DRC: Government and NHS complacency to tackle killer diseases.

Institutional discrimination is still rife within the NHS because of the lack of central leadership which is failing to prevent the high levels inequality of healthcare faced by millions of disabled people, says the Disability Rights Commission (DRC) today.

The DRC has identified 8 Strategic Health Authorities (SHAs) who are failing to comply with the Disability Equality Duty which came into force in December 2006. Crucially six SHAs have been given notice that they have 28 days to provide evidence of compliance before legal enforcement action is triggered.

Last September, the DRC reported on its Formal Investigation (Equal Treatment: Closing the gap) into primary care services in England and Wales (1). It found that people with mental health problems and/or learning disabilities were more likely to get killer diseases, get them younger, and more likely to die of them within 5 years. Despite this pattern of early death, they are less likely to get some standard, evidence based checks and treatments.

One year on after this investigation, two new reports by the DRC reveal that complacency and inaction within some sectors of the NHS have failed to address many of the DRC’s recommendations. Strategic Health Authorities in particular, are failing in their legal duty to promote equality for disabled people.

A DRC report into SHA compliance with the Disability Equality Duty found (2):

Only one Strategic Health Authority – North East – is fully compliant with the law.

Six schemes fall well below acceptable and;

London SHA and Yorkshire and the Humber SHA have not even produced one.
The DRC is recommending that the Equality and Human Rights Commission (EHRC), which takes over the role of the DRC on 1st October, 2007, takes forward legal action against those SHAs failing to produce acceptable schemes.

In the second report, (Equal Treatment: Closing the gap – One year on) an Independent Inquiry Panel examined the progress of primary care services to act on the DRC’s Formal Investigation recommendations made last September. The Inquiry Panel, chaired by Barrister David Wolfe, found a mixed picture.

Overall, the report found that the organisational shift from ‘command and control’ by the Department of Health to influence through ‘policy and incentives’ is not working. Without strategic leadership, says the report, “there is a strong risk of creating the conditions for allowing systemic discrimination to persist by default”.

The Inquiry Panel found that not nearly enough had been done and some of the most vital recommendations have still not been acted upon, e.g:

No national coherent strategies to tackle health inequalities for disabled people in England and Wales.

The lack of leadership from the Department of Health meant Strategic Health Authorities had failed to draw up action plans to tackle health inequalities.

No annual health checks for people with learning disabilities in England – this was introduced in GP contracts in Wales in 2006.

The Government has failed to accept that PSA targets broken down by disability could be used to better target resources.

However, some organisations are making real progress. In particular, the Welsh Assembly and some professional organisations such as the Royal College of GPs, the BMA and Equip Cymru have done much to tackle practice issues through professional learning and development.

Sir Bert Massie, Chairman of the DRC, said:

“Not nearly enough has been done. Inexplicably, there are still no coherent national strategies for tackling the unequal levels of healthcare experienced by disabled people. If the NHS decided to provide no services for the people of Birmingham there would be an outcry, yet deciding to leave out millions of disabled citizens appears to be acceptable. Such inaction amounts to institutionalised discrimination.

“This woeful failure is clearly unacceptable – legally and morally. Failing Strategic Health Authorities must be forced to act or face legal action.

“There is a clear fault line. Those with the worst health should get the best treatment, yet the incentive culture is not attuned to deliver that, nor could it by itself. We need everybody in the NHS to deliver a system that works for every citizen and that can only come from clear leadership from the Department of Health”.

The Independent Inquiry Panel is recommending that:

Negotiations between the Department of Health and the BMA must be resolved urgently to introduce regular health checks for people with leaning disabilities in England.

Much greater urgency across the health sector needs to be given to Disability Equality Schemes. Legal enforcement action will result from further inaction.

The Commissioning Framework for Health and Wellbeing must ensure local service planners specifically assess disabled people’s needs and ensure adequate data is collected locally to meet needs and improve services.

Further information from Sue Pratt, DRC Press Office, on 07971 590 002. After 28th September 2007: Nicola Pazdzierska at the ECHR Press Office on 07791 015 009

ENDS

Notes to Editors

The DRC closes on Friday 28 September 2007. The following Monday, the new Equality and Human Rights Commission (EHRC) opens its doors, taking on key aspects of the DRC's work.

The CEHR will enforce equality legislation on disability, age, gender, race, religion or belief and sexual orientation and encourage compliance with the Human Rights Act 1998. More information at http://www.cehr.org.uk

From Monday 1 October 2007, journalists needing information on disability rights (& other equality issues) should contact the EHRC press office on 020 7215 874/020 7215 2489 or out of hours on 07767 272 818.

1. The DRC Formal Investigation, ‘Equal Treatment: Closing the gap’, found that people with learning disabilities and people with mental health problems are much more likely than other citizens to significant health risks and major health problems. For people with learning disabilities these include obesity and respiratory disease; for people with mental health problems it includes obesity, smoking, heart disease, hypertension, respiratory disease, diabetes and stroke.

Both groups are likely to die younger than other citizens. Once they have them they are less likely to survive for 5 years. Despite this pattern of early death, these groups are less likely to get some standard, evidence based checks and treatments (e.g. screening, statin treatment for heart disease) and face huge access and attitude barriers in using health services.

There are 1 million people with learning disabilities, 200,000 people with schizophrenia or bipolar disorder and 6 million people with depression.

2. This Report assesses the Disability Equality Schemes and performance of 8 of the 10 Strategic Health Authorities: North East, East of England, North West, West Midlands, East Midlands, South Central, South East Coast, South West. The London and Yorkshire and Humber SHAs have not yet produced their schemes. An assessments of the schemes revealed a number of common weaknesses across all but two SHAs;

Failure adequately to involve external stakeholders

Failure to clearly and transparently indicate how involvement had influenced the Scheme

Failure to develop actions across the full range of the SHA functions.

Failure to show how they would use the information that they gathered.

Failure to include a methodology for conducting impact assessments of new and existing policies and practices.

3. Both reports are available from the DRC Press Office

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