Covid Vaccinations - A Reasonable Response

NDTi Associate Crispin Hebron, and one of the authors of the soon to be published ‘A for Adjustments’, reflects on the importance of reasonable adjustments being made throughout the process in ensuring that people with learning disabilities have the opportunity to be vaccinated.

The case for people with learning disabilities receiving greater priority for Covid19 vaccination is stark. People with learning disabilities have clearly been identified as being at greater risk of dying than the general population from Covid19 regardless of the level of learning disability they have. The ONS review of deaths identified people with learning disabilities as 3.7 times more likely to die and Public Health England found this to be 3.6 times higher.

Such evidence should act as a reminder to us all, that inequity lies at the core of the everyday lives and wellbeing of people with learning disabilities. The evidence is clear; so, whilst the arguments in relation to the pandemic (vaccination, shielding, DNACPR) are being well made and hopefully heard by policy makers and services across the country, I would like to offer some reflection on the wider and underlying picture. The understanding and availability of reasonable adjustments.

Undoubtedly what is and will be needed for any degree of success, with any agreed approach and prioritisation, is a sound understanding and application of legal responsibilities contained within the Equality Act (2010); specifically the requirement to provide reasonable adjustment – an anticipatory duty to make changes to ensure that those with a disability are not disadvantaged.

The Act states that reasonable adjustment should be considered in terms of:

• Changing the way things are done (provision, criterion or practice)
• Changing physical features (alternative or adapted environments)
• Providing auxiliary aids or services

It is worth taking a moment to consider the (legally required) adherence to such in the immediate arguments related to covid19 vaccination prioritisation; but also in respect of what is required from service responses to bring about any degree of equality in outcome, not only in respect of vaccination but also in meeting all the health needs of people with learning disabilities and addressing the wider evidenced health inequalities known to exist.

The NHS Long Term Plan places the reduction of health inequality at its heart with the framework of ‘right care at the right time in the right place’ – take a moment to consider this mantra alongside the three (legal duty) aspects of reasonable adjustment above!?

Any response to the health needs of people with learning disabilities (or indeed any disability) should already be considering such reasonable adjustment; the House of Lords in their review of the Equality Act (2010) reported that in relation to reasonable adjustment ‘witness after witness told us that, contrary to the Government’s view, the provisions were neither well known nor well understood’

Often the adjustments required that make the difference between success (vaccine administered, patient protected) or failure (vaccine wasted, patient traumatised, clinical time, etc.) are simple, cost effective and straightforward – an appointment at a quiet time, familiarisation with the environment or equipment, easy to understand information, extra time, extra support.

There are resources and approaches available for services and staff to help with this understanding and application; My colleagues at NDTi and I have recently collaborated on a training resource entitled ‘A’ for adjustment, consisting of 5 short learning episodes focussing on:

Adjusted Care – an introduction and overview of the Equality Act and the statutory duties including Reasonable Adjustments

Attitude – A framework / opportunity for staff to explore their thinking about disability, learning disability, discrimination and rights.

Approach – Guidance, advice and ideas for ensuring a positive, tailored, flexible and effective approach is offered to meet individual needs

Assessment – A review of the common health problems associated with learning disabilities, what to look out for and tools that can help.

Actions – Guidance for staff on what to do and where to get help in response to individual needs and concerns; includes suggestions on how to improve future responses and follow up actions.

The resource is due for publication soon on the HEE learning hub.

NHS Digital and NHS England are also developing a Reasonable Adjustment Flag for electronic patient records with a range of resources and information available on the NHS D website.

The importance of such measures cannot be underestimated. The called for and necessary benefits of increased prioritisation for covid19 vaccination of people with learning disabilities will only meet the established criteria of quality (effective, efficient, safe) if proper and legally required attention is paid to the understanding and application of the Equality Act through reasonable adjustments for people with learning disabilities.

A mountain rescue team would not be sent out without a rope, compass and first aid kit!