Physical & Sensory Impairments

The term disability covers a wide range of impairments.  The World Health Organisation defines impairment as, “a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations.”  

The term ‘physical impairment’ refers to one or more conditions or limitations which may be congenital or acquired at any age, be temporary, long-term, or fluctuating. People with physical impairments may often have unique and multi-dimensional requirements. Each individual disabled person, therefore, requires tailored services that address the effects of their disability in a person-centred, holistic fashion. 

The term ‘sensory impairment’ encompasses visual impairment (including those who are blind or partially sighted), hearing impairment (including those who are profoundly deaf, deafened or hard of hearing) or with dual sensory impairment (deaf-blindness). These impairments can be congenital or acquired at any age. Prevalence increases with age, often, alongside additional sensory, or other, impairments. Many sensory impairments develop gradually. Sensory impairment may often present as secondary to other disabilities. For example, the incidence of sight loss will increase in line with the increasing age of a population, and with an increase in underlying causes of sight loss, such as obesity and diabetes. 

A person living with a disability, such as sensory impairment, may experience significant effects on their daily life, from requiring additional personal support to access issues. Many people with sensory impairment face challenges related to communication, access to information, and mobility. The impact of these challenges on everyday life is often not recognised.  

Under the Care Act 2014 anyone deemed to be vulnerable is eligible for a care and support assessment. This includes people with physical disability and those with sensory impairment.

The following are strategies and policies providing local and national information about planning to provide the best health and social care support for people with disabilities and sensory impairments: 

• The Lincolnshire Adult Care Market Position Statement 2020 – 2023 
• National Disability Strategy 2021 
• The Care Act 2014 
• Royal National Institute of Blind People (RNIB) Outcome Framework – Seeing it My Way 
• Department of Health and Social Care 
• NHS England: Accessible Information Standard 
• The Department of Health and NHS England: Action Plan on Hearing Loss 
• Social Care Institute for Excellence (SCIE): Physical Disabilities, Hearing Loss, Sight Loss, Sensory Impairment 
• NHS England: What Works Guides – Action Plan on Hearing Loss 
• National Institute for Care and Health Excellence (NICE): 
  • Glaucoma Overview
  • Clinical Knowledge Summary: Macular degeneration – age-related Published December 2020 
  • Hearing Loss in Adults: assessment and management [NG98] 
  • Serious Eye Disorders [QS180] Published March 2019 
  • Hearing loss in adults [QS185] Published July 2019 
• Public Health England (PHE) Eye Health Needs Assessment: East Midlands and East of England Published: May 2018 

National statistics show that the prevalence of sensory impairment increases with age.  Hearing impairment, visual impairment, and multi-sensory impairment are common health problems among older adults and can hinder basic daily activities or result in social isolation and loneliness (Source: ONS). An impairment may lead to changes in social relationships or an individual becoming withdrawn from their community. Separation may be real or perceived but can lead to isolation or feelings of loneliness. Over time this could contribute to low self-esteem, social anxiety or depression.  

Effective support is vital to prevent detrimental impacts on socio-cognitive and language development, independence, and quality of life.  

There are specific health inequalities associated with sensory impairments, such as: 

• Approximately 40% of people with learning disabilities are reported to have a hearing impairment; people with Down syndrome have a particularly high risk of developing vision and hearing loss 
• Smoking, poor diet, physical inactivity, hypertension, and obesity are associated with increased risk of conditions such as glaucoma and diabetic eye disease. 

Research shows that individuals with a visual impairment are at greater risk of falling. 3.8 per cent of falls that result in hospital admissions could be directly attributed to visual impairment and cost 10 per cent of the local NHS cost of treating accidental falls (Source: Thomas Pocklington Trust).  

Studies also indicate an association between sensory impairment and challenging, self-injurious or suicidal behaviours (Source: BMJ). Unrecognised or undiagnosed sensory impairments may lead to miscommunication; frustration; fear; and in turn, challenging behaviour. 

Key challenges for people with sensory impairments, highlighted by local, national and international research, include: 

• A lack of accessible information; rehabilitation services; equipment to assist with loss of vision. This can reduce independence. These services are critical in enabling people with vision loss to interact with the built environment, maintain physical and emotional health, and participate in society. 
• People with significant hearing loss are often isolated because communication with the hearing world becomes increasingly difficult. This has been emphasised throughout the Covid19 pandemic.  Hearing loss has a major impact on the development of language and communication skills, as well many personal, socio-economic impacts throughout life.  
• Royal National Institute for Deaf People (RNID) report that 79% of people first receiving hearing aids are given no information regarding services at the ‘point of diagnosis’. The WHO estimates that, in the UK, adult-onset hearing loss will be in the ‘top ten’ of disease burdens by 2030, ranking above diabetes and cataracts. 

“Deafblindness is sight and hearing loss that impacts your communication, mobility and ability to access information. It affects different people in different ways” (Deafblind.org.uk). This combination of impacts presents barriers to achieving success in education, in a vocation and for all manner of social outcomes. 

Early intervention is key in preventing on-going needs across all sensory impairments. With the right information, advice, practical, and emotional support, a person with sensory impairments can lead a more independent, fulfilling life.  The person needs support to be provided at the right time and in the right format. Undiagnosed or poorly supported sensory impairments leads to poorer health and wellbeing outcomes, and a reduction in independence. 

Tablets, smart phones, and a range of specialist technologies enable people with sensory loss to remain independent and access information in different ways. For example, deaf people are now able to access a remote interpreter. Professionals and organisations must keep abreast of technological advances and of how people with sensory impairment are able to access it. 

Data projections show the prevalence of hearing loss and visual impairment amongst 18-64 year olds is likely to plateau, however prevalence amongst those aged 65 and over is projected to increase due to an ageing population and individual lifestyle behaviours. Age related damage to the cochlear is the single biggest cause of hearing loss (Source: RNID). Over 70% of people over 70 have hearing loss, and due to the ageing population, the number of people with hearing loss is set to increase (Davis, 1995). RNID estimate the UK will have approximately 15.6million people with hearing loss by 2035.

Information and advice can be found at Connect2Support. Lincolnshire County Council (LCC) commissions the following services for people with physical disabilities or sensory impairments to maximise their independence: 

Lincolnshire Sensory Services help people with sensory impairment maintain independence by providing enablement and rehabilitation support, reducing social isolation, encouraging better use of technology, and working with health organisations, professionals and families holistically, to deliver to care. 

The Eye Care Liaison Service, initiated by LCC, RNIB and Lincolnshire CCG, is an initiative that acts as a conduit between health and social services, supporting patients in eye clinics. They aim to prevent avoidable sight loss by talking through treatment and helping people to understand medications.  

The Lincolnshire Integrated Community Equipment Service (ICES) provide equipment and adaptations allowing people to remain independent at home. 

The Lincolnshire Telecare Service can help people with a disability live more independently.   

Wellbeing Lincs is a countywide service, funded by LCC, supporting adults across Lincolnshire to achieve confident, fulfilled and independent living. 

Direct payments with LCCs partner organisation Penderel’s Trust, who also provide access to a Personal Assistant database. LCCs Direct Payment Policy can be accessed here.

Suggestions from Sensory Impairment Service users in 2021 included: 

• Improved communication between the schools and the service. 
• More social activities for children, especially teenagers, and support for siblings of children who have a sensory impairment. 
• On-going specialist sensory impairment support. 
• More drop-in services, and social outings for deaf people. 
• More access to deaf services outside of the drop ins. 
• BSL translation available in home as well as drops ins. 

BID Services have been delivering the sensory service throughout Lincolnshire since April 2022. Customer and stakeholder feedback will continue to feed into the LCC contract monitoring process to identify gaps and opportunities in service provision. 

LCC’s customer satisfaction survey will be used to highlight potential gaps identified by people with physical disabilities or sensory impairments. 

LCC’s complaints system will identify key themes or issues requiring intervention and a solution for people with physical disabilities or sensory impairments.

Feedback from local agencies and community groups has outlined the following gaps/needs:  

• Whilst acknowledging funding constraints, more equipment ‘repair and support’ clinics are needed. 
• LCC to directly employ an additional Habilitation Specialist as part of the Sensory Education & Support Team. 
• Ensure all ‘Certificate of Vision Impairment’ registrations are passed through to appropriate organisations. 
• Access to more community events – such as coffee mornings. 
• Transport – to enable community participation. 

The feedback received from service users and stakeholders was stipulated in the specification for the re–procurement of the sensory services in 2022. The feedback will continue to be monitored as part of the quarterly contract meetings between LCC and BID Services. 

• Coronavirus and the social impacts on disabled people in Great Britain (ONS 2022)
• Which groups find it hardest to find a job following a period out of work? (ONS 2021)