Disability rights commission Health Dictionary

Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner, or within the range, considered to be normal for a human being. The term disability reflects the consequences of impairment in terms of functional performance and activity by the individual. Disabilities thus represent disturbances at the level of the person. See also “handicap”; “impairment”.... disability

Learning disability, previously called mental handicap, is a problem of markedly low intellectual functioning. In general, people with learning disability want to be seen as themselves, to learn new skills, to choose where to live, to have good health care, to have girlfriends or boyfriends, to make decisions about their lives, and to have enough money to live on. They may live at home with their families, or in small residential units with access to work and leisure and to other people in ordinary communities. Some people with learning disabilities, however, also have a MENTAL ILLNESS. Most can be treated as outpatients, but a few need more intensive inpatient treatment, and a very small minority with disturbed behaviour need secure (i.e. locked) settings.

In the United Kingdom, the 1993 Education Act refers to ‘learning diffculties’: generalised (severe or moderate), or speci?c (e.g. DYSLEXIA, dyspraxia [or APRAXIA], language disorder). The 1991 Social Security (Disability Living Allowance) Regulations use the term ‘severely mentally impaired’ if a person suffers from a state of arrested development or incomplete physical development of the brain which results in severe impairment of intelligence and social functioning. This is distinct from the consequences of DEMENTIA. Though ‘mental handicap’ is widely used, ‘learning disability’ is preferred by the Department of Health.

There is a distinction between impairment (a biological de?cit), disability (the functional consequence) and handicap (the social consequence).

People with profound learning disability are usually unable to communicate adequately and may be seriously movement-impaired. They are totally dependent on others for care and mobility. Those with moderate disability may achieve basic functional literacy (recognition of name, common signs) and numeracy (some understanding of money) but most have a life-long dependency for aspects of self-care (some fastenings for clothes, preparation of meals, menstrual hygiene, shaving) and need supervision for outdoor mobility.

Children with moderate learning disability develop at between half and three-quarters of the normal rate, and reach the standard of an average child of 8–11 years. They become independent for self-care and public transport unless they have associated disabilities. Most are capable of supervised or sheltered employment. Living independently and raising a family may be possible.

Occurrence Profound learning disability affects about 1 in 1,000; severe learning disability 3 in 1,000; and moderate learning disability requiring special service, 1 per cent. With improved health care, survival of people with profound or severe learning disability is increasing.

Causation Many children with profound or severe learning disability have a diagnosable biological brain disorder. Forty per cent have a chromosome disorder – see CHROMOSOMES (three quarters of whom have DOWN’S (DOWN) SYNDROME); a further 15 per cent have other genetic causes, brain malformations or recognisable syndromes. About 10 per cent suffered brain damage during pregnancy (e.g. from CYTOMEGALOVIRUS (CMV) infection) or from lack of oxygen during labour or delivery. A similar proportion suffer postnatal brain damage from head injury – accidental or otherwise – near-miss cot death or drowning, cardiac arrest, brain infection (ENCEPHALITIS or MENINGITIS), or in association with severe seizure disorders.

Explanations for moderate learning disability include Fragile X or other chromosome abnormalities in a tenth, neuro?bromatosis (see VON RECKLINGHAUSEN’S DISEASE), fetal alcohol syndrome and other causes of intra-uterine growth retardation. Genetic counselling should be considered for children with learning disability. Prenatal diagnosis is sometimes possible. In many children, especially those with mild or moderate disability, no known cause may be found.

Medical complications EPILEPSY affects 1 in 20 with moderate, 1 in 3 with severe and 2 in 3 with profound learning disability, although only 1 in 50 with Down’s syndrome is affected. One in 5 with severe or profound learning disability has CEREBRAL PALSY.

Psychological and psychiatric needs Over half of those with profound or severe – and many with moderate – learning disability show psychiatric or behavioural problems, especially in early years or adolescence. Symptoms may be atypical and hard to assess. Psychiatric disorders include autistic behaviour (see AUTISM) and SCHIZOPHRENIA. Emotional problems include anxiety, dependence and depression. Behavioural problems include tantrums, hyperactivity, self-injury, passivity, masturbation in public, and resistance to being shaved or helped with menstrual hygiene. There is greater vulnerability to abuse with its behavioural consequences.

Respite and care needs Respite care is arranged with link families for children or sta?ed family homes for adults where possible. Responsibility for care lies with social services departments which can advise also about bene?ts.

Education Special educational needs should be met in the least restrictive environment available to allow access to the national curriculum with appropriate modi?cation and support. For older children with learning disability, and for young children with severe or profound learning disability, this may be in a special day or boarding school. Other children can be provided for in mainstream schools with extra classroom support. The 1993 Education Act lays down stages of assessment and support up to a written statement of special educational needs with annual reviews.

Pupils with learning disability are entitled to remain at school until the age of 19, and most with severe or profound learning disability do so. Usually those with moderate learning disability move to further education after the age of 16.

Advice is available from the Mental Health Foundation, the British Institute of Learning Disabilities, MENCAP (Royal Society for Mentally Handicapped Children and Adults), and ENABLE (Scottish Society for the Mentally Handicapped).... learning disability

See HEALTHCARE COMMISSION.... commission for health improvement

The process of drawing up contracts with service providers to provide care.... commissioning

A severe, chronic disability which is attributable to a mental or physical impairment or combination of mental and physical impairments; is manifested before the person attains the age of 22; is likely to continue indefinitely; results in substantial functional limitations in three or more of the following areas of major life activity: self care, receptive and expressive language, learning, mobility, self direction, capacity of independent living, economic self-sufficiency; and reflects the person’s need for a combination and sequence of special, interdisciplinary or generic care treatments or services which are of lifelong or extended duration and are individually planned and coordinated.... developmental disability

Measures that can be initiated among those with a disease, usually a chronic disease, to lessen or delay the impact of disability from that disease, e.g. averting renal complications among those with diabetes.... disability postponement

A modification of conventional life expectancy to account for time lived with disability. It is the number of healthy years of life that can be expected on average in a given population. It is generally calculated at birth, but estimates can also be prepared at other ages. It adjusts the expectation of years of life for the loss on account of disability, using explicit weights for different health states.... disability-adjusted life expectancy

The number of healthy years of life lost due to premature death and disability.... disability-adjusted life years (dalys)

An o?cial, responsible to the United Kingdom’s parliament, appointed to protect the interests of National Health Service patients in matters concerning the administration of the health service and the delivery of health care (excluding clinical judgements). Known colloquially as the health ombudsman, the Commissioner presents regular reports on the complaints dealt with.... health service commissioner

Launched in 1999 in England and Wales as CHI, this is an inspectorate charged with protecting patients from ‘unacceptable failings in the National Health Service’. A statutory body under the 1999 Health Act, it evaluates and re?nes local systems designed to safeguard standards of clinical quality. Working separately from the NHS and the health departments, it o?ers an independent safeguard that provides systems to monitor and improve clinical quality in primary care, community services and hospitals. As of 2004 it became responsible for dealing with patients’ complaints if they could not be settled by the trust concerned. The board members include health professionals, academics and eight lay members. Scotland has set up a similar statutory body. (See APPENDIX 7: STATUTORY ORGANISATIONS.)... healthcare commission (commission for health improvement)

Classification of health and health-related domains that describe body functions and structures, activities and participation. The domains are classified from body, individual and societal perspectives. Since an individual’s functioning and disability occurs in a context, this classification includes a list of environmental factors.... international classification of functioning, disability and health (icf) a

A government-appointed expert advisory body on the use of MEDICINES in the UK.... medicines commission

This was set up under the CARE STANDARDS ACT 2000 as an independent regulator in respect of homes for the elderly, the disabled and children in the state and private sectors in the UK.... national care standards commission

A set of rights, privileges, responsibilities and duties under which individuals seek and receive health care services. As patients’ rights are often not explicit, the composition of the set varies from country to country and over time.... patients’ rights

Difficulty in one or more areas of learning in a child of average or above average intelligence.

Specific learning disabilities include dyslexia and dyscalculia, where there is a problem with mathematics.... specific learning disability

(CCGs) self-governing bodies set up by the Health and Social Care Act 2012, following the abolition of *primary care trusts and *strategic health authorities, to commission most NHS services in England. CCGs are formed of all GP practices within a given geographical area, and all GP practices must belong to a clinical commissioning group. All CCGs have their own constitution and governing body, which (in addition to GPs) must include at least one registered nurse and at least one secondary care specialist doctor. There are currently 195 CCGs in England.... clinical commissioning groups

(DALY) a common research measure of disease burden that accounts for both morbidity and mortality. One year lived in full health is equivalent to one DALY. Disabilities and disease states are assigned a weighting that reduces this figure, such that a year lived with disability is equivalent to less than one DALY. Some studies also use social weighting, in which years lived as a young adult receive a greater DALY weight than those lived as a young child or older adult. See also health-adjusted life expectancy; quality of life.... disability-adjusted life year

(DLA) (in Britain) a state benefit payable to help with the extra costs of looking after a child under the age of 16 with special needs. It has two components: a care component, payable at three rates to children needing help with personal care; and a mobility component, payable at two rates to those aged 3 years or over who need help with walking. The rates depend on the level of help required. DLA for adults aged 16–64 years has been replaced by the *personal independence payment (PIP). People aged over 65 years with a disability and requiring help may be eligible for the attendance allowance.... disability living allowance

a nondepartmental public body set up in 2007 to promote human rights and equality in regard to age, disability, gender, race, religion and belief, pregnancy and maternity, marriage and civil partnership, sexual orientation, and human rights. It replaced the Commission for Racial Equality, the Disability Rights Commission, and the Equal Opportunities Commission.... equality and human rights commission

(CQC) a publicly funded independent organization established in 2009 and responsible for regulation of health and social care in England; it replaced the Healthcare Commission, the Commission for Social Care Inspection, and the Mental Health Act Commission. The responsibilities of the commission include publication of national health-care standards; annual assessment of the performance of NHS and social-care organizations; reviewing other (i.e. private and voluntary) health- and social-care organizations; reviewing complaints about the services when it has not been possible to resolve them locally; and investigating serious service failures.... care quality commission

identifying services required to meet population health-care needs and obtaining such services from an appropriate service provider via allocation of resources and contracting arrangements. Commissioners monitor the quality of commissioned services, including adherence to any appropriate national standards. Most NHS commissioning is undertaken by *clinical commissioning groups or *NHS England.... health-care commissioning

a legal framework adopted by the United Nations following World War II that sought to define and promote fundamental entitlements, conditions, and freedoms to be afforded to all human beings. In the UK the Human Rights Act 1998 enacts the provisions of the 1950 European Convention on Human Rights, which sets out, via fourteen articles, an individual’s rights, entitlements, and freedoms.... human rights

the person in charge of the independent public agency set up to regulate the use and storage of personal data under the Data Protection Act 1998 (see data protection). The office of the Information Commissioner both regulates the use of data under the Act and takes any enforcement action required as a result of noncompliance with the principles of the statute. The Information Commissioner’s office also promotes public access to official information under the Freedom of Information Act 2000.... information commissioner

a regulating body in England and Wales, governed by the Mental Health Act 2007, that was responsible for regularly visiting psychiatric hospitals, reviewing psychiatric care, giving second opinions on the need for certain psychiatric treatments, and acting as a forum for the discussion of psychiatric issues. It was subsumed under the *Care Quality Commission in April 2009.... mental health act commission