Disability discrimination - responsibilities of dentists as service

providers
 Disability discrimination - responsibilities of dentists as service providers

Disability discrimination rules (now codified in Contents

the Equality Act 2010) were introduced to tackle
discrimination faced by those with disabilities. It is 3 Definition of disability
unlawful to treat a disabled person less favourably
for a reason related to their disability (unless it can 3 Duty on service providers
be objectively justified).

Everyone providing services, regardless of size, 4 Reasonable adjustments

must follow the requirements of the Equality Act. Access audits
Dentists are included because they provide health ‘Reasonable’
services. This advice covers your responsibilities New buildings and refurbishments
towards patients and the public at large. Related
provisions also relate to the duties towards 5 Planning permission
employees (see BDA advice Equality and diversity
in the workplace).
5 Leases

5 Further information

© BDA July 2013


Definition of disability
Only a person with a disability can claim that you have
failed to make a reasonable adjustment. The legal
definition of a person with a disability is ‘…if they have
a physical or mental impairment which has a substantial
and long term adverse effect on their ability to carry out
normal day-to-day activities.’ Such impairments include:
• Blindness
• Deafness
• An amputated limb
• Severe disfigurement
• A mobility impairment that requires the use of a
wheelchair
• A severe long-term medical condition such as
epilepsy, insulin-dependent diabetes or chronic
fatigue syndrome
• HIV, cancer or multiple sclerosis from the time it was
diagnosed
• Mental illness, although clinical recognition is not
essential for this to be a valid impairment.
The definition excludes:
• Alcohol, nicotine and substance addiction (unless
the addiction results from the substance being
prescribed)
• Tendency to set fires, steal, inflict physical or sexual
abuse on others, exhibitionism or voyeurism
• Hay fever, asthma and migraine (unless it aggravates
another condition).
• Tattoos and non-medical body piercing.
It may not be immediately obvious whether a person
falls within the legal definition of a disabled person. The
following are examples of impairments that may or may
not fall within the definition:
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Disability discrimination - responsibilities of dentists as service providers
• Partial sight
• Impaired hearing (uses a hearing aid, for example)
• Impaired mobility (resulting from arthritis, for
example)
• Learning difficulties
• A disfigurement
• A frail, elderly person.
To establish whether someone is protected by the
disability discrimination rules you should consider
whether their impairment substantially affects one or
more of the following:
• Mobility
• Ability to lift, carry or move ordinary objects
• Manual dexterity
• Physical co-ordination
• Continence
• Speech, hearing or eyesight
• Memory or the ability to concentrate, learn or
understand
• Recognising the risk of physical danger
• In the case of a severe disfigurement, a person is not
required to prove that the disfigurement affects the
ability to carry out normal day-to-day activities
Generally it should be a condition that will last (or is
likely to last) for at least 12 months.
Duty on service providers
As a provider of services, you have a duty to ensure that
the standard of service offered to a disabled person
is, as far as is reasonably practicable, the same as that
offered to non-disabled people. Achieving equality for
disabled people may mean changing the way in which
you deliver your service, providing extra equipment
and/or removing physical barriers; you have a duty to
make reasonable adjustments. Consider:
• Amending policies, procedures or practices that
make it impossible or unreasonably difficult for
disabled people to use of your services. For example,
amend a ‘no dogs’ policy to permit guide dogs.
• Providing auxiliary aids or services. For example,
providing an audio version of your practice
information leaflet for visually impaired patients
or installing a hearing-aid induction loop system
for patients with hearing difficulties. An auxiliary
service may be a sign-language interpreter for a deaf
patient.
• Making reasonable adjustments to your premises to
make it possible or easier for disabled people to use
your services. For example, installing a ramp may
make it easier for wheelchair users to access your
premises.
© BDA July 2013

Reasonable adjustments
If you find that there are barriers to disabled people
using your services, you must consider making
adjustments. If the adjustments are reasonable for
you to make, you must make them. You cannot wait
until a disabled person wants to use your services; you
must anticipate what disabled people with a range of
impairments might reasonably need – for example, a
visual, hearing or mobility impairment or a learning
disability.
There are possibly many alterations that you could carry
out to make your premises more accessible. In addition
to access ramps for wheelchair users, you could
consider widening a doorway, relocating light switches
or adding hand rails. Some reasonable adjustments may
not be obvious, so consider seeking expert help.
Access audits
An access audit involves a thorough site inspection
to identify access problems. The report of the audit
should make recommendations for improving access
and suggest how; alterations can be cost-effective and
planned over time. The report also provides you with
evidence of your intentions, should you be challenged
on a particular aspect of accessibility.
Your access audit should be carried out by a properly
qualified surveyor who has up-to-date knowledge
of construction and is familiar with the appropriate
building regulations as well as disability issues. The
independent National Register of Access Consultants
provides details of consultants who can carry out a
professional audit of your premises.
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Disability discrimination - responsibilities of dentists as service providers
‘Reasonable’
Many of the adjustments you can make will not be
particularly expensive, and you are not required to
do more than it is reasonable for you to do. What is
reasonable for you to do depends on the size of your
business and your resources (among other factors).
Your professional access audit proves that you have
sought professional advice to identify the issues and
considered what adjustments you need to make. You
must also be able to show that you have acted on the
advice or have a plan in place for when you will act
upon it.
You should consider:
• The effectiveness of the adjustment
• Whether the adjustment is feasible
• The time and effort involved in making the
adjustment
• What effect not making the adjustment would have
on a disabled person’s ability to access your services
• The financial and other costs of making the
adjustment (in absolute terms and in relation to
your size and resources as a service provider)
• The amount you have spent already in making
reasonable adjustments
• Whether the costs can be passed on to all service
users; disabled users alone should not bear the costs
of adjustments
• The disruption that would be caused.
If you decide against making an adjustment, you may
need to justify your decision if someone claims that
your premises are not accessible. Ultimately this would
be decided by the courts and you would need to show
that you have made all the adjustments that were
reasonably practicable and that you have objective
reasons for not making the adjustment complained
about. Your reasons could include onerous cost,
the effect on other service users and whether the
adjustment is necessary to provide the service. The
courts would assess whether it was unreasonably
difficult for the disabled person to use the service; time,
inconvenience, effort or discomfort entailed in using
the service would be considered.
Other patients without a disability may also benefit
from adjustments to the practice – easy-to-use door
handles and handrails may be appreciated by older
patients, ramps will make access easier for parents
pushing prams or buggies, or people using walking
frames or aids
New buildings and refurbishments
Your obligations to consider access are greater if
you are constructing a new building, putting up an
extension or undertaking a refurbishment. Building
regulations require reasonable provision to be made
to allow disabled people access to and use of non-
domestic buildings. If you are carrying out construction
works, you will be expected to incorporate features to
make your premises accessible or take steps to remove
or alter an existing physical feature that makes access
unreasonably difficult or impossible for disabled people.
Reasonable provision of toilets that are accessible to
disabled people is required.
Discuss the building regulations’ requirements with
your architect and builder; you should also liaise with
your local planning department.
© BDA July 2013

Planning permission
Reasonable adjustments are likely to involve physical
changes to your premises and you may need to obtain
planning permission, building regulations approval
and, if appropriate, listed building consent. Disability
discrimination rules do not override town and country
planning laws. However, the need to make your
premises accessible would normally be an acceptable
reason for carrying out building work. You should
liaise with your local planning department about their
procedures (see BDA advice Planning permission).
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Disability discrimination - responsibilities of dentists as service providers
Leases Further information
If your premises are leasehold, your lease may have Further information is available from the Equality and
restrictions on building work or alterations. In these Human Rights Commission (EHRC). The EHRC has offices
cases, you will need to seek your landlord’s permission in Manchester, London, Cardiff and Glasgow. The EHRC
to carry out any adjustments. The legislation provides helpline is operated by the Equality Advisory Support
a specific right for tenants to ask in writing for Service on 0800 444 205.
permission to carry out alterations required by disability
discrimination rules. The landlord cannot unreasonably
withhold consent (although consent may be given
subject to reasonable conditions).
If a landlord does unreasonably withhold consent, or
attaches unreasonable conditions to the consent, the
matter may be referred to court. Cases can be brought
against the landlord by the tenant, the service provider
(if they are different from the tenant) or a disabled
person who has an interest in the proposed alteration.
If the court determines that the landlord has been
unreasonable, it may authorise the alterations under a
court order.
If legal proceedings are brought by a disabled person
against a tenant who has been prevented from carrying
out adjustments by their landlord, then the claimant or
the tenant may request that the landlord be added as a
co-defendant.
Further information is available in BDA advice Leases
and licenses.
© BDA July 2013