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Equality Act

Bryan R
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Folkestone Welfare Union

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Across the district I live in not a single surgery has a textphone service for the deaf, speech impaired, aphasia or those who suffer from auditory hallucinations. Few of them have email contact addresses either.

I have written to all of them in an extensive letter informing them of their Public Sector Duty of Care and also their need to make ‘reasonable adjustment’.

The responses have been a real mixed bag. Some have said no outright, some have said yes outright and will make the changes, others have asked me in to discuss this matter.

My local CCG have no clear guidance on this issue, so I have written to them asking for their current guidelines.

I’d like to know if any of these services

email or textphone services are avaliable in some or all of the doctor’s surgeries across your districts.

Mike Hughes
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Senior welfare rights officer - Salford City Council Welfare Rights Service

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Interesting one. Deaf community don’t seem to set any great store by Textphone nowadays. It’s been usurped by fax or text message. It’s the sort of thing provided by those who wish to tick the box saying “We are disability aware. Oh yes we are!”.

No, you’re not.

Email is an interesting one. Depends on the level of IT literacy within a practice to some extent but also there are issues about how one records an email within an electronic record. Some surgeries and systems don’t have the capacity or knowledge so it’s not quite as straightforward a thing as we might want it to be.

I start from the perspective that if a GP can’t look at my medical records and note that I will be in need of large print correspondence then there’s no hope on other fronts. My favourite on this is Manchester Eye hospital whose lack of signage and inability to send anything but 12 point letters is nothing but a joy to behold.

Bryan R
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Folkestone Welfare Union

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Art 3 & Art 14 of the HRA would apply and I believe the ‘positive obligations’ would also mean that Doctor’s surgeries would at least have to put in place a textphone / text relay service along with a generic email contact.

How would someone who suffers from Auditory Hallucinations be able to use a phone to make an appointment when their illness is rampant? I think a textphone/text relay service might assist them, or an email address.

Of course the Blind would not be able to use either and those who elect to live independently what would they have to do? Walk to the surgery to make an appointment?

Mike Hughes
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At the risk of this becoming only a 2 person conversation…

I wouldn’t claim any expertise in the HRA as I generally find other stuff comes into play well before that. Might there be some confusion of terms though? I don’t see a public sector duty of care as such. There is the public sector equality duty, which is generally more about collective action and active promotion of equality. There is also the Equality Act and the concept of reasonable adjustments, which is more about individual action. 

The danger here is in making assumptions about what fulfils a need for individuals who are all very different. If a surgery serves a specific and significant number of people with hearing issues then you might want to argue for something across the board using the public sector equality duty but even then I doubt that would be an appropriate response.

We are dealing with individuals not a homogenous group. It’s not wise to generalise that textphone makes the issue go away. What do you do with the people with the same conditions for whom it does not? What do you do if surgeries implement only to find, as I strongly suspect they would, that it’s not used by patients or staff and no-one does refresher training to ensure it is even usable.

Is there any real evidence people with AH have specified textphone as the specific solution for them or is this in reality an individual for whom a reasonable adjustment would be a better solution?? It also ignores a simple, practical fact. Someone in the midst of auditory hallucination may well have significant concentration and memory issues that they don’t recognise and may simply not be able to communicate coherently in any format at all at that time let alone using text. There might also be a question mark over whether, in the midst of such a hallucination, the GP would be the appropriate first contact anyway? 

Might the better approach here be for surgeries to be made aware of their responsibilities under the Equality Act and to make adjustments to their communication processes on an individual basis? A letter to patients asking about whether they consider they’re covered under the EA and what reasonable adjustments they would need to communicate would produce far better results imo. GPs and nurses could also clarify by gathering this information when patients visit. 

I am a little concerned about the suggestion the “blind” would not be able to use textphone or email. That concerns me. Few people are wholly blind and text to speech (and indeed the reverse) is available from devices as large as PCs and as small as a smart phone even if they are at negligible to free cost. The key to this is to start by looking at what individual barriers are; look at what options might be available and go from there. The wholesale adoption of textphone and minicom and the like by the public sector is a salutary lesson in how one size does not fit all and just leads to a box on a spreadsheet being ticked somewhere and a whole pile of equipment gathering dust.

It’s Friday and I may be being a bit slow but what’s the relationship between independent living and walking to a surgery to make an appointment?

Bryan R
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Oh for a perfect world. I have tried the reasonable approach you have set out. In the last two years I have contacted all of the doctor’s surgeries across our district, have visited most of them, with Clts. Notes have been taken, action has been promised, yet when the clt/s try to use the route agreed, the walls go up and the car crash happens at the end of the dead end street. A bit like informing a hospital you have bad eye sight and need size 18 font, and they continue to send size 12 font. Are they listening?

Most of my clients who have serious health issues battle regularly with their practice to get ‘reasonable adjustment’ but it has failed to materialise on the next occasion.

The point that one size does not fit all is very valid and I take it on board. However, if they elect not to adjust what other route is there. Yes the ombudsman, been there done that and again the same issue occurs.

It would seem to me that the only way forward is the blanket policy. One could argue it is ‘Job Creation’ :-). But seriously it seems that requests go in one ear and out the other.

As for the Blind man walking to the surgery when ill, well, is it possible? Depends on the illness I would say and as for the technology issues not all of the more elderly clients I see are tech savy.

Thanks for your comments appreciated.

Mike Hughes
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Senior welfare rights officer - Salford City Council Welfare Rights Service

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Bryan R - 05 September 2014 03:04 PM

Oh for a perfect world. I have tried the reasonable approach you have set out. In the last two years I have contacted all of the doctor’s surgeries across our district, have visited most of them, with Clts. Notes have been taken, action has been promised, yet when the clt/s try to use the route agreed, the walls go up and the car crash happens at the end of the dead end street. A bit like informing a hospital you have bad eye sight and need size 18 font, and they continue to send size 12 font. Are they listening?

Most of my clients who have serious health issues battle regularly with their practice to get ‘reasonable adjustment’ but it has failed to materialise on the next occasion.

The point that one size does not fit all is very valid and I take it on board. However, if they elect not to adjust what other route is there. Yes the ombudsman, been there done that and again the same issue occurs.

It would seem to me that the only way forward is the blanket policy. One could argue it is ‘Job Creation’ :-). But seriously it seems that requests go in one ear and out the other.

As for the Blind man walking to the surgery when ill, well, is it possible? Depends on the illness I would say and as for the technology issues not all of the more elderly clients I see are tech savy.

Thanks for your comments appreciated.

Well I can certainly empathise with the 18 point 12 point issue. Have often wondered how many work colleagues you have to email in 16 point before it registers you might need that font back at you :)

I’m not sure all routes have been exhausted here. I do think the individual approach remains the better option FWIW. If an RA is implemented but then forgotten then the Equality Act provides specific routes to challenge that as would a practices complaints process and not just Ombudsman. I would be inclined to support clients to challenge the failure to keep implementing using the EA. Media also come in handy as a last resort too and individual cases will always play better there than an issue affecting a group (sadly).

Just a thought. Good luck. Surprised you haven’t had other contributions.