Neurodiverse conditions are disabilities a request for NHS action

As a GMC  registered doctor and a retired general practitioner I wish to raise with you issues regarding the behaviour of an NHS organisation (NHS digital) with regard  to a job applicant (my son) diagnosed with autism by HCPC registered clinical psychologists.

NHS digital are denying that his autism is a disability, in his case despite receiving the Diagnostic report confirming the diagnosis, indicating clearly that it is a disability and recommending a series of adjustments need to enable him to better participate in “normal life”> He is also in direct contact with Autism Plus who support his into work process, funded by the Local Authority as part of a care plan, which again clearly indicates substantial disability.

By denying this NHS digital are causing/creating

1.    costs to the NHS in legal fees

2.    costs to the legal system

3.    costs for the disabled person in legal fees time and effort

4.    adding to delay into the legal processes and wasting court time

5.    producing distress/for all distress to the complainant

We can and will prove to the court his disability however the following reason indicate that the NHS and others should not be creating further discrimination by allowing or be involved in the denial or unnecessary questioning of disability in neuro diversity individuals for each of the following reasons:

indicates that authorities are expected to support autistic people into and at in employment.

There is therefore clear evidence that neuro diverse conditions in general and autism in particular have to be disabilities  under The Act, if correctly diagnosed.

In this case the cost of proving Autism to NHS digital is likely to be

·        In legal fees for court time and reading information requested at least £1500, more if the resultant disability continues to be questioned thereafter.

·        At least 2 hours extra court time

·        Legal fees disabled person estimated at court time and requesting and reading information and creating an impact statement from Autistic client will likely to be £2500

·        3 month plus delay in court proceedings

·        Considerable stress and anxiety for the disabled person as a result of their diagnosis being questioned – whilst people with hidden disabilities are often accustomed to their condition and needs not being recognised by the general , public, questioning of disability by the NHS can be particularly distressing.

·        A GP and 3 NHS trusts having to produce extensive SAR reports involving many hours of NHS staff time currently exceeding 2000 pages of documents.

Thus

1.    a considerable amount of time and probably in excess of £5000 of tax payers money(in this case the disabled person is on legal aid) has or will be spent on questioning a disability in person who has a diagnosis which could not be made unless disability was present.

2.    By acting in this doing brings considerable doubt in the organisation  meeting its duties under the Public Sector Equality Duty as it is disregarding  the effect on disabled persons by the action being taken ? for no good reason)

3.    It is likely that the action is discriminatory as it produces an (inadvertent ?) detriment to the disabled person of being forced to defend/upheld hold a diagnosis they have received in good faith from a HCPC or GMC (equivalent)registered professional who is required to meet certain standards .

Questioning the diagnosis without a justifiable reason is unnecessary as those making the diagnosis are bound by their professional requirements/standards.  As Michael Charles(Solicitor) explains: 

Let me explain by taking a look at some of the professional requirements of medical and health care workers.

The GMC professional standards say all medical doctors should ;-

* Work with colleagues in the ways that best serve patients’ interests.

They must be honest and open and act with integrity.

They must

* Never discriminate unfairly against patients or colleagues.

* Never abuse a patients’ trust in the doctor or the public’s trust in the profession.

Further at para 35-38 all doctors must -

* work collaboratively with colleagues, respecting their skills and contributions.-

* treat colleagues fairly and with respect.

* be aware of how behaviour may influence others within and outside the team.

The HCPC which governs other health care professionals make similar statements.

For example at para 2 it states -

"2.5 You must work in partnership with colleagues, sharing your skills, knowledge and experience where appropriate, for the benefit of service users and carers"

How does any of this correlate with the statement made? Telling medical professionals to flatly disregard the opinion of other equally qualified professionals might very well infringe professional standards. This means that management could be exposing colleagues to the potential of complaint or worse (disciplinary action).

It seems to me that a culture change is needed from root to branch within the NHS and within the thinking of local Government. If more respect is given to all professional opinion (whether or not it comes from the private sector) , we might be saving not only a fortune by avoiding disputes in the first place but critically the best interests of children will be more likely to be served.

The NHS ,legal and education systems are all under pressure I believe that it would save considerable amount of NHS, Tribunal and Education  time and money if it were made clear that a professional diagnosis should only be queried if you believe you have professional backed reason to doubt the diagnosing professionals competence in making the diagnosis.

In specific terms I would suggest

1.    That NHS professionals should not agree to reassess a professional diagnosis unless they have clinical evidence presented to them indicating a clinical need to reassess.

2.    The legal profession should be expected to accept a clinical diagnosis meeting the definition of disability such as those in ICD11 unless there is clinical evidence to justify such a challenge.

3.    Those in education accepting the diagnosis indicate disability under The Act whether or not the person is meeting academic targets.

When the NHS, in particular, challenges the diagnosis and resultant disability of people with a neurodiverse condition, it will often causes additional distress and anxiety for the person with disability, increasing a sense of alienation and further undermining belief and trust in there being a degree of understanding and support from health professionals that people with disability crave in the face of the widespread discrimination and disadvantage that they encounter.  Whenever the NHS display a lack of understanding of neurodiversity and disregard  disability, the reputation of the NHS is further undermined. When NHS staff choose or allow its appointed legal representatives to challenge diagnosis, disability or disadvantage, it causes untold damage to people with a neuro-diverse condition, contrary to what the NHS stands for or at least should stand for.

It is also counter-productive in terms of:

(1)  increasing health need by exacerbating avoidable secondary mental health consequences of living with disability and resultant disadvantage.

(2)  exclusion from recruitment of potential employees with disability who just need reasonable adjustments to enable them to contribute effectively, when the NHS desperately needs staff

(3)  risking an avalanche of claims for disability discrimination in response to accumulating case law enforcing the Equality Act, potentially resulting in huge legal costs the NHS simply cannot afford.  

This is all mostly avoidable if the NHS fully embraced its responsibilities under the Equality Act and Public Sector Equality Duty and took effective action in terms of both required disability training and in advising and supporting implementation of Equality and Diversity polices by staff across all NHS organisations. I have no doubt that there are many individuals and organisations that would willingly and positively support the NHS in transforming its approach to disability amongst current and potential staff to the benefit of all partied, they just need to be given the opportunity to do so.  

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[1] https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england

[2] why a neuro diverse diagnosis indicates disability 2022-05-12.docx

[3] autism-guidance.pdf

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/422338/autism-guidance.pdf