageing societies. Previous forecasts have not considered the potential impact of trends in disease incidence. The present prediction model combines population trends in cardiovascular disease, dementia, disability, and mortality to forecast trends in life expectancy and the burden of disability in England and Wales up to 2025.MethodsWe developed and validated the IMPACT-Better Ageing Model—a probabilistic model that tracks the population aged 35–100 years through ten health states characterised by the presence or absence of cardiovascular disease, dementia, disability (difficulty with one or more activities of daily living) or death up to 2025, by use of evidence-based age-specific, sex-specific, and year-specific transition probabilities. As shown in the English Longitudinal Study of Ageing, we projected continuing declines in dementia incidence (2·7% per annum), cardiovascular incidence, and mortality. The model estimates disability prevalence and disabled and disability-free life expectancy by year.FindingsBetween 2015 and 2025, the number of people aged 65 years and older will increase by 19·4% (95% uncertainty interval [UI] 17·7–20·9), from 10·4 million (10·37–10·41 million) to 12·4 million (12·23–12·57 million). The number living with disability will increase by 25·0% (95% UI 21·3–28·2), from 2·25 million (2·24–2·27 million) to 2·81 million (2·72–2·89 million). The age-standardised prevalence of disability among this population will remain constant, at 21·7% (95% UI 21·5–21·8) in 2015 and 21·6% (21·3–21·8) in 2025. Total life expectancy at age 65 years will increase by 1·7 years (95% UI 0·1–3·6), from 20·1 years (19·9–20·3) to 21·8 years (20·2–23·6). Disability-free life expectancy at age 65 years will increase by 1·0 years (95% UI 0·1–1·9), from 15·4 years (15·3–15·5) to 16·4 years (15·5–17·3). However, life expectancy with disability will increase more in relative terms, with an increase of roughly 15% from 2015 (4·7 years, 95% UI 4·6–4·8) to 2025 (5·4 years, 4·7–6·4).InterpretationThe number of older people with care needs will expand by 25% by 2025, mainly reflecting population ageing rather than an increase in prevalence of disability. Lifespans will increase further in the next decade, but a quarter of life expectancy at age 65 years will involve disability.FundingBritish Heart Foundation.

Holiday Play for Children with Disabilities in England: Access, Choice and Parents’ Views about Integration

Families with children with disabilities can feel isolated during school holidays and concerns exist that they face greater difficulties than families of children without disabilities in finding enriching activities for their child. In the context of national policies that encourage integrated play, local service commissioners in England require evidence on what sort of short breaks parents and children prefer. The parents of 99 children with disabilities and 43 children without disabilities attending various holiday play schemes in summer 2010 completed mailed questionnaires. Parents of children with disabilities reported more difficulty getting information, less choice of schemes and further distances to travel than parents of children without disabilities. Although 72% of parents of children without disabilities and 55.5% of parents of children with disabilities stated integrated schemes would be suitable for their child, open text comments provided weaker support. Variety of provision is required to meet all needs and preferences.

Day services and home care for adults with learning disabilities across the UK

PurposeThe purpose of this paper is to compare data from national social care statistics on day services and home care for people with learning disabilities across England, Scotland, Wales and Northern Ireland.Design/methodology/approachNational social care statistics (England, Scotland, Wales and Northern Ireland) reporting the number of adults with learning disabilities accessing day services and home care were reviewed, with data extracted on trends over time and rate of service use.FindingsRegarding day services, despite some variations in definitions, the number of adults with learning disabilities in England, Scotland and Wales (but not Northern Ireland) using building-based day services decreased over time. Data from Scotland also indicate that adults with learning disabilities are spending less time in building-based day services, with alternative day opportunities not wholly compensating for the reduction in building-based day services. Regarding home care, there are broadly similar rates of usage across the four parts of the UK, with the number of adults with learning disabilities using home care now staying static or decreasing.Social implicationsSimilar policy ambitions across the four parts of the UK have resulted (with the exception of Northern Ireland) in similar trends in access to day services and home care.Originality/valueThis paper is a first attempt to compare national social care statistics concerning day services and home care for adults with learning disabilities across the UK. With increasing divergence of health and social service systems, further comparative analyses of services for people with learning disabilities are needed.

Abstract P336: Predicting Future Trends in Disability Individuals With Cardiovascular Disease: A Modelling Study to 2030

Background: Most industrialised countries have experienced remarkable reductions in mortality from cardiovascular disease (CVD) and other chronic diseases since the 1970s. Yet CVD and dementia together account for half of all disability in the elderly in the US, UK and beyond. However recent trends in CVD morbidity and disability prevalence in the US and UK offer some encouragement: concerns regarding a potential increase in the burden of these diseases do not appear to be materialising. Meanwhile, clinicians and service planners urgently need reliable forecasts of the burden of CVD and disability. Previous studies have not modelled the complex interactions of CVD, dementia and disability over time. In this study, we therefore set out to forecast trends in CVD related disability in England and Wales up to 2030. Methods: As part of the IMPACT-Better Ageing Model study, we developed and validated a probabilistic Markov model. This model tracked health transitions in the England and Wales population (60 million) through ten states characterised by the presence or absence of CVD, dementia, disability and death from 2015 to 2030. Disease occurrence and age/sex/year specific transition probabilities were derived from the English Longitudinal Study of Ageing (ELSA). We estimated future CVD and disability prevalence. As observed in ELSA, we assumed continuing parallel downward trends in CVD incidence and mortality and a 2.7% annual decline in dementia incidence. Uncertainty was estimated using Monte Carlo simulation. Findings: By 2030, approximately 2,100,000 individuals (2,000,000-2,200,000 95% Uncertainty Intervals) will live with CVD in England and Wales (a 35% decrease from 2015). Standardised CVD mortality rates will plummet by 75%. However, approximately 910,000 (882,000- 946,000 95% UI) of these CVD patients will live with disabilities (a 19% decrease from 2015). Approximately 185,000 (178,000- 192,000 UI) CVD patients will additionally be living with dementia. Despite the rapid decreases in CVD and disability burden, the standardised prevalence of disability among CVD individuals will therefore increase from 35.2% to 39.6%. Interpretation: Our model predicts a 35% reduction in the total burden of CVD in England and Wales by 2030. However, over one third of the individuals with CVD will also be living with poor functional levels. That will represent a substantial burden for our already hard-pressed health and social care services. Our results suggest that recent efforts on CVD prevention might not be enough, thus emphasizing the need for more effective prevention of all non-communicable diseases and dementia as the major causes of disability. Policies focussing on the shared NCD risk factors of poor diet, tobacco, alcohol and inactivity could substantially reduce the burden of these dread diseases and greatly benefit the future functional level of senior citizens in the UK, USA and elsewhere.