From the 1st of October this year, providers of dentistry all over the UK will be expected to take reasonable steps to make their practices accessible to people who are disabled. They will be expected to remove, alter or provide means of avoiding physical features that make it impossible or unreasonably difficult for disabled people to use their services.

This will include possible alterations to the design or construction of the building, the approach and access to and exit from the building - for example disabled parking bays and ramp access for wheelchairs and fixtures and fittings, furniture and furnishings and equipment and materials.

The changes stem from the Disability Discrimination Act 1995 (DDA). Under the act, it is unlawful to treat a disabled person less favourably for a reason related to that person's disability (unless it can be justified). The Act defines a disabled person as ‘A person who has or has had a physical or mental impairment which has a substantial and long-term adverse effect upon his or her ability to carry out normal day-to-day activities.’

The first set of rights under the goods, facilities and services part of the DDA came into force in 1996, and part II came into force in October 1999. This stipulated that service providers should amend their policies, procedures and practices, provide auxiliary aids or services and provide methods round physical barriers to a person with a disability.

For example, a ‘no dogs’ policy or rule would have to be amended to allow entry to service animals such as guide dogs or hearing dogs.

The requirements mean that dentists will have to take reasonable steps to provide auxiliary aids or services, which will enable disabled people to make use of their service. So, for example, when carrying out any treatment, the dentist should make a point of looking straight at a deaf or partially deaf patient, speaking clearly, removing any mask to allow the patient to see the mouth.

Where physical barriers make it impossible or unreasonably difficult for disabled people to use a service, the dentist will be expected to take reasonable steps to provide the service by a reasonable alternative method. So, for example, where the treatment rooms of the practice are upstairs and are inaccessible for those in wheelchairs and there is no possibility of using a ground floor surgery, a reasonable alternative may be to carry out a domiciliary visit if possible/appropriate or to refer a patient to an alternative practice with adequate facilities.

On 1st October 2004 Part III of the Act comes into place. Providers will be expected to take reasonable steps to remove, alter or provide means of avoiding physical features that make it impossible or unreasonably difficult for disabled people to use their services.

This will include possible alterations to the design or construction of the building, the approach and access to and exit from the building, eg disabled parking bays and ramp access for wheelchairs and the fixtures and fittings, furniture and furnishings and equipment and materials.

‘One sobering thought is that were one of the staff ever to become disabled, would the surgery be able to accommodate them?’

While newer practices may have had the opportunity to incorporate the guidelines on disability into their new practices, older practices may be looking at physically restructuring their practices to make them more accessible to those with disabilities.

One such practice is Oasis Dental Care in Sutton-in-Ashfield. Associate dentist at the practice Dr Ralph Davies says: ‘Changing the practice in order to comply to the DDA guidelines was a frightening prospect and a considerable worry. I was concerned as to what would be challenged, what was reasonable to change and what would happen if my practice could not be adapted to comply.’

He explained that the practice had steep entrance stairs, different levels, narrow doors, and that spending £100k would not get it compliant.

Instead he decided to move premises to a property for sale by tender in the town centre. ‘This new property had huge potential, and nine new surgeries were possible with five on the ground floor as well as disabled and staff parking. It did need gutting and internal rebuild which would cost around £200k’ he says.

With the help of a local businessman who wanted to invest in the venture, Dr Davies went ahead with the move. The businessman bought the premises, which the practice then rented, which gave them time to plan for the new space.

When thinking about the ‘patient journey’ to the practice, a lot of thought was put into difficulties that a disabled patient might encounter. For example, a portion of the reception counter was lowered so that it could give access to a wheelchair user.

‘Since the move to the new premises, the practice has had positive feedback from patients with disabilities.’

Oasis Dental provides eye level access for wheelchair users Credit: Pictures this page printed with permission of Oasis Dental Care Ltd

There was access to a disabled toilet, and the waiting room also had room for a wheelchair to manoeuvre, as did the surgeries themselves.

Dr Davies says, ‘While infra-red loops can be used for those hard of hearing, they can be confined to one room and patient confidentiality is potential problem. One answer would be to train the staff in sign language in order to overcome this, and for staff to lower their masks when talking to the patient so that they can lip-read.’

The surgery had contrasting coloured walls in each room as well as contrasting architraves so that the partially sighted could differentiate between them. Signage should also be large, and braille inserts could help partially sighted people get around the practice more easily. Large print information and patient leaflets were made available in the waiting room.

He added, ‘One sobering thought is that were one of the staff ever to become disabled, would the surgery be able to accommodate them? For this reason the staff spaces were well thought out to have as much room as possible.’

According to Dr Davies, since the move to the new premises, the practice has had positive feedback from patients with disabilities. ‘We have also has a large increase in the number of disabled patients seen,’ he says.

Guidelines suggest that it is advisable for the dentist to know what would be deemed reasonable and justify a refusal to comply with the provisions of the DDA. Although there are guidelines set out in the codes of practice issued by the Disability Rights Commission, ultimately the definition will be a matter for judicial decision when cases are brought to court. It is recommended that an access audit is carried out before any structural alterations are performed. Some of the guidelines for reasonableness include the type and nature of service provided, the size and resources of the service provider and the effect that a refusal would have on the disabled person.

In some cases, practices may wish to take steps to comply with the remaining duties in relation to physical features as they come into force in 2004, that is altering or removing a physical feature so that it no longer has the effect of making it impossible or unreasonably difficult for disabled people to use the services of the dentist (including providing an auxiliary aid which involves an alteration to the physical fabric of the building).

Credit: Pictures this page printed with permission of Oasis Dental Care Ltd

For example, when planning and executing building or refurbishment works to practice premises, such as an extension or making structural alterations to an existing building, it would be advisable to consider the removal or alteration of physical features which create a barrier to access for disabled people or the provision of a reasonable means of avoiding the physical feature, even though the law does not yet require this.

The Disability Rights Commission in partnership with BT, has developed an online interactive Self Appraisal Toolkit for small and medium sized businesses to enable them to identify areas where business development could help them respond positively to the requirements of the Act which can be visited at www.disabilityaware.org

The Code of Practice for the DDA is available from any branch of the Stationery Office or through the Government's mail order line 0870 600 5533. The Act is available at http://www.legislation.hmso.gov.uk/acts/acts1995/1995050.htm.

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