National Performance Framework - disability perspective: analysis

8. Health

National Outcome: We are healthy and active

There are nine indicators measuring health in the National Performance Framework. At present, one indicator is in development, one indicator considers the number of years are likely to be in 'good health', which makes it unhelpful to distinguish rates between those with and without a limiting longstanding condition. In addition, a further two indicators are not broken down in terms of disability status. Updated data is available for the remaining five indicators:

Mental Wellbeing (Pre COVID-19 Data)

The Scottish Health Survey measures wellbeing using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) questionnaire. The scores range from 14 to 70, with a higher score indicating better mental wellbeing. In 2019, prior to the COVID-19 pandemic, adults with a limiting long-term condition had a significantly lower average score than those adults without a long-term condition (45 compared to 52).^[42]

Figure 13, below, demonstrates that there has been no change in average mental wellbeing scores for adults with a limiting long-term condition in the period 2017-19, with scores for adults without a limiting long-term condition remaining consistently higher than those for adults with a limiting long-term condition.

Taking the above data into account, it is likely that disabled people have experienced increased mental health issues as a result of the COVID-19 pandemic. The Opinions and Lifestyle Survey (OPN) published by the Office for National Statistics (ONS) indicated that in September 2020 disabled people reported more frequently than non-disabled people that the coronavirus pandemic was affecting their wellbeing because it makes their mental health worse (41% for disabled people and 20% for non-disabled people), they are feeling lonely (45% and 32%), they spend too much time alone (40% and 29%), they feel like a burden on others (24% and 8%), or they have no-one to talk to about their worries (24% and 12%).^[43]

Health Risk Behaviours (Pre COVID-19 Data)

Health risk behaviours are defined as being a current smoker, engaging in harmful drinking, engaging in a low level of physical activity or obesity.

Figure 14, below, demonstrates that in the period 2017 -2019 adults with a limiting long-term condition were significantly more likely to engage in two or more health risk behaviours than adults without a limiting long-term condition.

Physical Activity (Pre COVID-19 Data)

The SHeS shows that in the period 2017-2019 adults with a limiting long-term condition were consistently less likely than adults without a limiting long-term condition to meet physical activity recommendations.^[44] In 2019, significantly fewer adults with a limiting long-term condition met physical activity recommendation, compared to adults without limiting long-term conditions. Just over half (55%) of adults with a limiting long-term condition met physical activity recommendations, compared to almost three quarters (73%) of non-disabled people.^[45] However, Figure 15, below, demonstrates that between 2017 and 2019 the percentage of adults with a limiting long-term condition meeting physical activity guidelines rose from 49% to 55% - a statistically significant change.

Journeys by Active Travel (Pre COVID-19 Data)

Figure 16, below, demonstrates that there was no significant difference between the percentage of disabled and non-disabled people who usually travelled to work by public or active transport across 2018-19. In 2019, almost two fifths (38%) of disabled people usually travelled to work by public or active transport, compared to 36% of non-disabled people.

Healthy Weight (Pre COVID-19 Data)

This indicator measures the percentage of adults, i.e. those over 16, who are a healthy weight. Healthy weight in this context refers to having a BMI of 18.5 to less than 25. Statistics on BMIs in the population are available from the SHeS for both children and adults.

Figure 17, below, shows that in 2017 there was little difference in the percentage of people with a healthy weight when considering adults with limiting long-term conditions, and adults without a limiting long-term condition. However, by 2019 there was a statistically significant difference between those with and without limiting long-term conditions. In 2019, 28% of adults with a limiting long-term condition were a healthy weight, compared to 35% of adults without a limiting long-term condition.

Additional Indicators

Premature Mortality (Pre COVID-19 Data)

Statistics concerned with premature mortality are not broken down in relation to disability. The 2018 Learning Disabilities Mortality Review (LeDeR) found the median age at death was 60 for men and 59 for women, for those (aged 4 and over) who died April 2017 to December 2018. This is significantly less than the median age of death of 83 for men and 86 for women in the general population. This means the difference in median age of death between people with a learning disability (aged 4 and over) and the general population was 23 years for men and 27 years for women.^[46]

Vulnerability to COVID-19

Disabled adults have a range of limiting long-term physical health conditions, such as those affecting the heart and respiratory system, which are linked to increased vulnerability to COVID-19. Figure 18, below, demonstrates the most common limiting long-term conditions among disabled adults as recorded in the 2019 Scottish Health Survey.

Deaths involving COVID in Scotland (monthly analysis)^[47] shows that as of 17^th January of the 6,834 deaths involving COVID-19 between March and December 2020, over nine in ten (93%, or 6,372) had at least one pre-existing condition.

Around 170,000 adults in Scotland have been defined on medical grounds as clinically extremely vulnerable due to having an existing health condition that puts them at very high risk of severe illness from COVID-19.^[48] An additional group of people are required to follow enhanced social distancing, because pre-existing health conditions or circumstances mean they are at increased risk of severe illness from COVID-19.^[49] A large proportion of disabled people will fall into these groups.

It is also possible that disabled people may be at increased risk of contracting COVID-19 due to barriers experienced in enacting preventative measures. Briefing by the World Health Organisation (WHO)^[50] states that disabled people may face greater challenges implementing regular handwashing and social distancing measures because of additional support needs. There may also be a requirement for some disabled people to use touch to obtain information from the environment or physical support, increasing the likelihood of virus transmission.

Disruption to Health and Social Care (COVID-19 Data)

The Coronavirus Act 2020 allowed local authorities to dispense with particular assessment duties in relation to adult social care, carer support and children's services where 'complying would not be practical or would cause unnecessary delay in providing support to any person'.^[51] This was intended to allow councils to prioritise care for those most at risk in the event of services becoming overwhelmed by increased demand or staff absences. Many disabled people in particular have faced disruptions to social care arrangements due to care staff being redeployed to work on COVID-19, reported lack of personal protective equipment for carers, and family members being unable to provide unpaid care due to themselves being ill or isolating.^[52]

The Opinions and Lifestyle Survey (OPN) published Office for National Statistics (ONS) indicated that in September 2020 around half of (50%) disabled people who were receiving medical care before the coronavirus pandemic began, were either currently receiving treatment for only some of their conditions (29%), or that their treatment had been cancelled or not started (22%). Less than 3 in 10 (27%) of non-disabled people who had a physical or mental health condition or illness and were receiving care before the pandemic reported receiving a reduced level of treatment or had their treatment cancelled.^[53]

Just under half (45%) of those disabled people who had reported receiving a reduced level of treatment or had their treatment cancelled in September 2020 reported that they felt their health had worsened in this time; in July 2020 this proportion was one-quarter (25%).^[54]