The forgotten story of social care

An introduction to disabilities This report focuses on individuals aged 18–64 with a disabled condition (a learning disability, a physical disability or a mental

Data analysis This programme of work involved completing in-depth analysis to better understand the working age and lifelong disabled population. National level insight into the historic and current trends was produced, alongside the forecasting of potential future impact. This included understanding the current and potential future impact on demand for adult services from individuals aged over 18 as a result of growth in SEND provision since legislative changes in 2016. 16 local authorities volunteered to take part in the programme’s local analysis, providing detailed data on the working age and lifelong disabled adults they support, their demographics, and the packages of support they received over the last four years (2020/ 21–2023/24 inclusive). Data from participating authorities received by August 2024 was used for the analysis, which will be updated as required with the participating authorities to support their local analysis. This enabled an evidence-based analysis of: • their reasons for requiring social care support • the volumes of individuals receiving different types of social care support • the costs associated • other factors which may contribute to need and outcomes, such as age, gender, and levels of deprivation in the local area • the extent to which any of these factors are staying constant or are changing. The method used to analyse this information was a popular machine learning algorithm: k-means clustering. This type of artificial intelligence is able to analyse vast numbers of individual cases, and analyse what they have in common, or what links them. The output is then a prioritisation of various factors and a grouping of appropriate features (such as demographic features, costs, and the way costs are changing over time for an individual). This has enabled a rich and data-led articulation of the different groups or cohorts of people who receive support beyond one reason or individual factor.

The extent to which these disabilities may impact an individual in their everyday life will vary. Naturally, the severity of the impairment if it is a constant condition makes a difference (e.g. partial or total sight loss), but it is also important to recognise other reasons that will affect the extent of the impact of the condition on an individual’s life, including: • What the activity is: few impairments will make every activity equally challenging. • How experienced the individual is and what their routine involves: few people complete an activity for the first time with the same level of assurance and expertise as when they’ve completed it for the hundredth time. • The nature of an individual’s environment: there is often difficulty in replicating something you can do in your own home (often with your own equipment or possessions, on your own, or with familiar company and surroundings) in an alien environment. • How adaptable aspects of society are: much of society is designed for ‘average’, despite this not typically reflecting how society operates. If important aspects of life are not sufficiently adaptable to different needs, the extent to which someone’s condition may affect their ability to interact with that aspect of life may vary. • Societal expectations and stigma: Societal stigma has a very real impact on limiting how someone can complete aspects of day-to- day life. This might include, for example, people with a learning disability being talked to or considered like children into their adulthood. All of these, similarly as they do for non- disabled individuals, have an impact on individual’s ease in completing day-to-day activities, and therefore the type or level of support they may need around them. In addition, these needs are not static – what someone needs in terms of support or adaptations will change throughout their life, for different areas.

health condition), and individuals aged 65+ with a lifelong disabled condition (a learning disability or a long-term mental health condition). The Equality Act (2010) shows the variety and breadth of impairments that can lead to a disability, such as: sensory conditions (e.g. visual

This data was used to build on and enhance local level insight to identify the main characteristic groups most authorities are likely to have, as well as any trends which are unique to particular authorities and regions. This analysis was provided to the 16 participating local authorities. The 16 participating local authorities represent 21.6% of all of England’s working age and lifelong disabled adults in receipt of adult social care support. As much as possible, statistically reliable data sources have been used. However, in some cases, where data is difficult to obtain, small samples have been gathered manually and analysed. In the analysis of national datasets, the data does not always allow for a perfect comparison. While best efforts have been made to navigate this, it inevitably leads to some degree of assumption and approximation. Where this is the case, the data is clearly highlighted. The financial analysis undertaken for this report calculates the direct costs of councils’ commissioning of care and support, such as residential and home-based care. This makes up the majority of adult social care spend and excludes costs of council staffing and back- office functions.

and hearing impairments) those with fluctuating or

recurring effects (e.g. chronic fatigue syndrome and epilepsy) progressive conditions (e.g. motor neurone disease) organ specific (e.g. respiratory conditions such as asthma, and cardiovascular conditions such as heart disease) developmental conditions (e.g. autism spectrum disorder, dyslexia, and dyspraxia – often recognised under the (e.g. anxiety, eating disorders, post-traumatic stress disorder and bipolar) mental illnesses (e.g. depression and schizophrenia) and those caused by injury to the body (e.g. loss of a limb, or brain damage). neurodiversity term) learning disabilities mental health conditions

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