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SUMMARY OF PILOT GROUP FINDINGS (n=100)

Disability discrimination is common in the NHS (Tyerman, 2023). Neither the disability requirements of the UK Equality Act (EqA, 2010) nor the UN Convention on the Rights of Persons with Disabilities (UNCRPD, 2006) are covered effectively in professional training. In response, resources were developed to raise awareness, promote good practice and reduce discrimination. This includes a Disability Discrimination Awareness Questionnaire (DDAQ); 5 Disability Discrimination Practice Checklists (DDPCs); background, suggested action and reference material, hosted on website: https://equitynotjustequality.co.uk/

The natural starting point is the DDAQ (Tyerman et al. 2023). This focuses on the objectives of the UNCRPD (2006) and Equality Act (EqA, 2010) rather than legal liability. Items are taken from the Equality and Human Rights Commission statutory codes on ‘services, public functions and associations’ (EHRC, 2011b) and ‘employment’ (EHRC, 20101a) and the technical guidance on ‘further and higher education’ (EHRC, 2014). Items cover the definition of disability (7) and forms of discrimination: direct (3), indirect (4), arising from disability (2), failure to make reasonable adjustments (10), harassment/ victimisation (2) and other unlawful behaviour (2). Results for the first 100 pilot healthcare respondents in the UK are reported below.

Respondents Of all respondents, 89% were health professionals, most of whom work with people with disability on a routine basis. This was mostly OTs (27%), Psychologists (19%), Medical staff (19%), Physiotherapists (9%) and Speech & Language Therapists (6%). The other responders include other therapists, nurses, administrative staff and assistants. The respondents are mainly experienced staff: 24% > 20 yrs.; 63% > 10 yrs. and 76% > 5 yrs. Of 88 asked, 37% reported a prior reason to seek information on disability discrimination. Total DDAQ score The distribution of DDAQ scores, plotted below, has a flat / wide peak (scores 11-22).

The mean total DDAQ score was 17.76 (median 17.5, range 1-30), equivalent to just 59% awareness. In order to prevent disability discrimination, you would want health professionals to know all except perhaps two DDAQ items (12 & 16), both related to the legal justification for not making adjustments. If you allow one other gap in awareness, the target score on the DDAQ is provisionally set at 27-30 (i.e. a score of 90% or higher). The target score of 27-30 was achieved by just 11% of respondents, with 38% scoring 50% or less and 13% scoring 33% or less.

Awareness on individual DDAQ items Awareness on individual DDAQ items ranged from just 23% to 97%, with 11/30 items known by less than 50% of healthcare staff. Whilst there were many ‘partly aware’ responses (range 3-51%), these would likely not prevent discrimination. It is a major concern that 3/7 items on the definition of disability in the EqA and 4/10 on duty to make reasonable adjustments were known by less than 50% of respondents, as detailed below.

Disability definition & reasonable adjustment: summary items <50% awareness Aware Q4 Exceptions to standard disability definition for people with cancer, HIV and MS 23% Q5. A medically diagnosed cause of impairment is not required 25% Q6 Need to set aside treatment & adjustments in judging if disability covered by EqA 46% Q21 Need for risk assessment if denying work/service adjustments on grounds of H&S 39% Q22 Anticipatory nature of duty to make adjustments for service providers (e.g. NHS) 44% Q23 If co-operation of others needed, obstructive/unhelpful behaviour to be dealt with 37% Q25 Reasonable step not taken if adjustment does not reduce disadvantage 46%

Awareness self-ratings (n=100)

As illustrated in the figure below, mean ratings of prior awareness after DDAQ completion was 5.78. As a result of the DDAQ training, mean ratings rose significantly by 1.96 to 7.74 (t = 12.05, p<0.0001). This represents a 34% increase in overall awareness. This encouraging increase is also likely reduced slightly through a partial ceiling effect as both the two ratings of pre-DDAQ awareness at 10/10 and the 7 scoring 9/10 did not have a need or scope to increase in line with the mean rise of 2.16 points for other 91 respondents. The mean increase of 2.16 (5.44>7.6) for 91 staff with a need to improve awareness (i.e. score 8 or below) represents a 40% increase (up from 34% for all 100).

The increase in awareness for staff with the lowest ratings is marked: those with a rating of 5 or below reduced from 42 % to 9% and those rating 4 or below from 25% to just 1%. The mean rise of 3.13 and 3.36 represents an increase of 89% and 109% respectively.

Mean self-ratings of awareness for retrospective pre-DDAQ awareness and post DDAQ training are plotted below for all 100 respondents, for 91 excluding 9 with a likely ceiling effect and for the 42% rating their awareness before training at 5/10 or below.

Summary and conclusions The first 100 DDAQ responses from mainly experienced health professionals, most of whom work with people with disability on a routine basis, confirms a striking lack of awareness of disability discrimination. The target score was achieved by just 11% of staff, with 38% scoring 50% or less. This is of particular concern as the UNCRPD sets out additional responsibilities for healthcare staff, over and above the core requirements of the Equality Act and Public Sector Equality Duty. Gaps in awareness were most common in the definition of disability and duty to make reasonable adjustments. As such, NHS staff and Trusts are at risk of inadvertent discrimination in clinical practice and service delivery. Completing the 15-20 min. DDAQ training exercise resulted in a 34% increase in self-ratings of awareness for all respondents. This increases to 40% if the 9 highest scorers with no need and little scope to improve are excluded. For those with previous self-ratings at or below 50%, awareness rose by 89%. The extent of the rise in awareness suggests a lack of effective training on the disability requirements of the UNCRPD and Equality Act. Results from this pilot suggest that the DDAQ training significantly improves awareness of disability discrimination. The DDAQ and other resources (i.e. Disability Discrimination Practice Checklists and reference material) are available to NHS staff now at no charge. There is parallel need for the DDAQ to be completed by a large group of representative staff to check for any differences across professions, experience and work settings and consider more targeted training. This would need commitment from one or more NHS Trusts. Whilst the resources were developed initially for the NHS, it seems likely that they would be of much wider application. This warrants exploration with interested parties. In conclusion, there is an urgent need to review training on disability rights and the responsibilities of health professionals under the UNCRPD and the Equality Act. Given the difficulty in engaging NHS staff in post in the DDAQ training, this could potentially be achieved by including the DDAQ in Trust induction programmes or on internal promotion to a service or staff management role. We would then be in a much stronger position to respond to the call for urgent action to advance health equity for persons with disabilities from the WHO (2022) and the UK Equality and Human Rights Commission (EHRC, 2017). Author & contact details: Dr. Andy Tyerman, BA., MSc, PhD, CPsychol, FBPsS, BEM, Honorary Consultant Clinical Neuropsychologist [email protected] 07889-494740

References EHRC (2011a). Equality Act 2010 Employment Statutory Code of Practice. Equality and Human Rights Commission. https://www.equalityhumanrights.com/sites/default/files/employercode.pdf EHRC (2011b). Equality Act 2010: Services, public functions and associations. Statutory Code of Practice. Equality & Human Rights Commission. https://www.equalityhumanrights.com/sites/default/files/servicescode_0.pdf EHRC (2014a). Equality Act 2010: Technical Guidance on Further & Higher Education. https://www.equalityhumanrights.com/sites/default/files/equalityact2010-technicalguidance-feandhe-2015.pdf EHRC (2017). Being disabled in Britain: A journey less equal. Equality and Human Rights Commission. https://www.equalityhumanrights.com/en/publication-download/being-disabled-britain-journeyless-equal Tyerman A (2023). The WHO call for urgent action to advance health equity, set in the context of the UN Convention on the Rights of Persons with Disabilities and the Equality Act. Clinical Psychology Forum, 368: 33-42. Leicester: British Psychological Society. Download ‘CPF_368_ Andy Tyerman (pdf)’ at the bottom of web page: https://equitynotjustequality.co.uk/context Tyerman A., Tyerman P., Tyerman, E., & Tyerman, C. (2023). The Disability Discrimination Awareness Questionnaire (DDAQ). On-line resource available at: https://www.equitynotjustequality.co.uk/ddaq United Nations Convention on the Rights of Persons with Disabilities (2006). UN General Assembly Reports on Social Development. https://social.desa.un.org/issues/disability/crpd/convention-on-the-rights-of-persons-with-disabilities-crpd WHO (2022). Global report on health equity for persons with disabilities. World Health Organization. https://www.who.int/teams/noncommunicable-diseases/sensory-functions-disability-and-rehabilitation/global-report-on-health-equity-for-persons-with-disabilities