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BDS2 PMHP > Protected Characteristics > Flashcards

Protected Characteristics Flashcards

1
Q

where do protected characteristics come from?

A

Equality Act 2010

“Protects individuals from unfair treatment and promotes a fair and more equal society”

9 protected characteristics

  • Unlawful to discriminate on the basis of these
  • Must not give someone a service of worse quality or in a worse way than you would normally provide the service
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2
Q

what are the 9 protected characteristics?

A

Age

Disability

Gender

Gender reassignment

Marriage/Civil Partnership no protection if single

Pregnancy and Maternity

Race and Ethnicity

Religion and Belief – includes no religion

Sexual orientation

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3
Q

what is the relevance of the 9 protected characteristics?

A
  • Unlawful to discriminate on the basis of these
  • Must not give someone a service of worse quality or in a worse way than you would normally provide the service
  • need to make reasonable adjustments for colleagues/employees
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4
Q

protected characteristics and GDC

A

GDC standard 1. Put Patient’s interests first
- 1.1 You must listen to your patients
- 1.2 You must treat every patient with dignity and respect at all times
- 1.3 You must be honest and act with integrity
- 1.4 You must take a holistic and preventative approach to patient care which is appropriate to the individual patient
- 1.5 You must treat patients in a hygienic and safe environment
- 1.6 You must treat patients fairly, as individuals and without discrimination
Guidance
- 1.6.1 You must not discriminate against patients on the grounds of:
Age
Disability
Gender reassignment
Marriage and civil partnership
Pregnancy and maternity
Race
Religion or belief
Sex
Sexual orientation.

You must also ensure that you do not discriminate against patients or groups of patients for any other reasons such as nationality, special needs, health, lifestyle or any other consideration.

  • 1.6.2 You must be aware of and adhere to all your responsibilities as set out in relevant equalities legislation.
  • 1.6.3 You must consider patients’ disabilities and make reasonable adjustments to allow them to receive care which meets their needs. If you cannot make reasonable adjustments to treat a patient safely, you should consider referring them to a colleague.
  • 1.6.4 You must not express your personal beliefs (including political, religious or moral beliefs) to patients in any way that exploits their vulnerability or could cause them distress.
  • 1.7 You must put patients’ interests before your own or those of any colleague, business or organisation
  • 1.8 You must have appropriate arrangements in place for patients to seek compensation if they have suffered harm
  • 1.9 You must find out about laws and regulations that affect your work and follow them
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5
Q

Age and Oral health

A

Oral health is important at all ages

Effects of poor oral health are cumulative over time
- Once get tooth decay, tooth will never be sound healthy tooth again – effect for life

Risk of oral health conditions change with age

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6
Q

children’s oral health in general

A

Caries

Reduced cares rates over the past 16 years
– Those who do have decay have lots

Dental extractions still most common reason for children to have GA

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7
Q

young adults oral health in general

A

Most – good oral health

Those with decay more likely to have multiple teeth affected

Coronal caries
- 36% of 25-34yr olds vs 22% of 65-74yr olds (younger age group more common)

Periodontal (gum) health good

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8
Q

Adult Oral health in general

A

Increased caries experience

  • <45 less likely to have had any fillings
  • 45-54yr old 97% had a filled tooth, with average 9.1 filled teeth

Oral health improving over years hence older generation
- Next survey age should rise (same group moving forward)

Maintenance of previous restorations

Increased levels of periodontal disease

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9
Q

older people oral health in general

A

Falling edentulous rates

64% aged 75+ have some natural teeth

Less coronal caries, BUT increased root caries
- Root caries: 1% of 16-24 yr old, 11% of 55-64 yr old, 20% 75-84 yr old

Periodontal disease more common and severe

Oral cancer
- Risk increases with age (not exclusive)

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10
Q

older people treatment complexity

A

Previous restorative work – advanced restorations
- Need to maintain

Medical conditions – co-morbidities, polypharmacy
- Has an impact on oral health and treatment procedures

Frailty – access issues

Cognitive decline – memory, comprehension
- Many complicating factors

Dependence – daily oral care

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11
Q

questions over age and equality act

A
  • Can a dentist refuse to treat a particular age group?
  • Can a dentist see children on NHS terms but adults privately?
  • Ways to justify - Unable to treat child patients well so better for them to see another dentist (unable to provide level of treatment want to under NHS)

Can oral health improvement target particular age groups?

  • Childsmile
  • Caring for Smiles (elderly equivalent)
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12
Q

can targeted intervention happen?

A

yes

  • They are currently missing out on services
  • Can show they have a different level of need
  • There is a track record of disadvantage
  • Low participation of this group
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13
Q

how are children targeted?

A
  • High caries rates
  • High dental GA rates
  • Early years = political priority
  • Good oral health part of overall child wellbeing (Helps holistically in early years)
  • Establishing good oral health early on will influence later life

justifies Childsmile

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14
Q

targeting older adults

A
  • Dental attendance declines with age
  • Older people less likely to have good oral health
  • Need for help with oral hygiene
  • Medical consequences of poor oral health
  • Oral health consequences for general health

justifies Caring for Smiles

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15
Q

how disabilities impact oral health

A

Not a single group

  • Physical/ cognitive/ sensory/ combination
  • Hidden disabilities
  • Varying severities – same diagnosis but impacted differently

Poorer oral hygiene

Poorer gingival health

Caries? Variable - not clear, depends on disability and severity
- Can be reliant on someone selecting their diet - could be good for oral health
- Unable to maintain good oral health
- Saliva composition can be difference
Too many factors to assess in one study

Fewer filled teeth, more missing teeth

  • More missing because can’t communicate issue with the tooth potentially
  • so may not get the tooth seen at an early enough stage to save tooth or corporation difficulties unable to sit for treatment so need GA go for removal as prevent a GA later due to complication of restoration
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16
Q

barriers that make disability treatment more complex

A

Access to care
- physical / cooperation/ understanding

Dental anxiety with learning disability

Communication
- Written/verbal
(Instruction/advice sheets may not work as well; May need sign language)

Treatment/management complexities
- Involuntary movements/positioning (ability to lie flat for duration)/tolerating treatment/ concentration span

Medical co-morbidities

Capacity to consent

17
Q

equality Vs equity for disabled care

A

Children and adults with a disability have the same rights as the rest of the population with regards to oral health”

  • Same RIGHTS to oral health
  • Not necessarily the SAME services

Equality - give them the same

Equity - look at outcome to make the same, all comfortable
- Want all to have same standard of oral health at end of treatment
- Outcome the same
Delivered in different services potentially

18
Q

equality

A

give them the same

19
Q

equity

A

look at outcome to make the same, all comfortable
- Want all to have same standard of oral health at end of treatment
- Outcome the same
Delivered in different services potentially

20
Q

disability and equality act

A

Requirement to make “REASONABLE ADJUSTMENTS”
- Disabled people should be able to use services as far as is reasonable to the same standard as non-disabled people

Requirement is ANTICIPATORY

  • Plan in advance
  • Think about different types of disability and possible difficulties
  • Think about everything needed
21
Q

examples of reasonable adjustments

A

Physical access
- ground floor, ramp, hoist, dom visit, referral

Communication
- written info (large print/images), hearing loop, BSL

Enabling treatment
- time, explanation, appointment time, treatment plan

Find out about patient and what they may need

22
Q

what is ‘reasonable’?

A

No formal definition

Depends on:

  • size and nature of business
  • physical features of premises
  • cost of making adjustments

Barriers which should have been identified and reasonable adjustments could have been made if court thinks should’ve been done
- required to pay compensation + make adjustment if challenged

23
Q

how are reasonable adjustment checked and assessed in NHS dental practices in Scotland

A

3 yearly Practice Inspection

Records whether can access without stairs

Essential to have:

  • Details of disabled access/facilities in practice information leaflet
  • Practice information leaflet available in large print
  • Disability Policy (ideally based on results of an Access Survey)
24
Q

access survey

A
  • Look at features that make the practice accessible and what can be improved
Access Panels (local groups of disabled people) can provide advice/info/visit practice 
- Currently 50 Access Panels across Scotland
  • Can also consult with disabled patients
25
Q

gender and oral health

A
  • Women more likely to be regular attenders
  • Women more likely to have “excellent oral health” (perio, caries, oral hygiene)
    BUT Women more likely to report dental pain
  • Men more likely to have pulpally involved lesions
  • Men more likely to have some natural teeth
    Why? women attend more = more treatment?
26
Q

pregnancy and maternity and oral health

A

Gingivitis – 60-70% of all pregnant women
- Related to hormones in pregnancy

Tend to receive less dental treatment at this time
- Free NHS dental treatment

Offered due to protected characteristics

  • Encourage attendance – engaging less
  • Early input into oral health of child
27
Q

what does race include as a protected characteristic

A
  • Ethnicity
  • Nationality
  • colour
  • national origins
28
Q

race amongst scottish children and oral health

A

NDIP data linked with school census

Similar pattern as seen in England

Gypsy traveller children most likely to have decay

African least likely to have decay

Asian – variation:

  • Bangladeshi – most decay,
  • Indian – least
29
Q

race amongst adults and oral health

A

Review of 2009 adult oral health survey:

Contrary to most inequalities, oral health better among non-whites, despite lower use of dental services

  • Less likely to have fillings, extractions or fewer than 20 teeth
  • Likely due to dietary sugar

Cultural practices e.g. chewing tobacco/Paan/Betel increase risk of oral cancer

Medical conditions

  • increased diabetes among Afro-Carribeans may influence oral health (more at risk of periodontal disease)
  • Thalassaemia (Mediterranean) /sickle cell disease (Afro-Caribbean) – increased risk if GA required

Access to dental care - language barrier etc

Attitudes/opinions relating to dental care may differ

30
Q

how to overcome race issues to not discriminate

A
  • Written information available in other languages
  • Translation services - Professional / family member?
  • Consider how medical/cultural factors may affect oral health/dental care
31
Q

intersectionality

A

The interconnected nature of social categorisations such as race, class and gender as they apply to a given individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage”

Can’t generalise based on one characteristic

Focussing on one shared identity ignores other factors which will also impact on individual people within the group

  • Applies to protected characteristics
  • Combine and intersect
32
Q

what else in important to consider when treating a patient?

A

socio-economic factors

specific ‘priority’ groups

33
Q

how can socio-economic factors influence oral health?

A

Strong links with dental health
- Deprivation = more caries, more likely to be edentulous, higher oral cancer rates

Socio-economic factors also linked with many of protected characteristics
- Disability, Race(immigration)

Interactions between protected characteristics and socio-economic status may amplify disadvantage

  • Discrimination/legal protection??
  • No law against as not a protected characteristic
34
Q

examples of priority groups

A
  • Homeless
  • Prisoners
  • Gypsy travellers
  • Addictions
  • Immigrants
  • Asylum seekers
  • Mental health

need to know are disadvantage
Some are protected for
- Race (gypsy, immigrants, asylum)

But not all, and all are disadvantage
- Law maybe doesn’t go far enough to protect them

35
Q

terminology for ‘priority’ groups

A 
“Hard to reach groups” 
- Are they hard to reach? 
- Are we hard to reach??? 
Are we set up for average population and not inclusive of disadvantage/priority groups
- Hard to hear??

“Vulnerable Groups”

“Priority Groups”

36
Q

dental priority groups

A
  • children (childsmile)
  • frail older people (caring for smiles)
  • people with special care needs
  • homeless (open wide)
  • prisoners (smile4life)
37
Q

issue of ‘shared identity’

A

Is every member of a “group” the same?
- E.g. Homeless….
Variations – street/BnB/ Sofa surfers

Beware of stereotyping/ stigmatising

BDS2 PMHP (8 decks)

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