Published: 24/04/2003, Volume II3, No. 5825 Page 26 27
Every trust is required to conduct an audit of disability access at its premises, but what are the less obvious things to take into consideration - and how can staff be made aware of key issues? Brian Morgan offers some pointers
A cup of coffee was the first challenge. Two of the team assessing access for people with disabilities at South Downs Health trust decided to meet for a drink in the restaurant at Brighton General Hospital.
But Michael Clarke, vice-chair of the trust's patients' advisory forum and a wheelchair user, found an insurmountable flight of stairs. The only way he could reach the restaurant was to go back down in the lift, take the perimeter road round the hospital, call in at the porters' room to find help negotiating a steep slope, go through the kitchens, up in the service lift and emerge from behind the serving counter.
He and architect Graham Lavender abandoned the coffee - but not the audit. Under the Disability Discrimination Act 1995, every trust in the country has had to complete one. From October 2004, all service providers will have to take reasonable steps to remove or alter physical barriers which make access difficult for disabled people.
South Downs Health trust is one of the largest community and mental health trusts in the country. It employs 2,500 people on 50 sites. Its hospitals range from Brighton General, a former workhouse built in the 1860s, to a purpose-built mental hospital in Hove. Its clinics include grade two-listed Regency buildings leased from both private and public sector landlords because of their convenient location in the heart of the city.
There are community homes for people with learning disabilities and supported houses for those with mental health problems scattered throughout the residential areas. There are day centres and flats in former mansions, offices above an arts centre, in an industrial unit, in converted houses, up stairs, down stairs and along miles of corridors.
Brighton has many hills and its Regency houses are tall and narrow. Sloping streets make access difficult by car, ambulance or on foot. Brighton General Hospital, the trust's headquarters, sits on top of one of the steepest hills. Parking is a perennial problem.
It took four months to complete the audit. The team consisted of Mr Clarke, Mr Lavender - an architect at Faulkner Associates with specialist knowledge of healthcare buildings - an occupational therapist, and the manager of each site visited.
Mr Clarke says the experience made him more aware of people whose disabilities are not immediately evident. 'It is fairly obvious what is needed to accommodate someone in a wheelchair, ' he says. 'It is less obvious for those with disabilities such as sight or hearing impairment or epilepsy.'
He found it revealing to work with the occupational therapists who were immediately conscious of the significance of colours, surface textures, braille on lift call buttons and clearer signing - all of which are so important for people with sight problems - and who could say where seats were needed for people with walking difficulties.
The team spent a day at each site and used the NHS Executive access audit checklist, designed to be used across all healthcare buildings from GP surgeries to major hospitals. It considers every aspect starting with the external approaches - the site or street, car park, pedestrian routes, steps, ramps, the entrance and reception areas, lifts, staircases and corridors, internal doors and spaces, catering and refreshment areas, lavatories, bathrooms, signage, exits and fire escapes.
Based on its findings, the audit team drew up a four-year plan of work at an estimated cost of£2.3m, including professional fees and VAT. Some of the work, such as painting the edges of steps, providing colour contrasts, repositioning entry phones and improving signage is being paid for through ongoing maintenance budgets.
In addition, over the last two years, the trust board has approved£470,000 to pay for major alterations to meet the requirements of the Disability Discrimination Act.Wherever major changes are needed, the trust's building officers have consulted the city's disabled access advisory group.
Major work completed includes installation of a lift to the first floor of the school clinic in the city centre and a chair lift to the restaurant at Brighton General. Substantial alterations to many of the residential homes include adapting ground-floor bedrooms and bathrooms for use by people in wheelchairs.
One of the areas where people were most cautious about suggesting change was in community houses for people with mental health problems. These are houses in residential areas and staff were anxious to avoid things - altering a door, putting in a better porch light, resurfacing a tiled path - which might mark the house out as 'different' from its neighbours.
While the work was carried out, the trust was keen that staff should understand the need for alterations and increase their awareness of disabilities.
By the end of 2002, more than 600 South Downs Health trust staff, including all board members, will have studied the distance learning course, Welcoming Patients with Disabilities, devised specifically for NHS staff.
The coursework book produced for the NHS is designed to help managers and staff understand the barriers which disabled people face, find out more about the law, understand how to meet the needs of particular disabled groups, and to improve communication skills.
Divided into sections with accompanying quizzes, the distance learning exercise leads up to a final telephone quiz, an interactive test which asks 12 questions at random about the topics covered. Staff then receive a certificate confirming they have completed the work book and test.
The latest evaluation shows that everybody who has read the work book has learned something.
Eight out 10 people said disability awareness training was relevant to their work, but only 29 per cent had previously been offered such training.
Around 87 per cent of staff taking the interactive telephone test passed first time; another 6 per cent succeeded second time round. But some people found it difficult to study on their own and, in particular, found the telephone test intimidating, so the trust arranged additional training around its sites.
Welcoming Patients with Disabilities will become part of the induction programme for every new member of South Downs Health trust staff.
Raising awareness of disability across the trust has led to other improvements:
Letters and leaflets for patients and also information for staff - including the staff newsletter - are all produced in large type. The new trust standards require a minimum of 12-point type for letters and for staff information, and 14point type for leaflets, which are also available in large print and on audio tape.
A new central text telephone number for people who are deaf or hard of hearing has been introduced.
Information systems now show if a patient did not keep an appointment because the service was not accessible to disabled people. This will help highlight any areas of particular concern.
A new video about NHS and social care services for people who are deaf or hard of hearing is being produced in partnership with the city council and Brighton and Hove City primary care trust.
Reception staff have been issued with information about how to recognise someone who is deaf-blind by their red and white cane, together with a card to help them use simple sign language.And all managers have been given a copy of The Deafblind Helpbook produced by Deafblind UK.
And the work to end discrimination is evident in other, less obvious, ways. South Downs Health trust's arts initiative, set up to provide a range of artwork in the trust's buildings, has broadened its remit to include disability awareness.
Its projects to date include working with children with complex physical disabilities at Chailey Heritage near Lewes, where the children have been using computers to explore the possibilities of digital art. South Downs Health trust provides NHS clinical services for children who attend Chailey Heritage School at a centre which is nationally recognised for the care and treatment of disabled children.
The Sussex rehabilitation centre in Brighton, which provides a prosthetics service for people living in East and West Sussex, is another South Downs Health trust service.The latest arts project plans to look at prosthetic limbs.
And every time the trust takes on new premises or puts up a new building of its own, that building gets its rigorous assessment on how accessible it is to disabled people.
A disability access audit carried out at a trust operating over 50 sites revealed that a£2.3m programme of work was needed.
The audit took four months, with the team spending a day at each of the premises.
The audit has been followed by a staff training programme in disability awareness.
The trust's information systems now show if a patient did not attend an appointment because of difficulties with physical access.
All letters to patients are produced in a minimum 12-point type.
Brian Morgan is project officer, South Downs Health trust.