PART ONE The Targeting Study
Chapter 2 Introduction to the Targeting Study
2.6 Note on the presentation of tables in Part One of the report
Percentages are rounded to the nearest whole number and as a result may sum to 99 or 101. Percentages less than one are shown as O. Cells with no cases are shown by ` ' . Base numbers are given in italics and may vary because of missing data. SD = standard deviation.
ANNEX 2.1
Summary of the qualifying conditions for DLA Rate Care component
Lower Attention with bodily functions for a significant portion of the day, or
Aged 16 or over and unable to prepare a cooked main meal.
Middle Needs frequent attention with bodily functions throughout the day, or Needs continual supervision throughout the day to avoid substantial danger to themselves or others, or
Needs someone to be awake during the night for a prolonged period of time, or at frequent intervals, in order to avoid substantial danger to themselves or others.
Higher Payable if one of the middle rate day-time conditions and one of the night-time middle rate conditions are satisfied.
Rate Mobility component
Lower Can walk but needs someone to provide them with guidance or supervision for most of the time when outdoors in unfamiliar places. Higher Payable if a person:
• is unable or virtually unable to walk, or
• has to exert themself to walk to such an extent that it would constitute a danger to life or would be likely to lead to a serious deterioration in health, or
• has had both legs amputated at or above the ankle, or
• was born without legs or feet, or
• is both deaf and blind and needs someone with them outdoors, or • is severely mentally impaired, displays severe behaviour problems
and qualifies for the higher rate care component.
Children under 16 must need substantially more attention or supervision than a child of the same age normally needs. The mobility component is not available for children under five.
For a comprehensive, accessible account of the conditions of entitlement, see The
ANNEX 2.2
OPCS measures of disability
For their surveys, the OPCS researchers adopted the definition of disability recommended by the World Health Organisation (WHO), namely:
Any restriction or lack (resulting from an impairment of the body or mind) of ability to perform an activity in the manner or within the range considered normal for a human being. (WHO, 1980)
This definition covers difficulties with ordinary activities: carrying or reaching for things, speaking to and understanding others, reading a newspaper or watching television, handling money, remembering things and so on. In other words, it focuses on what people cannot do, on individuals' functional limitations. The WHO model further suggests that impairment and disability lead to the disadvantages that disabled people experience.
Using information from their surveys, and the consensus reached by panels of judges which included health professionals, disabled people and their carers, the OPCS researchers devised scales for 13 different areas of disability. These are listed below. The higher the score, the more severe disability is judged to be. A score of zero indicates that the disability does not reach the minimum threshold of severity.
Type of disability Severity score Scale points
Locomotion 0, 0.5 to 11.5 14
Reaching and stretching 0, 1.0 to 9.5 11
Dexterity 0, 0.5 to 10.5 12 Personal care 0, 1.0 to 11.0 7 Continence 0, 1.0 to 11.5 12 Seeing 0, 0.5 to 12.0 10 Hearing 0, 0.5 to 11.0 9 Communication 0, 1.0 to 12.0 6 Behaviour 0, 0.5 to 10.5 9 Intellectual functioning 0, 1.0 to 13.0 12 Consciousness 0, 0.5 to 12.5 15
Eating, drinking and digestion 0, 0.5 2
Disfigurement 0, 0.5 2
Next, individuals' disability scores were weighted and combined to assign them to a ten-point scale of overall severity. To do this, the OPCS researchers first fitted a model to individuals' three highest, non-zero, severity scores from the 13 areas of disability. The three scores are combined according to the model:
highest score + 0.4 (second highest) + 0.3 (third highest)
to produce a single severity score in the range 0.5 to 21.4. These severity scores were then grouped into ten categories as follows:
Individuals without at least one non-zero score in the 13 areas of disability were excluded from the OPCS prevalence estimates because they fall below the severity threshold above which people were deemed to be disabled. Such individuals may nevertheless apply for DLA. To accommodate them we added a further category to the OPCS scale of overall severity, represented by zero. Further details of the OPCS measures of disability, including the concepts and methods used in the assessment of disability, and the use of panels of judges to scale severity levels, are given in Martinet al. (1988).
The WHO model underlying the OPCS scales represents a medical view of disability which focuses on individual capabilities rather than on the restrictions imposed by the social, economic and physical environments (Barnes, 1991; Oliver, 1990). Not surprisingly, the findings of the OPCS disability surveys have been criticised in relation to the measurement of disability, the ascertainment of extra costs arising from disability, and the scaling of childhood disability (Abberley, 1991; Berthoud et al., 1993; Loughran et al., 1992; Thompson et al., 1990). Despite this, the OPCS scales have been used successfully in other large-scale surveys, research on employment and handicap, for example (Prescott-Clarke, 1990).
To evaluate the targeting of lower rate DLA awards, this study expressly required replication of the methods and measures developed for the OPCS surveys of disability. It was beyond the scope of this study to develop and test new measures of disability; nor could we contribute directly to the evaluation of the OPCS measures. However, our study highlights the limitations of a global scale of overall disability as an evaluative as opposed to a descriptive instrument. Nevertheless, it shows that some of the individual scales of different types of disability are remarkably good proxies for many of the care and mobility needs that determine the outcome of a claim for DLA. Components of the OPCS scale of overall disability prove to be good predictors of DLA entitlement.
Severity category 10 (most severe) 9 8 7 6 5 4 3 2 1 (least severe)
Weighted severity score 19-21.40 17-18.95 15-16.95 13-14.95 11-12.95 9-10.95 7-8.95 5-6.95 3-4.95 0.5-2.95
ANNEX 2.3
Personal care and locomotion disabilities and overall severity
As part of the preparatory work for this study, we carried out secondary analysis of data from the OPCS survey of disabled adults living in private households ( Martin et al., 1988). We were particularly interested in the relationships between difficulties with self-care or mobility and severity of overall disability among adults under pension age. As proxy measures for care and mobility needs we used the OPCS scales of personal care disability and locomotion disability.
The findings suggest that it is unlikely that lower rate DLA awards would be shown to target less severely disabled people as measured by the OPCS scale. The reasons stem from the complex ways in which disabilities, and care or mobility needs, combine in individuals. Not surprisingly, neither the structure of DLA nor the overall severity scale adequately represents this complexity:
a. DLA comprises two distinct components with quite separate conditions of entitlement. According to the OPCS survey, personal care and locomotion disability scores are not strongly correlated and predictions from one to the other are very imprecise.3 In other words, care and mobility needs are
not necessarily found together; care needs cannot be inferred from mobility needs, or the other way round. As a consequence, applicants who are assessed as severely disabled enough to qualify for a higher rate award of one component, may be awarded the other at a lower rate, or not at all, because their disabilities, though severe, do not create the needs covered by the conditions of entitlement. While such cases can only weaken the hypothesised relationship between DLA outcomes and severity of overall disability, they do not necessarily imply that lower rate awards are poorly targeted.
b. As we have seen in Annex 2.2, the OPCS scale of overall severity is derived from the severity ratings of up to three different types of disability. These may or may not reflect the conditions of entitlement to a DLA award, so there will be no necessary relationship between overall severity and care or mobility needs. Thus, Table 2.1 shows that personal care and locomotion disabilities are not strongly associated with overall severity.4 This suggests
that, on its own, the OPCS scale of overall severity is an inadequate criterion for evaluating the targeting of DLA awards. If severity of overall disability does not distinguish the intensity or frequency of care or mobility needs, we cannot expect DLA, which is based on an assessment of those needs, to be precisely targeted in relation to the OPCS severity scale.
3 Including all individuals with a personal care or locomotion disability (n = 2656), the correlation between the two sets of scores is r = 0.32, or variance explained r2 = 0.10. When predicting personal care scores from locomotion scores, the standard error of estimate is 3.8, that is a 95 per cent confidence interval of ±7.5 for a scale ranging from 0 to 11.0. The standard error is 2.8 when predicting locomotion scores from personal care scores, a 95 per cent confidence interval of ±5.5 for the scale 0 to 11.5
eta' in Table 2.1 can be interpreted as the proportion of the total variability in disability scores that can be accounted for by knowing the categories of the OPCS severity scale.
18
Table 2.1 Severity of personal care and locomotion disability by OPCS severity categories
Severity category
Personal care disability mean (SD) Locomotion disability mean (SD) Base 0.1 (0.3) 0.5 (1.0) 996 2 0.2 (0.6) 2.5 (1.3) 588 3 0.3 (0.9) 1.9 (2.4) 559 4 0.8 (1.8) 2.3 (2.6) 551 5 1.5 (2.8) 3.2 (3.2) 512 6 2.4 (3.6) 3.7 (3.4) 366 7 4.5 (4.5) 4.5 (3.6) 281 8 6.9 (4.6) 5.7 (3.7) 221 9 9.6 (3.2) 7.8 (3.6) 158 10 10.4 (2.3) 9.2 (3.8) 50 Total 1.7 (3.5) 2.7 (3.1) 4286 eta-' 0.54 0.35
Source: OPCS data on disabled adults aged 16-64 years living in private households.
The implications for this evaluation are twofold. First, any evaluative criteria which aim to represent the set of needs and circumstances covered by one component of DLA should not be applied to the distribution of awards of the other component. In effect, the care and mobility components should be treated as two distinct benefits when evaluating the targeting of lower rate awards against disability-related criteria. Second, the severity of different types of disability should provide a more useful criterion, than severity of overall disability, for evaluating the targeting of lower rate awards on less severely disabled people. Lack of a relationship between the distribution of lower rate awards and severity of overall disability does not necessarily mean that the new lower rate conditions are unsuccessful in fulfilling policy makers' intentions.