There are a large number of services to cover in this section therefore these have been split into prevention, early identification, and support and treatment.
It is recognised that it could be viewed as contentious to have a prevention section; however the implication is not that all physical disabilities and sensory impairments are preventable, rather that a proportion may be.
Occupations associated with loud noise, including working in factories and on roadworks, were the most common precursor to hearing problems. This cause has now been minimised as a result of the tightening of health and safety rules. Working in a noisy industry should be less dangerous provided that the correct ear protection is utilised. Recreational loud noise is now the most common cause of hearing problems and it is increasingly affecting younger people.
Source: NHS Choices. Guidance for safer listening can be found here: http://www.nhs.uk/Livewell/hearing-problems/Pages/tips-to-protect-hearing.aspx
Good maternal care and nutrition can reduce the risk of prematurity, low birth weight and congenital abnormalities including spina bifida. Other factors are also important such as rubella vaccination. Please read the pregnancy JSNA chapter for more information on this.
Stroke is a major cause of disability, please read the JSNA chapter for more information. There are also other chapters such as smoking, diet and nutrition and obesity which are also relevant to stroke prevention which contain information on commissioned services.
Good diabetic blood glucose control reduces the risk of retinopathy which is a major cause of working age blindness. In those with diabetes, retinal screening should be carried out annually in order to detect and manage changes. Please read the diabetes JSNA chapter for more information about local services.
4.2 Early identification
Following an ear examination, GPs and practice nurses can refer patients to a specialist for a hearing test. A range of tests can be used to check the functioning of the ears. These include:
Automated optoacoustic emissions (AOAE) tests: a computer measures ear responses to clicking noises;
Automates auditory brainstem response (AABR) tests – nerve response is measured using head and neck sensors;
Pure tone audiometry tests: a button is pressed when varying sounds can be heard; and
Bone conduction tests: a vibrating noise sensor tests how well the hearing nerve is working.
Picking up hearing impairment early in infants is important for good outcomes. Early identification of hearing impairment gives children a better chance of developing speech and language skills, and of making the most of social and emotional interaction from an early age. More information on the new-born screening programme is available here: https://www.gov.uk/guidance/newborn-hearing-screening-programme-overview
Please also refer to the early years JSNA chapter for more information.
There are advantages for children and young people and/or adults being identified as having either physical disabilities or sensory impairments in terms of being able to receive support during education, leading to better outcomes at school and better employment chances
There is a full and detailed JSNA chapter covering children and young people with disabilities and learning difficulties- where full details of available services for this group can be found.
Early identification in adults, particularly those in their fifties, is also very important for good outcomes. This is of particular importance because of the link between hearing impairments and dementia in older adults (Lin et al., 2011).
The Nottinghamshire Fit for Work service is designed to support people to stay healthy and in work. It is funded to provide a service for people registered with a Nottingham City GP. A team of workplace health specialists provide an easy to access specialist service which meets the unique needs of individuals who are struggling with health problems and remaining in employment.
Employers have an obligation under the Equality Act 2010 to make reasonable adjustments to support those with disabilities in the workplace and not to discriminate in their recruitment processes.
4.3 Support and treatment
‘Care and support’ is the term used to describe the help some adults need to live as well as possible with any illness or disability they may have. It can include help with things like getting out of bed, washing, dressing, getting to work, cooking meals, eating, seeing friends, caring for families and being part of the community.
It might also include emotional support at a time of difficulty and stress, helping people who are caring for an adult family member or friend or even giving others a lift to a social event.
Care and support includes the help given by family and friends, as well as any provided by the council or other organisations.
(Source: DH (2015) Care and support, Care Act, FAQs)
4.3.1 Unpaid care
This section focusses on care formally commissioned or provided by the local authority. Clearly, a large proportion of care provided is informal and provided on an unpaid basis. Further information on this can be found in the Carers JSNA chapter.
4.3.2 Social care support
The health and care point carry out assessments to see if people with physical and sensory impairments are eligible to receive council services. More information can be found here: http://www.carechoices.co.uk/wp-content/uploads/2014/02/Nottingham-City-Care-Support-Services-Directory-2013-14.pdf
A range of teams then provide these services. These are summarised below:
18.104.22.168 Day Care
Acorn Resource Centre in Hyson Green, based at the Mary Potter Centre, offer interesting and varied activities during the day for people aged 18 and over. More information about the Acorn resource centre is available here: http://www.nottinghamcity.gov.uk/CHttpHandler.ashx?id=45956&p=0
22.214.171.124 Support at home
The Intake Reablement Team are a short-term home care team, focusing on helping people to regain skills that they may have lost, due to hospital admission or illness.
Homecare, support which is provided to people in their own homes to assist with personal care and practical tasks associated with daily living. There is a mix of framework provision funded by direct payments, in addition to internal provision.
Telecare provides a home safety and personal security system designed to enable people to remain living independently in their own homes for as long as possible. Support includes care alarms that, when activated, make a noise as well as flashing and vibrating, doorbells which are very loud and flash and also big button telephones and remote controls.
The Meals at home service provides hot meals up to five days a week, with the option of buying frozen meals for the weekend
126.96.36.199 Support with everyday life
Occupational Therapy, assisting people to be as independent as possible in their everyday lives.
The Adult Sensory team works with people who live in the Nottingham City area who are Deaf, have dual sensory loss or experience difficulty with their vision. The Deaf Service provides support to Deaf people of all ages, different cultures, disabilities and backgrounds. They provide communication equipment and flashing light/vibrating equipment to alert Deaf people to everyday aspects like: the doorbell, a smoke alarm, a telephone call or a baby crying.
The Dual Sensory Service provides services to children and adults who experience difficulty with both their vision and hearing. This includes blind and partially sighted people who are also deaf or hard of hearing. The service provides specialist knowledge and skills that can enable people to continue with many every day activities such as:
Helping people to develop skills such as mobility to enable independent travel and daily living activities such as preparing meals
Providing access to other services and organisations such as Talking Book Machines and the community fire service
Providing advice and information about applying for special equipment and funding
Delivering training such as typing, teaching you and those close to you the Deafblind manual and other communication methods
Access to information such as helping you get your bills in large print
The Visual Impairment Service
The Visual Impairment Service offers a social care and rehabilitation service to children and adults with a visual impairment. The Service is staffed by experienced rehabilitation officers, who have knowledge and skills in rehabilitation that can enable people to continue with many activities, both in their own homes and in their local communities. They can also enable people to learn new skills.
To be certified as severely sight impaired/ blind or sight impaired/ partially sighted a person’s GP needs to refer them to the consultant ophthalmologist at the Eye Clinic in their local hospital. A copy of the certificate is then sent to the Team for Registration purposes. The local authority then contacts the individual to give information, advice and to discuss their services.
Nottingham City Council Occupational Therapy Team assists people with disabilities (permanently and substantially disabled) of all ages to be as independent as possible in their everyday lives, through:
Working with clients to find a new way of doing a task such as preparing a meal or drink, dressing and personal hygiene, getting in, out and around the home
Providing specialist equipment to aid daily living
Providing minor adaptations such as grab rails
Arranging major adaptations such as ramps or stair lifts
Working with carers to offer advice on the best way to provide support
With consent, providing signposting to relevant services who may be able to help
Nottinghamshire Deaf Society
Nottinghamshire Deaf Society (NDS) provides a range of support, including:
Bespoke day centre services through twice weekly five hour sessions supported by a deaf support worker. This includes home visiting by deaf volunteers;
A welfare rights advice session three times a week delivered in British Sign Language;
A drop in Interpreting Duty Time Service that can interpret letters and make telephone calls on behalf of the individual; and
A twice weekly support service via Skype for Deaf people (who cannot use the telephone) and need to access any Nottingham City Council service.
NDS is commissioned to provide a non-chargeable British Sign Language/English Interpreting service and Lip speaking service to people who are deaf and live in Nottingham City and who need support to communicate with a City Council Department including schools and academies or any primary care service such as GPs, opticians or dentists.
More information about Nottinghamshire Deaf Society is available here: http://www.nottsdeaf.org.uk/
Physical and Sensory Impairments
The Sensory Impairments Team works with a number of organisations and agencies to deliver services to people with sensory impairment.
A list of companies who provide home care in Nottingham is available in the Care and Support Services Directory 2014/15. https://www.carersfederation.co.uk/wp-content/uploads/2013/11/Nottingham-City-Care-and-Support-Directory-2014-15-.pdf
4.3.3 Hospital treatment
188.8.131.52 Cochlear implants
The Nottingham Auditory Implant Programme established in 1989, has carried out more than 1,700 implant operations and was the first to provide a child in the UK with a cochlear implant. The Programme follows the British Cochlear Implant Group Quality Standards 2016. Further information on the programme is available at: https://www.nuh.nhs.uk/our-services/services/nottingham-auditory-implant-programme/.
184.108.40.206 Cataract treatment
Nottingham University Hospitals NHS Trust Cataract Clinic is based at the Queen’s Medical Centre and was established in 2000 as part of the Government initiative to reduce waiting times for eye surgery. The Clinic treats approximately 4,000 patients per year. Referrals to the Clinic can be made by either a patient’s GP or their optometrist.
220.127.116.11 Clinics for other areas of ophthalmology
Nottingham University Hospitals Trust provides a number of services for eye-related problems including: a macular clinic; eye casualty; and a head and neck unit. A full list of available services can be found here: https://www.nuh.nhs.uk/our-services/services/ophthalmology/
18.104.22.168 Transport by bus
Nottingham City Transport (NCT) states that it has one of the most accessible bus fleets in the country. All buses meet the legal requirement to have a bay which can accommodate a ‘standard reference wheelchair’. Larger wheelchairs cannot be carried. Buses can carry one wheelchair at a time only and if the bay is occupied by any other customer and they refuse to move the driver cannot force them to.
NCT states that the following measures are in place to accommodate people using wheelchairs:
Drivers park as close as possible to the kerb;
Drivers will use a ramp or kneel the bus; and
A bell in the bay area gives a different alert to notify the driver that a customer from the bay will be alighting.
22.214.171.124.2 Mobility scooters
NCT has signed up to the Confederation of Passenger Transport UK Code for Mobility Scooters. Class 2 scooters can be accommodated and scooters are classed as a wheelchair on the buses. In order to use the bus service with a mobility scooter, passengers must have a permit which is issued once NCT has assessed the scooter and provided training. Further information and contact details for arranging a permit and training are available here: https://www.nctx.co.uk/using-the-bus/easy-access-for-everyone/mobility-scooters/
126.96.36.199.3 Journey assistance cards
NCT has used the CPT Code to develop a range of journey assistance cards that aim to improve interactions between passengers and drivers, particularly in cases of hidden disability. The messages include requesting additional time to take a seat, alerting drivers to a disability and/ or sensory impairment and requiring an alert when a destination is reached.
Journey assistance cards can be downloaded from NCT’s website or by contacting the NCT. More information is available here: https://www.nctx.co.uk/using-the-bus/easy-access-for-everyone/journey-assistance-cards/
188.8.131.52.4 Blind and partially sighted customers
NCT expects its drivers to state their service number and destination when they reach a bus stop. More than 75% of buses have audio stop announcements and all routes will have these by 2017/18. Trained assistance dogs can be carried free of charge. Further detail, including a list of routes with audio announcements, can be found here: https://www.nctx.co.uk/using-the-bus/easy-access-for-everyone/blind-and-partially-sighted-customers/
184.108.40.206.5 Accessible information
Timetables and leaflets can be provided in Braille, large print and audio upon request. The website meets accessibility requirements and is a responsive site. The Travel Centre offers support with planning a journey and orientation slots on out of service buses.
220.127.116.11 Transport by tram
Each tram has two dedicated wheelchair spaces. These include help and stop request buttons.
18.104.22.168.2 Mobility scooters
An industry wide set of regulations for the carriage of mobility scooters is under development. Currently, scooters can be carried if they can board and exit the tram safely and park in a wheelchair space.
22.214.171.124.3 Blind and partially sighted customers
All Nottingham Express Transit (NET) trams have a low floor with wide double doors. White visibility strips and warning sounds for when doors are opening and closing are provided. Electronic signs and audible announcements provide information on the destination and the following stop. NET staff receive disability awareness training and drivers are trained to allow people with visible disability more time to get on and off. Guide and assistance dogs are welcome however, local feedback states that tram ticket machines are not accessible to people with a physical impairment.
126.96.36.199.4 Accessible information
Timetable information is provided in accessible formats (not including British Sign Language) upon request. Further information, including contact details, is provided here: http://www.thetram.net/access-for-all.aspx
188.8.131.52 Transport by train
East Midlands Trains provide the following assistance:
Help in planning a journey;
Information on further transport following a train journey;
Advice on the most appropriate tickets, including discounted fares;
Help in booking tickets;
Assistance in getting on and off trains;
Luggage assistance; and
Help with transfers between services.
A team of Assisted Travel Advisors is available 24 hours a day, seven days a week. Further information, including contact details, can be found here: http://www.eastmidlandstrains.co.uk/travelling-with-us/accessibility-assistance/
Nottingham Train Station provides station maps in Braille and large print. These can be downloaded or collected free of charge from the station’s Information Desk. Further information is available here: https://www.eastmidlandstrains.co.uk/stations/nottingham-station/
Local feedback states that redevelopment on Station Street has increased the required travel distance to the closest taxi rank on Trent Street and to mitigate this a taxi rank has been set up on Queens Road.
Nottingham City Council commissions disability equality training which aims to improve staff confidence in working with, and providing a high standard of service for, disabled people.
184.108.40.206 Adult Sensory Team
The Council’s Adult Sensory Team works with citizens who are deaf, have dual sensory loss or experience difficulty with their vision. The team works mainly with adults but will also work with children and families. Team members include a social worker, community care officer, rehabilitation officers, equipment officer and communicator guides who work in people’s homes and communities. The Team also includes care support advisors, a service support advisor and an eye clinic liaison officer.
220.127.116.11 Disability Involvement Group
The quarterly Nottingham Disability Involvement Group works with Nottingham City Council to ensure its policies, procedures, processes and services are accessible, fairly applied to Disabled citizens, and reach equality standards in line with the aims of the Equality and Fairness Commission.
4.3.5 Access to work
Access to work grants pay for practical support for people with a disability, health or mental health condition. The grant does not have to be repaid, nor does it affect other benefits. Local authorities contribute to the cost of equipment.
4.3.6 Unpaid care
There are 5.41 million people in England providing some level of unpaid care. Of these, 58% are female and 42% are male. Female carers represent 11.9% of the total female population and the same is true for 9% of the male population. These percentages have increased slightly compared to ten years ago. Nationally, 50-64 year old women carry the greatest burden of care. Full details of unpaid carers are provided in the Carers JSNA chapter.
POhWER provides information, advice, support and advocacy to people who experience disability, vulnerability, distress and social exclusion. Information about how to contact the service is available here
on the accessible website.
The Care Act
The Care Act (2014) places a duty on local authorities to provide accessible information to citizens about the range of services available to them to meet their needs. Local authorities have to make sure that people who live in their areas:
receive services that prevent their care needs from becoming more serious, or delay the impact of their needs;
can get the information and advice they need to make good decisions about care and support;
have a range of providers offering a choice of high quality, appropriate services.
In Nottingham City this requirement has been partly met through the development and launch of the Nottingham Self-care website, available at: https://www.nottinghamselfcare.org.uk/