What barriers exist in access to healthcare for disabled people

Lydia Bull (WHS), Julie Chen (OHS) and Amy Simonds (WHS)

15% of the world’s population have some form of disability; either a physical or mental impairment that has a substantial and long-term negative effect on their daily life. Disability is more than a medical term but instead comprises of many social dimensions. Rates of disability are increasing because of the ageing population and more chronic health conditions, among other causes. Inequality in healthcare causes many barriers for such people including accessibility, availability of services, knowledge and skills of health workers. We focused on waiting times, stigma around disability and costs.

A study done by the BMJ found that the highest percentage of people having unmet needs is due to long waiting lists in the UK. This can lead to significant implications on both people with mental and physical disabilities due to health deterioration in the waiting periods for medication, appointments, referrals and more. For example, thousands of disabled children in England who need a wheelchair must wait more than four-months for equipment to be delivered. Delays like these effect rehabilitation and daily life such as attending school, and social life, therefore having significant long-term consequences. Moreover, this barrier hugely affects mental disability causing 75% of young people get worse before treatment. The Care Quality Commission found that some people in England were waiting for 18 months to get help, and as such, people are ending up unemployed, divorced or in financial distress. The NHS was built on the principle of delivering equal access to healthcare for all so should be expected to work towards greater access to healthcare as waiting times cause more strain on healthcare services in the long term due to deterioration of conditions. Inequality due to waiting time is experienced by most countries but is prevalent in the UK because of the current financial context and demand pressures the NHS faces. There has always been a stigma around dealing with disabilities. Across the world disabled people experience discrimination and exclusion, which is a cause of underlying stereotypes and prejudice of different cultures. Disabled people face constant misconceptions about their dispositions and abilities and are often not treated as equals to abled people. Sometimes, the effects of this stigma are more obvious, such as outright denial of care, or are more abstract, like making people wait longer or passing them onto less experienced colleagues. Healthcare workers are often unaware of how their views can impact disabled people and therefore may not even recognize that this stigma exists. However, there is little work in place to address these issues, and this needs to change. One in four people will experience a mental health problem at some point in their lives, and a similar number are physically disabled, and as such it is important that this stigma is addressed so that quality healthcare is available to everyone. Nine out of ten people with mental health problems say that stigma and discrimination have had a negative effect on their lives. This stigma stems from views that are now outdated, leading to ignorant and prejudiced ideals, which can eventually cause discrimination. Thus, it is crucial that we break the stigma so that disabled people have equal access to care.

Scope, a national disability charity has led research into the costs faced by disabled people and their families. Their 2019 Disability Price Tag reports show that those living with a disability face extra costs on average of £583 per month, moreover, one in five disabled people face extra costs of more than £1000 a month. While these costs can vary between different disabilities, the main costs cover specialised equipment, increased transport costs and alterations to the home. Using housing as an example of one of the many issues, you can see how cost acts as one of the most apparent barriers. There is a shortage in the adapted housing stock as there are many difficulties obtaining funding from councils for adaptations to make homes suitable for disabled people. These adaptations include lift access, elevated toilet seats and handrails. What makes these increased costs close to unbearable is the loss of income and reduced working hours; long-term stable employment is incredibly difficult to find for those with disabilities. They struggle to keep up with the costs and this means that disabled people are disproportionately living in poverty, and as such one fifth of disabled adults struggle to keep their homes warm. In addition, there have been severe cuts in disabled people’s benefits - personal independence payment (PIP) as well as employment and support allowance (ESA). These together have shrunk by almost £5 billion since 2010.

Disabled people are less likely to receive the medical care that they need due to these barriers, and therefore, are unable to live in the same way as those that have full access to care. This leads to a difficult life for the disabled person, as they must focus so much of their attention into ensuring that they are on top of their health as the care is not available, and then have less time to focus on a job. In the US, 8% of disabled people are unemployed, compared to 3.7% of abled people. This means that disabled people are not able to pay for food and housing and have to lead a more challenging life.

Sources: World Health Organisation – Disability and Health (2018) British Medical Journal (BMJ) - Access to healthcare for men and women with disabilities in the UK: secondary analysis of cross-sectional data (2017) The Guardian – Disabled children waiting too long for NHS wheelchairs (2018) The Independent - Mental health waiting times mean 75% of young people get worse before treatment, report warns (2018) UK Gov – Disability stigma in developing countries (2018) BMC Medicine - Stigma in health facilities: why it matters and how we can change it (2019) Mental Health Foundation – Stigma and Discrimination

Scope – Extra Costs (2019) Joseph Rowntree Foundation – Disabled people’s costs of living (2004) Disability Rights UK - Disability benefit spending reduced by £5 billion over the last decade (2018) Bureau of Labour Statistics (BLS) - Persons with a Disability: Labor Force Characteristics Summary (2019)