http://www.direct.gov.uk/en/DisabledPeople/RightsAndObligations/DG_4019061
Access to goods, premises and services
The Disability Discrimination Act gives disabled people important rights not to be discriminated against
- in accessing everyday goods and services like shops, cafes, banks, cinemas and places of worship
- in buying or renting land or property
- in accessing or becoming a member of a larger private club (25 or more members)
- in accessing the functions of public bodies, like the issuing of licences for example
Your rights in employment
It is unlawful for employers to discriminate against disabled people for a reason related to their disability, in all aspects of employment, unless this can be justified. Justification is only possible in certain circumstances.
Your rights in health
The Disability Discrimination Act gives disabled people rights of access to health services and social services, such as doctors' surgeries, dental surgeries and hospitals.
You also have a right to information about healthcare and social services in a format that is accessible to you where it is reasonable for the service provider to provide it in that format.
Your rights in education
The Special Educational Needs and Disability Act 2001 amended the Disability Discrimination Act 1995 (DDA) to make it unlawful for education providers to discriminate against disabled pupils, students and adult learners; and to make sure disabled people are not disadvantaged in comparison with people who are not disabled.
Mental health and your rights
Many people with a mental health condition do not think of themselves as 'disabled' - but they have rights under the Disability Discrimination Act.
The Mental Health Act 1983 covers the assessment, treatment and rights of people with a mental health condition.
The Mental Capacity Act aims to protect people with learning disabilities and mental health conditions. It provides clear guidelines for carers and professionals about who can take decisions in which situations.
Your rights - motoring and transport
Disabled people have rights of access in relation to motoring, transport and travel infrastructure, such as railway stations and airports, under the Disability Discrimination Act.
The Disability Discrimination Act also means that you have a right to information about transport - timetables, for example - in a format that is accessible to you where it is reasonable for the transport provider to provide it in that format.
PDF version http://www.direct.gov.uk/en/Disabledpeople/index.htm
http://www.equalityhumanrights.com/http://www.equalityhumanrights.com/
http://www.disabilityalliance.org/
http://direct.gov.uk/en/DisabledPeople/RightsAndObligations/DisabilityRi...
http://www.odi.gov.uk/research/research-reports.php?utm_source=Google&ut...
http://www.opsi.gov.uk/ACTS/acts1999/ukpga_19990017_en_1
Disability rights
The Disability Discrimination Act (DDA)
An introduction to the Disability Discrimination Act
Definition of 'disability'
The definition of 'disability' for the purpose of the Disability Discrimination Act
The Disability Equality Duty
The duty of public sector organisations to promote equality of opportunity
The Equality and Human Rights Commission
The commission aims to end discrimination and protect human rights
UN Convention on disability rights
The UN has set up an international human rights convention on the rights of disabled people
The Office for Disability Issues
Co-ordinating the development and delivery of services for disabled people
Your rights in health
The Mental Health Act and Mental Capacity Act
http://www.direct.gov.uk/en/DisabledPeople/RightsAndObligations/Disabili...
45,000 public bodies across Great Britain are covered by the Disability Equality Duty (DED), which came into force in December 2006. The DED is meant to ensure that all public bodies - such as central or local government, schools, health trusts or emergency services – pay ’due regard‘ to the promotion of equality for disabled people in every area of their work.
The Disability Rights Commission (DRC) produced a range of information on the duty, some of which is available to download here. The DRC closed at the end of September 2007, and was replaced in October 2007 by the Equality and Human Rights Commission. You can find more information on the duty and the work of the new Commission at: www.equalityhumanrights.com
For introductory information, including the Code of Practice, and guidance on key elements of the duty, such as involving disabled people and impact assessments, see below. The sectoral guidance page contains information written for public bodies across the different sectors. The putting the duty into practice page contains reports and assessments by the DRC on how the public sector had responded to the duty before the end of September 2007.
Research reports published by the Office for Disability Issues
- Choice and Control/Access to Goods and Services: A Rapid Evidence Assessment
- Access to independent advocacy: an evidence review
- An in-depth examination of the implementation of the Disability Equality Duty in England
- Experiences and Expectations of Disabled People
- Disability Equality Duty: compliance audit report
- Independent Living Report
- Improving Information for Disabled People
- Guidance on the Disability Equality Duty
- Guardian's Independent Living Supplement
- Implementation of the Disability Equality Duty (Executive Summary) audio version
- Advocacy services and older people's entry into care homes in England
http://www.odi.gov.uk/research/research-reports.php?utm_source=Google&ut...
Numerical list of factsheets
- Factsheet F1 - human rights act
- Factsheet F2 - disability living allowance for people with mental health problems
- Factsheet F3 - charging for community care
- Factsheet F4 - charging for residential accommodation
- Factsheet F5 - community care direct payments
- Factsheet F6 - complaining about local authority decisions
- Factsheet F7 - benefits in hospital
- Factsheet F8 - the right payment programme
- Factsheet F9 - a guide to tax credits
- Factsheet F10 - work focused interviews
- Factsheet F11 - tips for preparing for tribunals
- Factsheet F12 - pension credit
- Factsheet F13 - benefits checklist
- Factsheet F14 - prescription charges/health benefits
- Factsheet F15 - finding a local advice centre
- Factsheet F16 - the stages of a parliamentary bill
- Factsheet F17 - the motability scheme
- Factsheet F18 - trusts - effect on benefits and tax credits
- Factsheet F19 - finding the law
- Factsheet F20 - armed forces compensation scheme
- Factsheet F21 - finding information on the disability alliance website
- Factsheet F22 - attendance allowance
- Factsheet F23 - disability living allowance
- Factsheet F24 - incapacity benefit
- Factsheet F25 - incapacity benefit - the personal capability assessment test
- Factsheet F26 - list of organisations providing benefits advice
- Factsheet F27 - access to work
- Factsheet F28 - bereavement benefits
- Factsheet F29 - blue badge scheme
- Factsheet F30 - carer's allowance
- Factsheet F31 - employment and support allowance overview
- Factsheet F32 - employment and support allowance medical tests
- Factsheet F35 - work for people who are sick and disabled
- Factsheet F36 - reconsideration and appeal - the basics
- Factsheet F37 - medical evidence and appeals
- Factsheet F38 - first tier tribunal submissions
- Factsheet F39 - appealing to the upper tribunal against a first tier tribunal decision
- Factsheet F40 - child benefit and guardian's allowance
- Factsheet F41 - the social fund
- Factsheet F42 - maternity, paternity and adoption benefits
- Factsheet F43 - help with council tax
- Factsheet F44 - housing benefit
- Factsheet F45 - income support
- Factsheet F46 - jobseeker's allowance
- Factsheet F47 - child trust fund
- Factsheet F48 - education maintenance allowance and adult learning grants
- Factsheet F49 - housing grants
- Factsheet F51 - disabled facilities grants
- Factsheet F52 - help with the digital switchover
- Factsheet F53 - help with heating
- Factsheet F54 - independent living fund
- Factsheet F56 - voice risk analysis and benefit claims
- Factsheet F57 - appeal tribunal reform
- Factsheet F58 - the watersure scheme
Alphabetical list of factsheets
- access to work
- adult learning grants
- appealing to the upper tribunal against a first tier tribunal decision
- appeals - first tier tribunal submissions
- appeals - medical evidence
- appeals -reconsideration and appeal
- appeals - tips for preparing for tribunals
- appeals - tribunal reform
- armed forces compensation scheme
- attendance allowance
- benefits checklist
- bereavement benefits
- blue badge scheme
- carer's allowance
- charging for community care
- charging for residential accommodation
- child benefit and guardian's allowance
- child trust fund
- community and residential care - complaining about assessments or charges
- community care direct payments
- council tax help
- digital switchover help
- disabled facilities grants
- disabled facilities grants - complaining
- disability living allowance
- disability living allowance for people with mental health problems
- education maintenance allowance
- employment and support allowance medical tests
- employment and support allowance overview
- finding a local advice centre
- finding information on the disability alliance website
- finding the law
- heating help
- hospital benefits
- housing benefit
- housing grants
- housing grants - complaining
- human rights act
- incapacity benefit
- incapacity benefit - the personal capability assessment test
- independent living fund
- income support
- jobseeker's allowance
- maternity, paternity and adoption benefits
- motability scheme
- organisations providing benefits advice
- parliamentary bill stages
- pension credit
- prescription charges/health benefits
- right payment programme
- social fund
- tax credits guide
- trusts - effect on benefits and tax credits
- voice risk analysis and benefit claims
- watersure scheme
- work focused interviews
- work for people who are sick and disabled
http://www.disabilityalliance.org/fact.htm
Titled 'Addressing the Structural Barriers to HIV/AIDS - Stigma, Human Rights and Law Reform in the Commonwealth', the programme will support reform of the legal environment in Commonwealth countries to ensure equal access to HIV prevention, treatment and care, and thereby creating a firm basis for addressing stigma and discrimination.
The Commonwealth Foundation will be joined in partnership with the Commonwealth HIV and AIDS Action Group (CHAAG), the International HIV/AIDS Alliance (IHAA) and the Commonwealth Secretariat. Dr Mark Collins, Director of the Foundation said "In a matter as important as this we need to use the full scope and experience of all Commonwealth organisations. This is why we will engage with governments, professional networks and civil society organisations on how law reform can be used to create a more supportive environment for those living with, or at risk from, HIV and AIDS".
This announcement comes shortly after the Commonwealth Heads of Government Meeting and Commonwealth People's Forum in Port of Spain, Trinidad and Tobago, where citizens and governments alike recognised that treatment availability is falling far short of need, especially in Sub-Saharan Africa. While the Commonwealth comprises over 30% of the world's population, it contains over 60% of people living with HIV and AIDS, many of them women and children. Inadequate legal frameworks compounded with insufficient awareness and education programmes mean that stigma and lack of treatment remain widespread and many people with HIV experience violence, eviction and loss of employment.
In Port of Spain the Commonwealth People's Forum drew attention to widespread practices and laws in the Commonwealth that discriminate against people living with HIV and AIDS, as well as against vulnerable groups. They called for development of comprehensive policy and legislative instruments to address stigma and discrimination. "The values and principles of the Commonwealth, reiterated by the Heads of Government in Port of Spain, are clear in calling for equality, respect and rights for all, without discrimination on any grounds" said Dr Collins, adding "These principles apply as much to those living with HIV and AIDS as to anyone else. We cannot defeat this pandemic if we drive it underground".
The programme presents an exciting opportunity for the Foundation to build on its HIV and AIDS support. This project and previous support to civil society networks addressing the pandemic at grass roots level, sees the Foundation's contribution to HIV and AIDS work climb to over £400,000 in the past three years. The Foundation also hopes to help networks strengthen their governance structures and become accredited to the Commonwealth so that they can participate in the full range of Commonwealth processes that can contribute towards halting the HIV/AIDS pandemic. The Foundation's grants programme is another means by which support to HIV and AIDS projects can be directed at a community level.
http://www.commonwealthfoundation.com/uploads/documents/Addressing%20the...
http://www.commonwealthfoundation.com/sustainabledev/hiv/Universal%20Acc...
The continuous development of new and improved medical treatment both for HIV and the illnesses associated with it, has led to major changes in the pattern of HIV disease progression which people in the UK and similar countries can expect to experience.
First of all, doctors have become very skilled at treating some AIDS-defining illnesses. For example, the AIDS-defining pneumonia, PCP, was often fatal in the very early days of the HIV epidemic. Now, doctors are able to treat it and people who have had it go on to live healthy lives for many years afterwards.
What’s more, doctors know how to prevent many infections from occurring in the first place. Once your immune system becomes damaged to such an extent that you are vulnerable to certain infections, it is possible to take medicines to prevent these developing. This is called prophylaxis. It’s considered in more detail in the section Symptoms and illnesses.
However, the biggest improvement of all came in the mid-1990s, when effective treatment that targets HIV itself became available. This antiretroviral treatment has led to very substantial reductions in the numbers of people dying of HIV or becoming ill because of HIV in the UK and othef countries. Use of antiretroviral drugs has been shown to prevent peoples' immune systems from becoming weakened by HIV. What’s more, antiretroviral therapy has also been shown to work for many people with advanced HIV disease, including people with AIDS, for many of whom anti-HIV drugs have brought about a remarkable recovery in health.
It's also worth noting that there have been further significant improvements in HIV treatment since the mid-1990s with anti-HIV drugs becoming available that are more powerful, easier to take and less likely to cause side-effects than those used even five years ago. What's more, many promising new HIV drugs are in development. Treatments for HIV are considered in a lot more detail in the section HIV treatment.
How long will I live? - Prognosis
The prognosis, or life expectancy, for people with HIV has changed dramatically since the first cases of AIDS were diagnosed in the early 1980s. In those early days, it was thought that most people would die within a few months of first being diagnosed with the condition. This changed, partly because it was recognised that HIV was the cause of AIDS and that it took many years to gradually destroy the immune system, and partly because doctors gradually learnt more about recognising and treating infections and cancers commonly seen in people with HIV. By the mid-1990s (before the introduction of effective HIV treatment), it was thought that in rich countries such as the UK, it would take between eight and 15 years (on average) after infection with the virus for HIV to cause life-threatening illness or death.
But this has changed significantly because of effective HIV treatment. Many doctors now believe that, provided a person with HIV receives effective HIV treatment before their immune system has been severely damaged by the virus, and if they take their drugs properly and can tolerate them, they could live a more or less normal life span. Indeed, doctors now think that with the right treatment and care, many people with HIV will be able to live into their 70s - that's a more or less normal life-expectancy. Some doctors are even more optimistic and think that newer, more powerful and less toxic anti-HIV drugs, will mean that people with HIV will be able to live a completely normal life span.
That's not to deny that people with HIV still become ill. Indeed, a few hundred HIV-positive people a year die in the UK, many as a direct consequence of their HIV infection. But these deaths often involve people who are diagnosed with HIV late in the disease process, when their immune system is already severely damaged. Furthermore, much of the serious illness seen in people with HIV in the UK now is no longer directly caused by HIV itself.
Research into the prognosis of people starting HIV treatment indicates that the risk of becoming very ill or dying because of HIV within the next five years is linked to five key factors: having a CD4 count below 200 or a viral load above 100,000 at the time of starting treatment; being aged over 50; being an injecting drug user; or having had a prior AIDS-defining illness.
For a long time the UK treatment guidelines recommended that patients should start HIV treatment once their CD4 count fell below 200, which is an indication that HIV has damaged the immune system to such an extent that it becomes vulnerable to serious illness. In 2008, this recommendation was changed so that people are now advised to start treatment sooner, when their CD4 cell count is around 350. Better results and less illness are seen in people who start treatment at CD4 cell counts around 350. It is also strongly recommended that you start anti-HIV drugs if you become ill because of HIV. Starting treatment in these circumstances has been shown to improve prognosis compared to delaying treatment until later.
You can find out more about when to start HIV treatments in the section HIV treatment.
Some non-AIDS-related illnesses are seen more frequently in people with HIV than in the general population. These include liver disease caused by hepatitis viruses B or C; heart disease; and certain cancers. Treating HIV has been shown to reduce the risk of some of these illnesses which is why you are recommended to start HIV treatment when your CD4 cell count is around 350. Many people with HIV, however, develop depression or their treatment causes side-effects. Treatments for depression work well in people with HIV and it's nearly always possible to do something about side-effects. There’s more information on hepatitis B and C in the section on Symptoms and illnesses, and depression is considered in a lot more detail in the section on Mental and emotional wellbeing. The section Side-effects provides a lot more information about these.
Obviously, there are many other causes of ill health apart from HIV, and so more general health advice (such as stopping smoking, taking regular exercise, eating a balanced diet) is also relevant to people with HIV. To find out more about these issues, read the section Daily health issues, Exercise and Nutrition and HIV.
http://www.namlife.org/cms1254901.aspx
Disability discrimination
This information applies to England, Wales, Scotland and Northern Ireland
- Discrimination because of disability
- What is disability
- Disability discrimination at work
- Access to goods, facilities and services
- Discrimination when buying or renting property
- Discrimination in education
- Access to public transport
- Further help
http://www.adviceguide.org.uk/index/your_rights/civil_rights/disability_...
The National Assistance Act and other community care legislation (revised 21.04.09)
Under section 21 of the National Assistance Act 1948 local authorities have had a duty for many years to support those who have a local connection with their area who are in need of accommodation and services by reason of age, disability or some other substantial reason.
This duty was amended in 2002 so that it is not owed in situations where someone is in the UK as an illegal entrant (other than an asylum seeker with a current claim) or is in breach of removal directions.
There is other community care legislation of which asylum seekers may take advantage without reference to their status, whether that be treatment, adaptations, disability bus passes etc. The assessment of care needs is of necessity quite complex and one should obtain the advice of an experienced advisor in this area, as well as looking at sources such as the LAGSupport for Asylum Seekers book.
What is the criteria for help?
Following the decision in the R(M) v Slough case in 2008, a local authority may only help destitute applicants who are in need of care and attention that will be provided in the accommodation they supply. This replaces the previous ('destitution plus') test.
The care and attention means the applicant has a need to be 'looked after' - for instance they need regular care or supervision in order to avoid coming to harm. Each case needs to be assessed individually but it can cover both mental health problems where an individual may need regular visits from a psychiatric social worker or CPN, as well as a physical disability where someone might need a carer or nurse to visit to help in connection with their bodily functions or to enable them to cook etc.
Social Services should assess in each case - if you have difficulty getting them to assess the applicant use the letter in the downloads section or the Asylum Support Appeals Project pro forma letter.
Pre-decision Asylum Seekers
The position for pre-decision asylum seekers is best outlined in the 'Support for Asylum Seekers' guide produced by the Legal Action Group - LAG.
Additionally, UKBA Asylum Policy Bulletin 82 has examples of cases that still ought to be the responsibility of local authorities under the community care legislation, even if the asylum seeker is currently receiving UKBA Asylum Support payments
Failed Asylum Seekers
Failed asylum seekers who have exhausted their appeal rights are excluded from UKBA Asylum Support payments support. They are also excluded from entitlements to be supported and accommodated under the National Assistance Act if:
a. they are failing to comply with removal directions; or
b. they have entered the UK unlawfully (typically where they did not claim asylum upon arrival
except where it is necessary to avoid a breach of their human rights - in particular freedom from inhuman and degrading treatment.
The position in relation to UKBA Asylum Support payments is complicated. This is because failed asylum seekers may only apply for section 4 support in very limited circumstances:
- If they have agreed to return voluntarily to their home country and are taking all necessary steps to do so
- If they are unfit to travel - this means unfit to get on the plane (and not that they would not get treatment abroad or ought to stay to get treatment in the UK) e.g. in the latter stages of pregnancy
- If the Home Secretary declares that there is no safe route of return to the country to which the asylum seeker would be returned
- Where the asylum seeker is mounting a challenge to the decision by way of judicial review
- If support is necessary to avoid a breach of the asylum seeker's human rights. Again, this is most likely to occur when it would cause inhuman or degrading treatment for the asylum seeker to be destitute. The problem is that, except where the asylum seeker has got a credible fresh claim for asylum,UKBA may successfully argue that it is not causing the inhuman treatment because the asylum seeker may get support by agreeing to return home voluntarily.
Thus, two issues arise in relation to community care support:
- Can the local authority also refuse support on the basis that destitution (and a breach of human rights) can be avoided by the failed asylum seeker agreeing to return home and thus getting section 4 support?
- Can UKBA avoid supporting a failed asylum seeker under section 4 where they have a community care need such that the local authority is obliged to support them?
Can NAA support be refused to illegal entrants and overstayers?
In effect, yes, because of the 2002 Act provisions. However:
a. failed asylum seekers who claimed at the port of entry and are on temporary admission are arguably lawfully present in the UK, and thus may not be excluded by these provisions; or
b. it may be a breach of the human rights of a failed asylum seeker who would otherwise have a need for NAA support to be left destitute - even more so because of illness, age or disability; but
c. The destitution may arise only because the failed asylum seeker is failing to avail themselves of other support that could alleviate their destitution by failing to agree to return to their own country (i.e. section 4 support) ; BUT
d. even in those cases there may be cases where the extent of the disability etc is such that support should not be refused on article 3 grounds because it is one which, in case law, is such that in a civilised society it cannot be resisted.
Can NAA support be refused if section 4 support may be available?
This raises the same issue about primacy of legislation that was also raised in the Westminster CC decision in relation to conventional section 95 support.
This matter has already been settled in fact by the case of R(AW) -v- Croydon (see below), which stated that the Asylum Support Regulations allow support to be refused where some other means of support are available and this would include community care under the National Assistance Act.
However, a recent case regarding a failed asylum seeker, who was a pregnant women, indicated that UKBA may be the best people to decide through section 4 applications whether a new asylum claim is manifestly unfounded, and in these circumstances the council was able to refuse the application for NAA support where section 4 support was provided. The same case also decided that a pregnant womean was not necessarily someone who needed 'care and attention'.
The other issue related to this is whether the same arguments apply in relation to a breach of human rights arising only where the asylum seeker is failing to avail themselves of other support, particularly by failing to agree to return to their own country. Again similar considerations as in section 4 cases may arise, such as the ability to travel, whether this argument is reasonable where they have a fresh case and so on.
- R (M) v Slough
- George House Trust report on Slough v M case
- Slough v M
- Care and Health Law report on R (AW) v Croydon - full text at http://www.hmcourts-service.gov.uk/judgmentsfiles/j3681/aw_v_croydon_1205.htm
http://www.nrcentre.org.uk/index.php?view=category&id=43:national-assist...
1. National Assistance Act 1948
2. National Assistance (Amendment) Act 1951
3. Health Services and Public Health Act 1968
4. Chronically Sick and Disabled Persons Act 1970
5. Local Authority Social Services Act 1970
6. Health and Social Services and Social Security Adjudications Act 1983
7. Mental Health Act 1983
8. Disabled Persons (Services, Consultation and Representation) Act 1986
9. Children Act 1989
10. NHS and Community Care Act 1990
11. The Carers (Recognition and Services) Act 1995
12. Community Care (Direct Payments) Act 1996
13. Housing Act 1996
14. Housing Grants, Construction and Regeneration Act 1996
15. Community Care (Residential Accommodation) Act 1998
16. Health Act 1999
17. Human Rights Act 1998
18. Immigration and Asylum Act 1999
19. Carers and Disabled Children Act 2000
20. Care Standards Act 2000
21. Local Government Act 1972
22. Local Government Act 2000
23. Nationality, Immigration and Asylum Act 2002
24. Local Government Act 2003
25. Health and Social Care Act 2001
26. Community Care (Delayed Discharges) Act 2003
27. Health and Social Care (Community and Health Standards) Act 2003
28. Carers (Equal Opportunities) Act 2004
29. Children Act 2004
30. Disability Discrimination Act 2005
31. Mental Capacity Act 2005
32. Commissioner for Older People (
33. NHS Act 2006
34. NHS (
35. Safeguarding Vulnerable Groups Act 2006
36. The Local Government and Public Involvement in Health Act 2007
37. Mental Health Act 2007
38. Health and Social Care Act 2008
39. Autism Act 2009
http://www.opsi.gov.uk/acts.htm to access Acts of Parliament
With Thanks to the Law Commission
In brief
- With increasing emphasis being placed on the role of the internet in helping people to make informed choices about their health care, this project explores whether or not comparative hospital data helps patients to make better choices.
- The project, a joint venture between The King’s Fund and experts in decision making at the London School of Economics and the IESE Business School, seeks to inform the development of public- and patient-facing websites that present comparative information about quality and performance.
- The project will make recommendations about how comparative quality information can best be presented to ensure that it is clear and accessible to all, regardless of levels of education, literacy and/or numeracy, and to maximise the role that quality information can play in decision making.
- We examine how patients use comparative performance information and which factors are important to them when choosing a hospital. We also assess how comparative performance information is presented and how this presentation affects decision making.
- The final report will provide commentary and recommendations for policy-makers and those designing online comparative quality information. The report will be published in summer 2010.
http://www.kingsfund.org.uk/current_projects/informed_choice/
In brief
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Patient choice is a key part of the government’s programme of reforms to improve the quality and efficiency of the NHS in England. Since April 2008, all patients referred by their GP for a non-urgent hospital appointment have had the choice to be treated at any NHS hospital or registered independent sector provider listed in a national directory of services. Patients have had a more limited choice of hospital since January 2006.
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The King’s Fund is working with the Picker Institute, RAND Europe and Nancy Devlin at the Office of Health Economics to examine the implementation of patient choice policy and its impact on the quality of services in the NHS. This project is funded by the Department of Health as part of its Policy Research Programme.
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Field work has been conducted in four local health economies in England and includes interviews with patients, GPs and senior staff in NHS and independent sector provider organisations, as well as a questionnaire sent to patients recently referred for treatment (early findings from which have been published in Choice at the point of referral: Early results of a patient survey).
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A final report from this project will be published in spring 2010.
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http://www.kingsfund.org.uk/current_projects/patient_choice/
Key points
- Lord Darzi's NHS Next Stage Review defines quality in three parts: clinical effectiveness, safety and patient experience. It urges the NHS to ensure that its focus on quality covers all three elements.
- Gathering better information on quality is at the centre of Lord Darzi’s vision for improving quality. In the NHS Next Stage Review he announced extensive plans to measure systematically and publish information about the quality of care on the front line. It is hoped this wealth of new data will allow patients to make informed choices about their care, allow clinicians to benchmark their practice and improve their performance, and allow commissioners to buy services based on quality.
- A national set of comparative quality measures or metrics – measuring things like mortality and survival as well as complication rates – will be developed across all services. The quality indicators for acute care are being developed at the moment and will be followed by similar indicators for community and primary care services. Data will also be available on ‘clinical dashboards’ – that is, simple, easily accessible graphic representations of the performance of a trust or department.
- New patient-reported outcome measures (PROMS) will provide detailed feedback from patients on their experience following a procedure, on measures ranging from mobility and pain to mental health and overall health. The first set of PROMS – covering hip and knee replacements, hernias and varicose veins – should be available in 2010.
- NHS trusts and provider organisations will in future be expected to publish annual ‘quality accounts’ similar to their financial accounts. These accounts are intended to improve public accountability and increase boards' focus on quality.
- Each strategic health authority (SHA) will develop Quality Observatories to allow local benchmarking and to help staff to use the information on quality to provide innovative and improved services.
- A National Quality Board will oversee the work of improving quality metrics and will advise the Secretary of State as well as reporting on progress on the quality agenda and leading change across the NHS. Its first annual quality report will be in June 2009.
- That patients will be able to choose based on information on quality is another lever for change. Under Darzi’s proposals patients will have a number of rights, including choice of GP, hospital and form of treatment, enshrined in the new NHS Constitution currently being considered by parliament as part of the Health Bill. It is hoped this increased consumer power – combined with other policies such as Payment by Results, where money follows the patient, and the availability of a wider range of providers – will complete the shift from centrally issued targets to market-style incentives that will automatically drive up quality.
- Commissioning is also critical to making the focus on quality a reality. The world class commissioning strategy, launched in December 2007, provides a means of measuring whether primary care trusts (PCTs) are delivering improved health outcomes for their population. It is overseen by the SHAs, whose role is to manage the performance of PCTs and ensure that the quality of care remains at the heart of commissioning decisions. The NHS Next Stage Review will also introduce new mechanisms to allow commissioners to reward for quality, such as the Commissioning for Quality and Innovation system (CQUIN) and the introduction of best practice tariffs.
- NICE (now the National Institute for Health and Clinical Excellence) has a new role in assuring quality. It will clarify, set and approve more independent quality standards and publish information for clinicians on these standards through a new service, NHS Evidence.
- The new independent Care Quality Commission, which began work on 1 April 2009, brings together three previous inspection bodies – the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission. Improving quality as well as regulating for safety and ensuring minimum standards is a central part of its mission. It will have greater powers than its predecessors, including the right to close down organisations and make unannounced spot checks. And for the first time all health care as well as social care providers will have to be registered to ensure common standards of quality and safety.
- It is not clear how much the changes put forward in the Darzi reforms will cost and whether, given the economic recession and the probability of a much-reduced health care budget in future years, they will all be affordable. It may also be increasingly challenging for boards to focus on improving quality when under extreme financial pressure. However, an increased focus on quality does not necessarily mean increased costs. Indeed, much quality improvement could in fact improve productivity and save money.
http://www.kingsfund.org.uk/topics/quality_of_care/index.html
Summary
The government is committed to improving the quality of care, and as part of this commitment they aim to make more information available to the public about the performance of trusts. Providers of NHS services are now required to publish quality accounts – reports for the public on the quality of the services they provide. Quality accounts aim to:
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increase NHS accountability by making more information about quality available to the public
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encourage boards (or the equivalent senior management) to focus more on quality improvement.
Accounting for quality to the local communityassesses how far current plans for quality accounts meet the first of those objectives. It outlines the conclusions of focus groups that were conducted with local community representatives, such as members of local involvement networks (LINks) and health overview and scrutiny committees (HOSCs), and with members and governors of foundation trusts.
Quality accounts provide a real opportunity to increase public accountability on quality. The discussions emphasise that providers should not simply fulfil the letter of the policy, but should take this opportunity to meet the far more difficult challenge of embracing the spirit of quality accounts. Thispaper argues that providers should look at quality accounts as a year-round process and should seek input from their local community from the outset.
But there are clear challenges for all groups involved in the quality accounts process. While local community groups should be involved as early as possible in the process, there is a risk that the work this entails will put them under pressure. Providers and local community representatives need to work together to determine a desirable level of involvement.
Participants in the focus groups also emphasised the importance of the information provided to the public being robust, honest and presented in a readable way. Quality accounts will fail if they are not trusted by those who it is hoped will use them.
The paper includes recommendations for: policy-makers, providers and commissioners, and local community representatives.
http://www.kingsfund.org.uk/publications/quality_accounts.html
As we wait to hear who will govern the UK, the charity National Voices calls on the new government to put patients and families at the heart of decisions around health and social care.
In this time of uncertainty some things are already clear and National Voices – a coalition of 200 heath and care charities - outlines the issues that must be addressed:
Politicians need to be honest about the scale of the financial challenge in the NHS and what it will mean for services.
We need a new way for communities to be involved in local service change. Existing mechanisms don’t work and waste money. They can lead to poor decisions and public disaffection.
Patients, carers and families need to have much greater control over decisions about their own care – we can no longer afford the old paternalist model.
Reform of social care for elderly and disabled people must not be kicked into the long grass. The unfairness and confusion in the current system must be tackled with a sense of urgency.
Jeremy Taylor, chief executive of National Voices, says: “Now the election is over, the challenges facing health and social care must be tackled with urgency. National Voices looks forward to working with the new government to put people at the heart of health and social care.”
http://www.nationalvoices.org.uk/patients-hold-the-key-to-nhs-solutions
This page provides a round-up of all the equality and diversity legislation that public bodies must be aware of, plus external links to the full legal texts.
Civil Partnerships Act 2004:
Provides legal recognition and parity of treatment for same-sex couples and married couples, including employment benefits and pension rights.
Access the Civil Partnerships Act 2004 at the website of the Office of Public Sector Information
Disability Discrimination Act 1995
Outlaws the discrimination of disabled people in employment, the provision of goods, facilities and services or the administration or management of premises.
Access the Disability Discrimination Act 1995 at the Office of Public Sector Information (OPSI) website
Disability Discrimination Amendment Act 2005
Introduces a positive duty on public bodies to promote equality for disabled people.
Access the Disability Discrimination Act 2005 at the OPSI website
Employment Equality (Age) Regulation 2006
Protects against discrimination on grounds of age in employment and vocational training. Prohibits direct and indirect discrimination, victimisation, harassment and instructions to discriminate.
Access the Employment (Age) Regulation 2006 at the OPSI website
Employment Equality (Religion or Belief) Regulation 2003
The directive protects against discrimination on the grounds of religion and belief in employment, vocational training, promotion and working conditions.
Access the Employment Equality (Religion or Belief) Regulation 2003 at the OPSI website
The Employment Equality (Sex Discrimination) Regulations 2005
Introduces new definitions of indirect discrimination and harassment, explicitly prohibits discrimination on the grounds of pregnancy or maternity leave, sets out the extent to which it is discriminatory to pay a woman less than she would otherwise have been paid due to pregnancy or maternity issues.
Access the Employment Equality (Sex Discrimination) Regulations 2005 at the OPSI website
Employment Equality (Sexual Orientation) Regulation 2003
The directive protects against discrimination on the grounds of sexual orientation in employment, vocational training, promotion, and working conditions.
Access the Employment Equality (sexual orientations) Regulation 2003 at the OPSI website
Equal Pay Act 1970 (Amended)
This gives an individual a right to the same contractual pay and benefits as a person of the opposite sex in the same employment, where the man and the woman are doing: like work; work rated as equivalent under an analytical job evaluation study; or work that is proved to be of equal value.
Access the Equal Pay Act (Amendment) 1970 at the OPSI website
Equality Act 2006
Establishes a single Commission for Equality and Human Rights by 2007 that replaces the three existing commissions. Introduces a positive duty on public sector bodies to promote equality of opportunity between women and men and eliminate sex discrimination. Protects access discrimination on the grounds of religion or belief in terms of access to good facilities and services.
Access the Equality Act 2006 at the OPSI website
Further information at the Women and Equality Unit website
Gender Recognition Act 2004
The purpose of the Act is to provide transsexual people with legal recognition in their acquired gender. Legal recognition follows from the issue of a full gender recognition certificate by a gender recognition panel.
Access the Gender Recognition Act 2004 at the OPSI website
Race Relations Act 1976
The Act prohibits discrimination on racial grounds in the areas of employment, education, and the provision of goods, facilities, services and premises.
Further information at the Equality and Human Rights Commission (EHRC) website.
Race Relations Amendment Act 2000
Places a statutory duty on all public bodies to promote equal opportunity, eliminate racial discrimination and promote good relations between different racial groups.
Access the Race Relations Amendment Act 2000 at the OPSI website
Race Relations Act 1976 (Amendment) Regulation 2003
Introduced new definitions of indirect discrimination and harassment, new burden of proof requirements, continuing protection after employment ceases, new exemption for a determinate job requirement and the removal of certain other exemptions.
Access the Race Relations Act 1976 (Amendment) 2003 at the OPSI website
Racial and Religious Hatred Act 2006
The Act seeks to stop people from intentionally using threatening words or behaviour to stir up hatred against somebody because of what they believe.
Access the Racial and Religious Hatred Act 2006 at the OPSI website
Sex Discrimination Act 1975
The Act makes it unlawful to discriminate on the grounds of sex. Sex discrimination is unlawful in employment, education, advertising or when providing housing, goods, services or facilities. It is unlawful to discriminate because someone is married, in employment or advertisements for jobs.
Access the Sex Discrimination Act 1975 at the Press for Change website
The Sex Discrimination (Gender Reassignment) Regulations 1999
The Act seeks to prevent sex discrimination relating to gender reassignment. It clarified the law for transsexual people in relation to equal pay and treatment in employment and training.
Access the Sex Discrimination (Gender Reassignment) Regulations 1999 at the Press for Change website
Rights for people with MS, cancer or HIV
The rules about who is protected against unfair treatment under the DDA are very complicated. Some people with cancer, HIV and MS have had problems in the past showing that they are protected under the DDA. There have always been special rules for people with ‘progressive conditions’ such as these, but following changes to the law in 2005, they are now simpler and clearer. Anyone with cancer, MS or HIV is now protected against unfair treatment in the workplace, education, housing or in accessing services from the point of diagnosis. It doesn’t matter whether you have any symptoms.
These changes have been made in recognition of the stigma that is often associated with a diagnosis of these conditions. The rules apply to all forms of cancer, regardless of whether or not they involve substantial treatment.
If you are treated unfairly because of a past disability – for example because you had cancer in the past – you are also protected under the DDA.
Rights for people with mental health conditions
If you have a mental health problem, you no longer have to show you have a ‘clinically well recognised’ condition to qualify for protection under the DDA, although you do have to meet other conditions.
Lots of other people are protected under the DDA. If you have a different disability or health problem that affects your everyday life, a lot of the information here will be helpful to you.
People who have had a disability in the past
No one should discriminate against you unlawfully because of a past (or current) disability.
If you have had a disability (as defined in the DDA) and someone, such as an employer, treats you unfairly as a result of this, then you will still be protected by the DDA, even if you have now recovered.
Example
Saira had clinical depression for two years after the birth of her child. She applied for a job as a senior HR manager. On the medical questionnaire, she declared the period of depression and stated truthfully that this had occurred four years previously. After being offered the job subject to references and medical clearance, the offer was withdrawn. On questioning, the employer said that the job was ‘high pressure’ and they were concerned that it might cause a recurrence of her condition.
This is discrimination against Saira because of her past disability, and the employer may be liable to legal action under the DDA.
Do I have to declare my condition or disability?
The DDA does not require you to tell anyone. But if you don’t tell your employer, for example, they won’t be able to make any ‘reasonable adjustments’ you require. It’s probably best to let them know at the outset – such as once you have accepted a job, because if they find out later, by accident, it could affect your working relationship with them. We know this can be worrying – we are encouraging employers to be positive about disability so people feel more comfortable disclosing a health condition or impairment.
There are some advantages to disclosure. Say you apply for a college course and you tell the institution about your condition on the application form. From that point on, they should bear that in mind – for example, if they ask you for interview they should ask you if you need any reasonable adjustments to get to and take part in the interview. If they don’t make any adjustments and you make a complaint about this, they can’t use the excuse of ignorance.
Declaring a disability can sometimes be difficult for many different reasons:
- you feel you will not get a job if you say you have a disability
- no one can see the condition that affects you and you feel embarrassed about bringing it up
- you may be worried about how an employer will respond, particularly if they have not been sympathetic to someone else in a similar situation
- you may not like asking for help because you feel you can manage or because you don’t want a fuss
- you think your manager will tell you to get on with it or tell you ‘everyone has difficulties and they cope’
- you are afraid you might lose your job because your boss will see you as ‘less able’.
All of these and many more may be real fears. But it is important to remember that statistics show that disability is increasingly common: one in four people either has a disability or health condition, or is close to someone who does.
When should I tell my employer about my disability?
It’s up to you whether or not to declare your disability or health condition to your employer, although not everyone has the choice. If you do decide to declare it, you can do so at any of the following stages:
- on an application form or CV
- before or at an interview
- when you have been offered a job
- when you start a job
- later, when you are in work.
For the most part, it is best to be honest in work about your health or disability and what you need. Sometimes problems are created if this is a no-go area. Many people have experience directly, or through their family, of health conditions and disability. You can talk to your employer when the time seems right – perhaps once you have a job offer or during a regular review, if you are in work and your health condition or disability begins to have a bigger effect on you.
Should I tell the school about my child’s disability?
Yes, it may be the best thing to do. If you decide not to tell, and your child is discriminated against, the school may be able to claim in its defence that it did not know about the disability. Schools are advised to ask if your child has a disability when he or she starts school.
http://www.equalityhumanrights.com/your-rights/disability/the-law-about-...
This topic also refer to. http://benefits.tcell.org.uk/forums/your-rights-entitlements
We are responsible in government for upholding justice, rights and democracy.
http://www.dca.gov.uk/