BDA advice

Disability discrimination –
dentists’ responsibilities as service providers

January 2020
 Disability discrimination – dentists’ responsibilities and
service providers
Overview
Contents Everyone providing a service to the public must ensure that people with a disability
3 Duty on service providers can access their service; dentists are no exception.

3 Who is disabled? The Equality Act 2010 provides the rules for disability discrimination. You must not
treat a disabled person less favourably for a reason related to their disability (unless
4 Reasonable adjustments you have objective grounds for exemption). Consider the steps you need to take to
Access audits ensure your service is accessible and assess whether you can implement the
Deciding what is reasonable necessary changes or need to identify alternative arrangements.
New buildings and refurbishments
Further information is available from the Equality and Human Rights Commission
5 Changes to the building (EHRC). It provides guidance on What equality law means for your business and
Planning development permission operates the Equality Advisory Support Service helpline on 0808 800 0082.
Leases
See also BDA advice Equality and diversity in the workplace, which covers the duties
6 Written information of businesses towards disabled employees.
Accessible information standard (England)
Key learning points
This advice describes your responsibilities as a service providers and will help you to

• Understand and implement the requirements of the Equality Act to avoid (as a
service provider) discriminating against those with a disability
• Understand who might be regarded as a person with a disability
• Decide what reasonable adjustments are needed
• Demonstrate that your services are accessible
• Seek and act on appropriate advice.

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 Duty on service providers
As a provider of services, you must 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 that you deliver
your service, providing extra equipment or removing physical barriers; you have a
duty to make reasonable adjustments. Consider your policies and procedures, the
need for auxiliary aids and removing physical barriers.
Policies and procedures
Review and amend policies, procedures or practices that make it impossible or
unreasonably difficult for disabled people to use of your services. For example, a ‘no
dogs’ policy should permit guide dogs.
Auxiliary aids
Provide auxiliary aids or services to improve accessibility. For example, provide an
audio version of your practice information leaflet for visually impaired patients or
install a hearing-aid induction loop system for patients with hearing difficulties.
An auxiliary service may include a sign-language interpreter for a deaf patient.
Removing physical barriers
Make reasonable adjustments to your premises to make it possible or easier for
disabled people to use your services. For example, installing a ramp to improving
access for wheelchair users.
© BDA January 2020
Who is disabled?
Only a person with a disability can claim that you have failed to make a reasonable
adjustment.
A person with a disability must have a physical or mental impairment that 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 – for example, epilepsy, insulin-dependent
diabetes or chronic fatigue syndrome
• HIV, cancer or multiple sclerosis (from the time the condition 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 impairments may or may not fall within the
definition: partial sight; impaired hearing (for example, where a hearing aid is used);
impaired mobility; learning difficulties; a disfigurement; and being frail or elderly.
Disability discrimination – dentists’ responsibilities as service providers 3
 Impairments Reasonable adjustments
To establish whether someone is protected by the disability discrimination rules,
consider whether their impairment substantially affects the individual’s As the laws on disability discrimination have been in place for some time, you may
have made adjustments already. Although you are not required to do more than is
reasonable, the duty to make reasonable adjustment is ongoing and adjustments
• Mobility
that were previously impractical may, over time, become reasonable to implement.
• Ability to lift, carry or move ordinary objects
• Manual dexterity
Your responsibilities also cover how people access or interact with your service:
• Physical co-ordination
• Continence • Premises and facilities: how members of the public enter and get around the
• Speech, hearing or eyesight premises; direction signs; counters and equipment; and toilet facilities
• Memory or the ability to concentrate, learn or understand • Information provided: details about your service in signs, information leaflets,
• Ability to recognise the risk of physical danger. advertising and on the internet
• Staff responses: how staff communicate with the public – in person, in writing
Generally, the impairment will (or is likely to) last for at least 12 months. and over the telephone.

For severe disfigurement, a person is not required to prove that the disfigurement If you are aware of any barriers to disabled people using your services, or become
affects the ability to carry out normal day-to-day activities. aware of new ones, you must make reasonable adjustments. 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.

There are many possible alterations that you could carry out to make your service
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
audit report should make recommendations for improving access and how they can
be made. Use the report to: plan alterations over time; assess whether changes are
practical or cost-effective; and demonstrate that you have taken accessibility
seriously and have a plan to address it.

The audit should be carried out by a properly qualified surveyor; you must seek
advice from a professional with up-to-date knowledge of construction and who is
familiar with the appropriate building regulations and disability issues. The
independent National Register of Access Consultants provides details of advisors
who can carry out a professional audit of your premises.

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 Deciding what is reasonable Changes to the building
What is reasonable, depends on the size of your business and your resources. Your Reasonable adjustments may involve physical changes to your premises that
professional access audit proves that you have sought professional advice to require you to seek planning development permission or affect the terms of your
identify the issues and considered what adjustments you need to make. You must lease.
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. Consider: Planning development permission
Disability discrimination rules do not override planning laws and you may need to
• The effectiveness of the adjustment, whether it is feasible, the time and effort
seek planning development permission, which includes planning permission,
involved, and the disruption
building regulations approval and, if appropriate, listed building consent. The need
• The effect on a disabled person’s access if you did not make the adjustment
to make your premises accessible would normally be an acceptable reason for
• Financial and other costs of making the adjustment (in absolute terms and in
carrying out building work. You should liaise with your local planning department.
relation to your size and resources as a service provider)
• The amount already spent in making reasonable adjustments Leases
• Passing on the costs to all service users; disabled users alone must not bear the
Leasehold premises may restrict building work or alterations and you will need your
costs of adjustments.
landlord’s permission to carry out any adjustments. The legislation gives tenants the
right to seek permission to carry out alterations required by disability discrimination
You may need to justify a decision against making an adjustment if someone claims
rules. The landlord cannot unreasonably withhold consent (although consent may
that your premises are not accessible – for example, by demonstrating that you
be given subject to reasonable conditions).
made all reasonable adjustments and have objective reasons for not making the
adjustment complained about. Your reasons might include cost, the effect on other
users and whether the adjustment was necessary to provide the service. The courts If a landlord does unreasonably withhold consent, or attaches unreasonable
conditions, the matter may be referred to court. Cases can be brought against the
decide whether your service was unreasonably difficult for the disabled person to
use – the individual’s time, inconvenience, effort or discomfort would be considered. 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
Adjustments may improve the service for all patients – for example, easy-to-use determines that the landlord has been unreasonable, it may authorise the
alterations under a court order.
door handles and handrails may be appreciated by older patients, ramps may
improve access for those with prams or buggies.
If legal proceedings are brought by a disabled person against a tenant who has
New buildings and refurbishments been prevented from carrying out adjustments by their landlord, the claimant or the
tenant may request that the landlord be added as a co-defendant.
You must consider access by disabled people if you are building a new property or
extending or refurbishing an existing building. You will be expected to incorporate
features to make your premises accessible or to remove or alter an existing feature
that makes access unreasonably difficult or impossible for disabled people.

Discuss the building regulations’ requirements with your architect and builder and
liaise with your local planning department.

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 Written information
Some disabilities can make it difficult for a patient to find information about your
services or to contact you. Consider the information you provide about your services
(in writing, on your website or in advertisements) and how you can make it easy for
disabled people to understand and communicate with the practice. You may need
to make the information available in alternative formats.
Contacting the practice
You must provide one or more contact methods – for example, allowing patients to
contact the practice by email, text message, telephone and text relay.
Ask patients
You are not expected to identify patients with a disability, impairment or sensory
loss, so ask all patients about their communication or information needs. Use
various methods (practice newsletter, practice information leaflet, signs and
website, for example) to encourage patients to contact you about their
communication needs.
Note their needs
Note a patient’s communication needs (not their disability) in their records and in a
way that make it clear and obvious; many software systems allow you to create an
alert but, if this feature is not present, you will need to develop a system to alert you
about communication needs.
Sharing information
When referring a patients with communication needs, you should pass on
information about their needs to the clinician accepting the referral (with the
patient’s permission).
Appropriate format
Patients must be able to obtain and understand information about your services.
You might consider large print, braille, audio or electronic formats. If needed, you
must arrange appropriate professional support – for example, British Sign Language
(BSL) interpreters and deaf-blind manual interpreters. The NHS might help in
providing these services but current provision is highly variable. You must not ask
patients or their carers to meet any costs incurred in providing for their information
or communication needs.
© BDA January 2020
Communication professionals
Communication professionals must be appropriately qualified and registered with
their appropriate professional body – for example, the National Registers of
Communication Professionals working with Deaf and Deafblind People (NRCPD) for
sign language interpreters. They must also have had a DBS check.
Appropriately qualified practice staff who are also registered communication
professionals, or the patient’s family member, friend or carer, may provide support
but the patient must be able to receive support from a dedicated professional, if
they wish. The patient’s family member, friend or carer may not have sufficient skill
to convey a message accurately or objectively and should only be used where it is
the patient’s explicit preference. The patient’s preference and agreement to receive
support must be recorded in their clinical records.
Accessible Information Standard (England)
NHS England’s Accessible Information Standard reinforces requirements on the
information you provide about your services. To help practices implement the
standard, NHS England has produced detailed guidance on making health and
social care information accessible, including scenarios and example questions. The
standard suggest various ways to make contact, asking and recording patient
preferences and having different formats available to meet contractual
requirements in England.
You must publish or display an accessible communications policy describing how
you are meeting the Accessible Information Standard.
Assessment and compliance
NHS commissioners are expected to seek assurance from practices of their
compliance with the Standard and may ask for a copy of your policy or examples of
how information has been made accessible in other formats. As part of its
inspection, the CQC will consider how you have implemented the Standard when it
assesses the responsiveness of your service to people’s needs.
Disability discrimination – dentists’ responsibilities as service providers 6