El papel determinante de las relaciones de producción

The OPCS scale of locomotion disability largely covers difficulties associated with walking and climbing and should distinguish between higher rate recipients and other applicants. Up to three disabilities - seeing, behaviour and intellectual functioning - could imply a need for guidance or supervision when out of doors and the expectation was that these disabilities in particular would be associated with lower rate mobility awards.

Table 5.4 Prevalence of different types of disability by DLA mobility awards

Higher rate mobility Lower rate mobility Rejected claims Not claimed Type of disability (%) ( %) (%) (%) Locomotion 99 58 85 45 Personal care 85 38 64 64 Dexterity 50 22 44 69 Behaviour 26 62 34 35 Intellectual functioning 23 64 31 33 Hearing 30 25 32 30

Reaching and stretching 36 10 29 46

Seeing 19 38 21 17

Continence 22 23 22 18

Communication 14 39 17 24

Disfigurement 10 6 8 16

Consciousness 3 23 5 3

Eating, drinking, digestion 4 5 4 3

Base (= 100%) 572 306 645 103

Percentages sum to more than 100 because some people have more than one disability. 5.3.1 Prevalence of disabilities - mobility awards

Table 5.4 shows that almost everyone with a higher rate mobility award has a locomotion disability (that one per cent apparently do not is probably due to errors in the survey process or the DLA database). The raised prevalence of reaching and stretching, dexterity, and personal care disabilities among higher rate recipients also suggests that they are more likely to be physically disabled than

other applicants.

As expected, the findings show that seeing difficulties and disabilities associated with mental impairment - behaviour, intellectual functioning and communication - are most prevalent among recipients of lower rate mobility awards. Lower rate recipients are also more likely to report fits or convulsions. The lower rate criteria note that people who tend to fall may need watching over when walking, and this would apply to those with a consciousness disability, especially if they have no warning of an attack.

Nonetheless, there is considerable overlap in the prevalence of different types of disability between mobility outcomes. Rejected claimants often have the same disabilities as successful applicants: the vast majority have a locomotion disability and around a third are mentally impaired, for instance. Substantial minorities of claimants not applying for a mobility award also have these disabilities. Such apparent inconsistencies could be explained if the disabilities associated with mobility needs are less severe among rejected claimants and non-applicants.

5.3.2 Severity of disabilities - mobility awards

The severity of each disability is summarised in Table 5.5 according to the outcome of an application for a mobility award. Compared with other applicants, it can be seen that locomotion disability is more severe among higher rate recipients and the difference is statistically significant. Although other respondents report walking difficulties, it would appear that these are not severe enough on average to qualify for the higher rate.

Table 5.5 Severity of different types of disability by DLA mobility awards

Type of disability Higher rate mobility mean (SD) Lower rate mobility mean (SD) Rejected claims mean (SD) Not claimed mean (SD) Locomotion 6.5 5.3 5.3 4.2 (2.5) (2.7) (2.5) (2.2) Personal care 7.3 7.2 6.6 8.7 (3.8) (4.0) (4.0) (3.2) Dexterity 7.4 7.3 7.4 7.1 (1.8) (2.0) (1.9) (1.7) Behaviour 6.1 7.2 6.6 6.9 (2.9) (3.1) (3.1) (2.8) Intellectual functioning 4.8 5.9 4.8 4.6 (3.0) (3.0) (3.0) (2.4) Hearing 1.8 1.9 1.9 2.0 (2.2) (2.2) (2.4) (2.1)

Reaching and stretching 4.4 4.2 4.3 2.9

(2.4) (1.9) (2.4) (2.4) Seeing 2.0 3.8 1.4 1.8 (2.9) (3.6) (1.9) (2.2) Continence 5.4 5.3 5.3 4.0 (2.9) (2.7) (2.9) (3.6) Communication 4.4 4.5 4.0 4.8 (2.6) (2.6) (2.5) (2.3) Consciousness 6.7 8.9 7.7 6.7 (3.0) (2.5) (2.9) (3.7)

* Excludes people below the minimum threshold for each disability. Severity levels for disfigurement and digestion disabilities were not defined.

Other significant differences are consistent with the need for guided mobility covered by a lower rate award. Thus lower rate recipients have a more severe seeing or intellectual disability than either higher rate recipients, unsuccessful claimants or non-applicants. Behaviour and consciousness disabilities are also more

severe on average among lower rate recipients than other outcomes.

In spite of these associations there is a good deal of overlap. To illustrate this, Figure 5.2 plots the distribution of individuals' scores on severity of walking difficulties by mobility outcomes. It can be seen that, apart from those not applying for an award, all outcomes include individuals across the full severity range of the locomotion disability scale (0.5 to 11.5). Higher rate recipients report the most severe walking difficulties on the whole but many lower rate recipients and unsuccessful applicants have similar problems getting around. As might be expected, severity of walking difficulties does not distinguish lower rate recipients and unsuccessful applicants.

Figure 5.2 Severity of locomotion disability by DLA mobility outcomes

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Higher rate Lower rate Rejected Not claimed

5.3.3 Combinations of disabilities - mobility awards

To discover which subset of disabilities best distinguishes lower rate mobility awards, we carried out two analyses, one comparing higher and lower rate awards and another comparing lower rate awards and rejected claims.

Table 5.6 Lower rate mobility awards and different types of disability

Association with lower rate care awards versus: Type of disability

Rejected claims

OR OR*

Higher/Middle rate awards

OR OR* Locomotion 0.86 0.89 0.68 0.73 Personal care 0.92 ns 0.84 0.88 Dexterity 0.87 0.92 0.85 0.91 Behaviour 1.14 ns 1.22 1.10 Intellectual functioning 1.22 1.22 1.30 1.22 Hearing ns ns ns _0.81

Reaching and stretching 0.78 0.85 0.73 ns

Seeing 1.40 1.44 1.27 1.32

Continence ns ns ns ns

Communication 1.23 ns 1.25 ns

Disfigurement ns ns 0.29 ns

Consciousness 1.21 1.21 1.34 1.37

Eating, drinking, digesting ns ns ns ns

Outcomes correctly predicted 80% 86%

* OR adjusted for the effects of one disability upon another.

ns_{= not significant.}

The findings, summarised in Table 5.6, show that together four types of disability are significantly associated with lower rate mobility awards:

Seeing Consciousness

Intellectual functioning Behaviour

As suggested above, these four disability areas closely mirror the lower rate criteria on the need for guidance and supervision out of doors. Communication difficulties

are also associated with lower rate awards but not when the effects of other disabilities are taken into account. This is because communication difficulties are associated with severe mental impairment which, with severe behaviour disorders, often implies supervision needs. So communication difficulties are covered by intellectual disability when all disabilities are considered together. The implication is that people with communication difficulties but who are not severely mentally impaired would not necessarily be eligible for a lower rate mobility award.

Higher rate recipients are also clearly distinguished according to patterns of disability. In addition to severe walking difficulties, these findings confirm that many people who are unable or virtually unable to walk often have other physical disabilities, affecting dexterity and self-care, for example.

Both models correctly predict four out of five mobility outcomes. Adjudication of mobility needs, therefore, distinguishes most applicants according to distinct patterns of disability. This was not unexpected. Walking difficulties and guidance needs, which define the higher and lower rate criteria respectively, arise from quite unrelated impairments.'4 Higher rate recipients, for example, do not necessarily meet the conditions of entitlement to a lower rate mobility award. Indeed, the higher rate and lower rate mobility criteria could be said to define two different benefits. As a consequence, we would expect the determination of mobility awards to discriminate clearly between applicants according to different subsets of disability.

One implication is that unsuccessful applicants form a rather diverse group, some with walking difficulties, others with supervision needs, some with both, but in neither case sufficient to qualify for an award at either level. However, our findings suggest that unsuccessful applicants are more likely to have disabilities which give rise to walking difficulties than to needs for guidance outdoors. Most would be better characterised as unsuccessful applicants for a higher rate than a lower rate award.

Thus Table 5.6 shows that many of the disabilities associated with higher rate awards are also associated with unsuccessful applicants more or less to the same extent. Both have more severe locomotion disabilities and less severe `

guidance disabilities' than lower rate recipients, suggesting, on the face of it, that unsuccessful applicants are very similar to higher rate recipients. To investigate this further, we compared the disabilities of higher rate recipients and unsuccessful applicants by logistic regression analysis. Not surprisingly, higher rate recipients were differentiated by more severe locomotion disabilities (OR = 1.24); they also have more severe personal care disabilities than unsuccessful applicants (OR = 1.06), suggesting generally higher levels of physical disability. But only one `guidance disability', behaviour disorders, separates the two groups (OR = 0.93), being more severe among unsuccessful applicants than higher rate recipients. Both groups are equally likely to present the guidance needs arising from seeing, intellectual and consciousness disabilities. As a consequence, the distinction between higher rate recipients and unsuccessful applicants is somewhat less clear- cut than that between other mobility outcomes. Altogether, the model predicts 64 per cent of higher rate awards and rejected claims.