Memorandum by the Disability Rights Commission
(WP 91)
1. BACKGROUND
1.1 The Disability Rights Commission was
created by the Disability Rights Commission Act 1999 (DRCA). Section
II of the DRCA imposes the following duties on the Commission:
— To work towards the elimination of
discrimination against disabled persons;
— To promote the equalisation of opportunities
for disabled persons;
— To take such steps as is considered
appropriate with a view to encouraging good practice in the treatment
of disabled persons;
— To keep under review the workings
of the Disability Discrimination Act (DDA) 1995 and this Act.
1.2 The Commission's goal is a society in
which all disabled people can participate fully as equal citizens.
2. RESPONSE
Summary
2.1 The DRC welcomes the Government's commitment
to tackling health inequalities and the focus set out in the White
Paper Choosing Health on removing the barriers to effective
health care choice and access for all.
2.2 We urge the Government to build on its
current programme and make reducing the inequality gaps in health
access and increasing healthy living options for disabled people
one of the centrepieces of future health policy and part of a
joined-up strategy across all Government departments.
2.3 Providing high quality health services
to disabled people can also play a crucial role in supporting
them in other areas of their lives, like helping them to stay
in work and participate in family life and other activities. It
is important to relate to the person in the context of their whole
life and to enable them to participate in society—not to
focus on treatment alone.
2.4 For our part the DRC has made the achievement
of greater equality in health outcomes and choice one of our four
strategic priorities for 2004-07. We aim to achieve this by promoting
and implementing new rights under the DDA effectively, by using
our enforcement powers as a catalyst for change, by strengthening
the rights framework in health where evidence suggests policy
gaps or weaknesses and by building major partnerships with the
NHS and its regulatory bodies.
3. Whether the proposals will enable the
Government to achieve its public health goals?
3.1 The DRC welcomes the government's broad
commitment to tackling health inequalities. We also welcome that
the white paper acknowledges there is a need to "step up
action" on tackling the causes of ill health and health inequalities.
3.2. However we remain concerned that opportunities
for good health are not shared equally by all people Evidence
points to the fact that disabled people have higher mortality
rates (ie die earlier) than the overall population—not always
for reasons related to their impairment. Some deaths are preventable
illnesses.[163]
Disabled people have unequal access to health screening, treatment
and assessment and—partly as a result—are more likely
to die young from preventable "killer" diseases like
coronary heart disease.
3.3 For example, one piece of research has
shown that people with learning disabilities risk of dying before
the age of 50 is 58 times greater than the general UK average.[164]
Another found that people who are psychiatric outpatients are
nearly twice as likely to die as the general population.[165]
3.4 Disabled people—people with physical,
sensory, learning or psychiatric impairments or other long-term
health conditions—make up about 22% of all adults and a
far higher proportion of primary care service users. Therefore
making disability equality central to the health service is essential
to meeting national priorities. It is not possible to improve
the overall quality of care and support, to deliver on patient
choice or to meet service standards without meeting the needs
of disabled people. Disabled people are a "target group"
on which local action needs to be focused in order to make progress
against targets to reduce health inequalities.
4. Whether the proposals are appropriate,
will be effective and whether they represent value for money?
Appropriateness
4.1 The DRC welcomes the Government's outline
proposals laid out in the white paper Choosing Health to
support people in disadvantaged groups to make informed and healthy
choices and take control of better access to healthier choices.
4.2 Offering disabled people access to a
health check and support on making healthier choices from a health
trainer is a positive step in the right direction but further
concerted action is required to close the gap in health outcomes
between disabled and non-disabled people.
4.3 We look forward to seeing more detailed
proposals on the government's plans to equip people with the skills
to look after their own health and provide individuals with appropriate
local support and services to do this.
Effectiveness
4.4 For the DRC, the provision of health
and social care are not ends in themselves. They should be seen
as a means of enabling disabled people to enjoy the same opportunities
for participation as any other citizen could reasonably expect.
If we want disabled people to be full and equal citizens this
requires individuals ultimately to carry the same responsibilities
and rights as others. However this has to be accompanied by the
right to whatever support or additional requirements needed to
enable such responsibilities to be met.
4.5 It is important that debates about extending
choice, rights and responsibilities are not defined in ways that
disadvantage disabled people, but rather that disabled people
are enabled to secure their rights and take on responsibilities
as active citizens. Ensuring disabled people have "equal
opportunity" to exercise choice and access health services
or health promotional activities requires change at national,
community and individual levels.
4.6 Health and health promotional services
and activities need to be accessible to all, including people
with mobility, sensory or mental health impairments. Service providers
need to ensure that disabled people have fair access to services
and that disabled people are consulted when services are being
developed.
4.7 People cannot take a more active role
in maintaining their own health unless they have access to information
and other resources they need to make informed choices. Access
to information is essential to enabling disabled people to exercise
choice about their health. Equally important are how information
is communicated and processed and—where applicable—the
availability of advocacy to enable self-directed decision making.
Wider benefits of participation
4.8 There is a link between poverty and
poorer health outcomes, and disabled people make up a disproportionate
percentage of those who live on Social Security benefits. Providing
high quality healthcare services to disabled people is crucial
in supporting them in other areas of their lives, like helping
them to stay in work and participate in family life and other
activities. This in turn helps to support a healthier and fitter
population.
4.9 In reality, disabled people are customers,
workers, students, parents, taxpayers and voters, and community
members. The purpose of any form of support should, therefore,
be to enable people to overcome the practical barriers they face
to participating in all of these roles and activities. By meeting
the health and social care needs of disabled people appropriately,
and gearing services to their rights to choice, independence and
inclusion, disabled people can have improved opportunities to
participate in employment, public life and service delivery. Increased
participation not only benefits disabled people themselves but
also produces economic benefits to governments, businesses and
communities.
4.10 Improving services for disabled people
can also bring about improvements in services for all service
users. Disabled users may have impairments which can make it particularly
difficult for them to exercise choice and access appropriate services—and
if services can be responsive to their needs and wishes, then
they will also be responsive to people who face less significant
obstacles. For example, providing information in ways that are
accessible to people with learning disabilities may also help
people whose first language is not English; and improving physical
access for wheelchair users can help parents with pushchairs.[166]
5. Whether the necessary public health infrastructure
and mechanisms exist to ensure that proposals will be implemented
and goals achieved?
5.1 We remain concerned that despite compelling
evidence of inequalities in health outcomes between disabled and
non disabled people, government policy to date has concentrated
on health inequalities due to geographic area, deprivation level
and ethnicity.
5.2 The DRC believes specific measures are
required to address health inequalities experienced by disabled
people. Differences in how disabled people access and experience
health services need to be fully understood and systematic action
taken to close the gap in health outcomes between disabled and
non-disabled people.
5.3 On our part the DRC has decided to use
its powers of formal investigation to instigate a comprehensive
inquiry into physical health inequalities experienced by people
with long term mental health problems and people with learning
difficulties. Launched In December 2004 the formal investigation
will run for 18 months. The investigation will look at both health
inequalities and potential solutions with the aim of proposing
practical solutions to tackle inequality that can be taken forward
at primary care level. The work will include recommendations for
national policy and implementation.
5.4 The DRC is committed to working in partnership
with the Government to ensure that Disabled people are able to
routinely access the full range of health and health promotion
services with the same ease as anyone else. Over the past 12 months
the partnership framework between the Commission and the Department
of Health has started to deliver a number of tangible products
that will help raise awareness about disability equality among
staff in the health service and equip them to make real changes
on the ground.
5.5 The new Public Sector Duty (PSD) to
promote equality for disabled people offers a real opportunity
for local authorities to provide a strong lead on disability equality
and to help drive forward a culture change across the public sector.
The PSD will require all public bodies to produce action plans
to tackle discrimination and improve outcomes and to monitor the
impact on the lives of disabled people.
5.6 Mainstreaming disability equality and
anti-discriminatory practice into national standards for health
and social services is a key means of transforming services. The
DRC looks forward to working with partner organisations the Healthcare
Commission and the Commission for Social care Inspection to develop
a framework of standards that better support and promote participation
and independent living.
6. CONCLUSION
AND RECOMMENDATIONS
6.1 While we welcome proposals to offer
disabled people support to make healthier choices we urge the
Government to:
— Develop demonstrable leadership on
the issue of disability equality.
— Develop PSA (Public Services Agreements)
targets to reduce health inequalities experienced by disabled,
as compared to non-disabled, people.
6.2 The agreed compact between the DRC and
the Department of Health and planned partnerships with inspection
and health promotion agencies offer major opportunities for strategic
change in key areas such as promoting inclusion and equality,
tackling access and communication barriers for disabled people
and through greater representation of disabled people in NHS employment
changing attitudes and approaches on the ground.
6.3 Disabled people being able to routinely
access the full range of health services with the same ease as
anyone else isn't just a matter of equity. It makes a real difference
to people's chances of living happy and healthy lives and, in
many cases, to how long they will live.
February 2005
163 For more evidence on inequalities in health outcomes
for disabled people see the Background evidence paper for the
DRC's formal investigation into health inequalities experience
by people with learning disabilities or mental health problems,
available online at http://www.drc.org.uk/newsroom/healthinvestigation.asp,
accessed January 2005. Back
164
Sheila Hollins et al "Mortality in People with Learning
disabilities: risks, causes and death certification findings in
London" 1998. Back
165
Harris EC, Barraclough B. "Excess Mortality of Mental Disorder".
British Journal of Psychiatry 1998; 173; 11-53. Back
166
For more information on making health services accessible for
disabled people see the DRC/DH You can make a difference leaflets
Available online at http://www.dh.gov.uk/assetRoot/04/08/92/84/04089284.pdf Back
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