Some positions in life can seem more difficult depending on what angle we are viewing them from. Our obligations concerning disability access is one of those issues. On one hand, it can seem an onerous responsibility and a financial millstone. On the other hand, it can be a satisfying challenge and a source of good public relations and even income. The bottom line is that we do not have to adhere to the exacting requirements for a new-build surgery in an existing practice, just do our best in the circumstances.
There are ethical, moral and legal reasons for helping people with limited mobility to access our services. It isn`t always possible, but there are some things we need to do and some things it`s good to do. Here comes the disclaimer: this article is not a comprehensive guide to meeting regulations or legal requirements, it is a discussion and some advice based on practical experience.
OK, before the Disability Discrimination Act, before UDA`s and about the time of dinosaurs, we could do what we wanted and make it as easy or difficult as we wanted for anyone to get through the front door. The law now states that we have to make adjustments where physical circumstances “place the disabled person concerned at a substantial disadvantage in comparison with persons who are not disabled, it is the duty of the employer to take such steps as it is reasonable”. Now those words do not apply to patients, they are about our obligations as an employer. This is the first thing most principals forget, there are now responsibilities in being careful not to show discrimination where potential employees are concerned and the same rules apply to patient access too.
So what can we do? First, if it`s a new-build project, then we have to go the whole way. Otherwise, the words “take such steps as it is reasonable” are applicable. So mix and match from the following practical specifications that I`ve applied in various projects in the past. The more you apply, the better your profile will look. Use your website to highlight how thoughtful and considerate you are as a service provider. The NHS Choices website also lists dentists by area. Under facilities, each practice can fill in disability access details about their surgery, including hearing loops, Braille translation services, disabled parking and wheelchair accessibility. Additionally, you can use the Fair Access, Diversity and Inclusion Policy and Procedure in your practice publicity.
Go and stand outside your practice (or potential practice) and imagine you are in a wheelchair or reliant on a walking frame. Now ask yourself a number of questions. Is there parking near the practice? Is the practice car park flat and with no steps or kerbs towards the front door? If the door is raised above ground level, is there a suitable ramp? The gradient of the ramp can vary from 1:12 to 1:20 depending on the length and the ramp should be 1,500mm wide. Again, if the door is raised, are there also steps for elderly people who may actually find a ramp difficult? Are there hand rails to the side of the ramp? Is the outside well lit for approach on dark Winter afternoons? Is the door wide enough to accommodate a wheel chair?
Now go in through the door and ask more questions. Are the corridors wide enough and free of hazards (as well as dumped equipment, boxes of printing paper and the photocopier that won`t fit in the office)? Is the reception desk at split heights to accommodate wheelchair users as well as standing patients? If on more than one floor, is there a lift (requirement for a new build) or ability to install a stair-lift? Are there high-contrast colours on walls, floors and furnishings to help people with visual impairments. Are waiting room chairs in a variety of heights to give choice for different abilities? Are floors of a non-slip material to help prevent falls?
Now for the toilet. In a new-build this needs to be 2.2m by 1.5m with safety rails and an alarm system. The door should be 1m wide and outward opening, this is so that if anyone collapses inside they don`t block access. Seek specialist advice for the exact specification as it can be tricky.
At last, address the surgery itself. The door can be down to 780mm wide and the room ought to be wide enough to accommodate a wheel chair besides the dental chair so that treatment can be performed without transfer. Logically, the equipment should reach too!
In a new build, there is also a regulation regarding the safety of a wheelchair user on the first floor in the event of a fire. A suitable emergency voice communications system and signage is required in a wheelchair refuge area, with communication to a suitable location at ground floor level for fire service use. If a fire were to occur, the team member looking after the wheelchair user, or the wheel chair user themselves, may need to notify authorities of the emergency. This is why there needs to be an area with a call point.
A few details to think about too, such as printing literature in large format print and braille, and then you are away. Compliant and safe, with a practice which shows a commitment to inclusion and equality.
