"Health inequalities are the preventable, unfair and unjust differences in health status between groups, populations or individuals that arise from the unequal distribution of social, environmental and economic conditions within societies, which determine the risk of people getting ill, their ability to prevent sickness, or opportunities to take action and access treatment when ill health occurs." (Source: Public Health England 2019)

People with disabilities often have worse health than people in the general population and are more likely to experience several health conditions at once. The health inequalities faced by people with disabilities in the UK start early in life and often result from barriers they face in accessing timely, appropriate and effective health care. 

Barriers to health equality: 

• Patients not identified as having a learning disability or hidden disability 

• Staff having little understanding of learning disability and/or autism  

• Staff not recognising that someone has a sensory impairment, due to a lack of awareness, 

• Staff not understanding how to communicate with someone that has a sensory impairment  

• Building/rooms inaccessible for physical disability/ guide dog/ no hearing loop 

• Allowance for additional time for appointments for successful communication  

• Staff might assume that someone with a physical impairment is unable to effectively advocate for themselves 

• Staff not understanding Autistic people and their specific communication needs 

• Failure to recognise that a person with learning disabilities is unwell 

• Failure to make a correct diagnosis 

• Anxiety or lack of confidence in people with disabilities 

• Lack of joint working between different care providers 

• Not enough involvement allowed from carers/support staff and them not being listened to 

• Inadequate aftercare or follow up care 

• Autism: different communication and sensory needs can make support inaccessible 

• Autism: increase social isolation can lead to deterioration and loss of confidence 

• Autism: social anxiety and previous poor experiences of healthcare can become a barrier to accessing support 

• Autism: if pain is ‘normal’ people may not recognise this as a cause for concern 

The Confidential Inquiry into premature deaths of people with learning disabilities (CIPOLD) reviews showed the lack of reasonable adjustments provided to people with a learning disability (especially in accessing clinic appointments and investigations) as a contributory factor in a number of avoidable deaths. They also found that 38% of people with a learning disability died from an avoidable cause, compared to 9% in a comparison population of people without a learning disability (Source: Heslop et al., 2013). 

Healthcare professionals have a legal duty to provide reasonable adjustments for disabled people (Public Health England, 2016). This can include providing easy-read information, avoiding medical jargon or longer appointment times. 

 

Reasonable adjustments

Healthcare professionals have a legal duty to provide reasonable adjustments for disabled people (Public Health England, 2016). This can include providing easy-read information, avoiding medical jargon or longer appointment times. 

The Equality Act (2010) states all organisations including health and social care, such as hospitals and GP surgeries must take steps to remove the barriers individuals face because of disability.

The NHS must make it as easy for disabled people to use health services as it is for people who are not disabled.

Examples of reasonable adjustments could be things like 

• making sure there is wheelchair access in hospitals 

• providing easy read/other accessible formats for appointment letters 

• giving someone a priority appointment if they find it difficult waiting in their GP surgery or hospital  

• Telephone call reminder about an appointment rather than a text 

• longer appointments if someone needs more time with a doctor or nurse to make sure they understand the information they are given. 

 

For hearing impaired Individuals:

1. Communication Support:
• Sign Language Interpreters: Providing interpreters to facilitate communication
• Speech-to-Text Services: Using real-time captioning to transcribe spoken words
2. Visual Aids:
• Written Information: Offering appointment details and instructions in written format
• Text Messaging: Using text messages for appointment reminders and communication
3. Assistive Technology:
• Hearing Loops: Installing hearing loops in consultation rooms to improve sound quality
• Amplified Phones: Providing phones that amplify sound for better communication

For sight impaired Individuals:

1. Guidance and Navigation:
• Personal Assistance: Offering staff assistance to guide individuals through the facility
• Tactile Maps: Providing tactile maps or floor plans to help navigate the space
2. Accessible Information:
• Braille and Large Print: Providing appointment letters and information in Braille or large print
• Audio Formats: Offering information in audio format for easy access
3. Environmental Adjustments:
• Clear Signage: Ensuring clear, high-contrast signage throughout the facility
• Consistent Layout: Maintaining a consistent and hazard free layout to avoid obstacles and ensure easy navigation

All of these examples of adjustments aim to create a more inclusive and supportive environment for individuals who have a disability.

The Equality Act 2010 requires organisations to make reasonable adjustments to ensure that disabled people are not at a substantial disadvantage compared to non-disabled people. Here are the key points:

Duty to Make Reasonable Adjustments

Three Requirements:

• • Changing Practices or Policies: Adjusting any rules or procedures that put disabled people at a disadvantage
  • Providing Auxiliary Aids: Offering additional support or equipment to help disabled individuals
  • Physical Adjustments: Making changes to the physical environment, such as installing ramps or accessible toilets

Anticipatory Duty

• Proactive Approach: Organisations must anticipate the needs of disabled people and make adjustments in advance, rather than waiting for a request

Factors to Consider

• Reasonableness: The adjustments must be reasonable, considering factors like the cost, practicality and the extent to which the adjustment would alleviate the disadvantage

If you are supporting someone with specific needs or requirements, it's always helpful to communicate them to the healthcare provider in advance, allowing them time to make the reasonable adjustments.

Be familiar with the legislation and be ready to quote it if the people you support face resistance to their requests for reasonable adjustments. NHS England » Reasonable adjustments.

Asking for reasonable adjustments | Disability charity Scope UK

Have a look at these recordings about reasonable adjustments

“What other reasonable adjustments might help the individuals

that you support with their health needs?”  

Diagnostic Overshadowing

Diagnostic overshadowing is when a healthcare professional assumes that a person’s symptoms are due to their existing disability or mental health condition, rather than investigating other possible causes.  

There is a common barrier that often affects people with any type of disability and that is known as ‘diagnostic overshadowing’. 

This is the term given to overlooking a physical illness because of presuming symptoms are part of the pre-existing, sometimes mental health condition, thus missing the opportunity to screen for other physical disease. 

Diagnostic overshadowing increases the risk of further health complications and delay in accurate treatment. 

Diagnostic overshadowing is increasingly recognised as contributing to health inequalities experienced by the disability population. 

Using the information and tools within this Toolkit will help your organisation to achieve that goal.