Disability

1. Disability Dr Elizabeth Howard MRCGP

2. Define Disability • Impairment • Disability • Disability Discrimination act defines a disabled person as someone who has a physical or mental impairment that has a substantial and long –term adverse effect on his or her ability to carry out normal day-to-day activities

3. Disability and Work • Discrimination illegal • Best Candidate • Reasonable adjustments • Grant for adaptive equipment • BEST not to lose Job

4. Are These Disabilities? • Hypertension • Coronary artery disease • Diabetes • Cancer • HIV • Multiple sclerosis • Severe facial disfigurement • Chronic fatigue /ME

5. Disability and the Surgery • You are feeling ill, • You feel you need to see a doctor today.

6. Wake up

7. Get out of bed

8. Telephone surgery + negotiate urgent appointment

9. Wash & Dressed

10. Negotiate stairs, have breakfast

11. Walk down path, cross the road,

12. Get on bus, pay fare, get off at correct stop

13. Check in at reception

14. Respond to call system

15. Find Dr , communicate needs, get on couch to be examined

16. Got to chemist

17. Sign and pay for prescriptionSort out medicines

18. Choose and book a hospital appointment

19. ADL involved in seeing a doctor • Wake up – see, set, hear alarm • get out of bed • Telephone surgery • Negotiate for appt • Get washed and dressed • Stairs, Breakfast and take medicines • Walk down road, cross road • Get correct bus -+ pay fare, Get off at correct stop • Check in at reception • Call system • Find, communicate with Dr / get on examination couch. • Go to chemist • Sign / pay for prescription – you are not automatically exempt • Get your hospital appt – choose andbook

20. Disability and the Surgery • You are feeling ill, you feel you need to see the doctor today. • You have a ‘hidden disability’, you are fiercely independent and not ‘housebound’ so do not expect to get a home visit. Your relatives are at work.

21. ALERT Colleagues • Use Yellow flags or alerts for communication issues • Hard of hearing/ deaf • Part sighted / Blind • Memory impaired- agreed contact • Unable to read/ write ( safety – embarrassed) • Priority 1 – wheelchair users for neurological reasons, • hoists / lifts at home • if abdo ‘pain’ – may just sweat or faint

22. ConsultationRoom

23. Dependence vs. Independence • Impairment • Other disabilities ( e.g. hearing + sight) • Personality – self reliant vs. dependant • Depression / anxiety • Opinions in community • Willingness to be seen with aids • Ability to afford better aids • No two the same !!!

24. Pride and Prejudice

25. Hearing • Hearing aids – ‘Don’t want to look like a retard’ • When did you last see one? • Mobiles: Adjust ring tones, Alarms – test first ! • Modern fire alarms in public buildings More severe • Sensory SS -Yew tree lodge /RNID shop (exempt VAT) • Alarms that are loud, vibrate (pillow) / flash vibrate, FIREALARMS , doorbell baby monitor gadgets • Text phone

26. Part sighted/ Blind • Optician best correction – eventually none • Only 1 in 3 registered ( consultant – social services ) • part sighted - 3/60-6/60 • blind – <3/60 unable to perform work • Tax allowance, training stick/ Braille/ audio books, blue badge, TV licence, travel permit/ taxi card • Low vision aids • Tel: Big buttons, speech dialling, verbal orders for meds. • Guide stick – sensory SS , awareness/ help • No on bus? Blind spot in ARMD large • Guide dog – only young workers/ physical disabled

27. Yew tree Centre • Sensory Disability social services • Registered blind/ deaf • Mock up kitchen with gadgets, fire alarm, baby alarm, • Freedom pass – Speech ? Sight/ Hearing ( if cannot drive – blue badge • White stick training

28. Physio, OT, Speech therapy • Tools for independence • Require compliance • Why can’t I have a wheelchair, then my son can push me around!

29. Driving – v important • DVLA rules for driving • Car vs. Minibus / bus/ HGV • www. DVLA – medical rules • Sight < 6/9 corrected • < 3/60 one eye ( - may consider after 1 yr) • Night blindness • Visual defect

30. Blue badge & Motability • Blue Badge – EU • Allows parking on yellow line/ in disabled space 3 hrs • NOT always free parking • Congestion zone free • Too many around – easy or confused GP’s? • Form :appalling – amputees • Able to walk 50 yds unaided without stopping for severe pain / breathlessness • Motability – swap for highest mobility DLA

31. Prescriptions • Medical Exemptions include • Cancer requiring continued medication • ESA/ Tax credits / income support • Not exempt - prepay if more that 14 scripts a year - back repeat sheet on FP10

32. Managing Absence Dr Elizabeth Howard

33. Managing Absence • Plan return to work from start • Have they talked to their employer? • Re-deployment / adjust role • What activities does their job involve • Do they like their job? • Best to move job not lose Job • 6m off <50% return to work. Over a year few return. Legally dismiss 1yr • Depression – only off in severe / short time, planned return part of recovery may be difficult to get them to return the longer they are off

34. Medical certificate – Risk: benefit ---Therapeutic intervention --- Benefits Risks • Forced into sick role • ‘msg: work is dangerous ‘ • Loss of confidence , self esteem, role in society • fear of return esp. depression • Stress • Loss of income • Delay in qualification • Tension • with boss / colleagues • Protection from physical harm – e.g. post open laparotomy • Space to make initial recovery from SEVERE depression / mental heath • Public health/ infection control

35. Med 3 • Needed for 8th day onward • ( short term absence : self certificate from employer/ private ) • CONSULTED that day/ previous day • PROSPECTIVE • CLOSED specific date up to 14d • ‘OPEN’ certificate 2w, 4w, • should officially be closed with a final date to return but usu only adhered to by some employers • REMARKS • Continuous claim • Able to work: part time, light duties, from home ............rehab back into work advice legal obligation to employer. Can remark on adjustments to work without signing off !!

36. Med 5 • SEEN by someone else / you another day . • May give up to 4 weeks forward based on a report less than 4 w old from another doctor. • Gap ?

37. Med 4 – Green • Requested by DWP for prolonged time off • good practice to keep running total • for continuing benefits after statutory sick pay. • MAIN DIAGNOSIS , • Other contributing DISABLING diagnoses • REMARKS: • Treatment and Progress / response, planned rx. • On crutches.. 2 sticks/ NEEDS Zimmer frame .. • Ability to travel 90min by public transport to centre. i.e. do they NEED home visit / severely disabled/ taxi funded (Romford)

38. DS1500, Med 6 & RM7 • DS1500 • Terminal illness is defined in Social Security legislation as: • ‘A progressive disease where death as a consequence of that disease can reasonably be expected within 6 months'5. • claim 'special rules'. Disability Living Allowance (DLA), Attendance Allowance (AA) or ESA (IB) • Med 6 • Back of med3 pad : • Submitted to DWP with accurate diagnosis at same time as Med3 or Med 5 if unable to enter proper diagnosis for fear of harm to patient or disclosure to employer will cause harm. • RM7 – not Brooklands ward • Confidential submission to request assessment – do not need to enter a diagnosis

39. ESA ESA – EMPLOYEES support allowance (was IB) • Assess at 3m , no more certificates from GP for same condition • Right to appeal if refused • Take hosp letters + medications. • Under/ overplay according to finances/ pride / beliefs • ESA 113 – doctors report – • severe disability = exempt from medical exam , entered into support group. • Allowed to work but not obliged to • Medical Exam : • Qualify for ESA financial support ( was IB) • Support group vs. help to prepare for re-entry to work

40. DLA vs. AA • Age • Assessment at home or in centre • FUNCTIONAL HISTORY • Care – Mobility – Duration of need • Cancer requiring chemo/ DXT automatic now to cover costs of illness