Protected Characteristics Flashcards
where do protected characteristics come from?
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
what are the 9 protected characteristics?
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
what is the relevance of the 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
- need to make reasonable adjustments for colleagues/employees
protected characteristics and GDC
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
Age and Oral health
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
children’s oral health in general
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
young adults oral health in general
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
Adult Oral health in general
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
older people oral health in general
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)
older people treatment complexity
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
questions over age and equality act
- 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)
can targeted intervention happen?
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
how are children targeted?
- 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
targeting older adults
- 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
how disabilities impact oral health
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
barriers that make disability treatment more complex
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
equality Vs equity for disabled care
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
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
disability and equality act
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
examples of reasonable adjustments
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
what is ‘reasonable’?
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
how are reasonable adjustment checked and assessed in NHS dental practices in Scotland
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)
access survey
- 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
gender and oral health
- 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?
pregnancy and maternity and oral health
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
what does race include as a protected characteristic
- Ethnicity
- Nationality
- colour
- national origins
race amongst scottish children and oral health
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
race amongst adults and oral health
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
how to overcome race issues to not discriminate
- Written information available in other languages
- Translation services - Professional / family member?
- Consider how medical/cultural factors may affect oral health/dental care
intersectionality
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
what else in important to consider when treating a patient?
socio-economic factors
specific ‘priority’ groups
how can socio-economic factors influence oral health?
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
examples of priority groups
- 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
terminology for ‘priority’ groups
“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”
dental priority groups
- children (childsmile)
- frail older people (caring for smiles)
- people with special care needs
- homeless (open wide)
- prisoners (smile4life)
issue of ‘shared identity’
Is every member of a “group” the same?
- E.g. Homeless….
Variations – street/BnB/ Sofa surfers
Beware of stereotyping/ stigmatising
