Ymchwil gymdeithasol Social research Rhif/Number: 55/2015 Review of Evidence of Inequalities in Access to Healthcare Services for Disabled People in Wales Review of Evidence of Inequalities in Access to Healthcare Services for Disabled People in Wales Shaun Smith ESRC PhD Internship Scheme This research was produced as part of a four month-long PhD Internship with the Welsh Government, funded jointly by the Welsh Government and the Economic and Social Research Council (ESRC). The ESRC was not involved in the study’s design, collection of data, analysis or writing of the report. Views expressed in this report are those of the researcher and not necessarily those of the Welsh Government. For further information please contact: Joanne Coates Social Research and Information Division Knowledge and Analytical Services Welsh Government Cathays Park Cardiff, CF10 3NQ Tel/Ffôn: 02920 825540 Email/Ebost: [email protected] Welsh Government Social Research, 15 October 2015 ISBN: 978-1-4734-4870-4 © Crown Copyright 2015 All content is available under the Open Government Licence v3.0 , except where otherwise stated. http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/ Contents Acronyms ................................................................................................................... 5 Executive Summary ................................................................................................... 6 Introduction........................................................................................................................ 6 Methodology ...................................................................................................................... 6 Main Findings .................................................................................................................... 6 Summary of Evidence – general findings ................................................................... 6 Specific Findings ............................................................................................................... 7 Physical Disability .............................................................................................................. 7 Sensory Loss..................................................................................................................... 8 Chronic and Long Term Conditions ................................................................................... 8 Learning Disability ............................................................................................................. 8 Mental Health Conditions................................................................................................... 9 Chapter One - Introduction ....................................................................................... 10 Chapter Two - Methodology ..................................................................................... 11 The Purpose of the Research .......................................................................................... 11 Scope of the Report......................................................................................................... 11 Literature Search Strategy ............................................................................................... 12 Consultation Exercise ...................................................................................................... 13 Research Aims ................................................................................................................ 13 The Structure of This Report ........................................................................................... 14 Chapter Three - Contextual issues ........................................................................... 16 Defining Disability, Access, Equity and Equality .............................................................. 16 Access and Need ............................................................................................................ 16 Equality and Equity .......................................................................................................... 18 Contextual Issues - Situating Disability ............................................................................ 19 What is the Social Model of Disability? ............................................................................ 20 What is the Medical Model of Disability? .......................................................................... 21 How Disability is defined under The Equality Act 2010 .................................................... 21 How Disability is defined in Welfare Benefit Payments .................................................... 22 Criticisms of the Social Model of Disability ....................................................................... 23 Disabled People’s Attitudes towards the Social Model of Disability .................................. 24 1 Emerging and Other Models of Disability ......................................................................... 24 Areas of Contention ......................................................................................................... 25 The Extent and Prevalence of Disability in Wales ............................................................ 26 The Intersection between Poverty, Inequality and Disability ............................................ 28 Research Concerning Inequality and Disability in Wales and Subsequent Research Gaps ........................................................................................................................................ 31 Disability and Demographic Factors ................................................................................ 31 Increasing Population ...................................................................................................... 31 Age and Ageing Population ............................................................................................. 32 The Urban Rural Divide ................................................................................................... 32 Chapter Four: General Evidence of Inequalities ....................................................... 34 Life expectancy and Excess Mortality .............................................................................. 34 Health Literacy ................................................................................................................ 35 Carers ............................................................................................................................. 36 Welfare Reform ............................................................................................................... 39 Extra-healthcare Costs .................................................................................................... 40 Telehealth and Social Isolation ........................................................................................ 41 Person-centred Planning, Personalisation and Direct Payments ..................................... 42 The Experience and Expectations of Disabled People ..................................................... 45 Comorbidity and Disability ............................................................................................... 46 Chapter Five: Specific Evidence of Inequalities ....................................................... 48 Physical Disability, Musculoskeletal Conditions and Pain ................................................ 48 Wheelchair and Physical Access ..................................................................................... 48 Wheelchair Services ........................................................................................................ 49 Rehabilitation................................................................................................................... 50 Specialist Spinal Cord Injury Services ............................................................................. 52 Diagnostic, Referrals and Health Seeking Behaviour ....................................................... 54 Orthotic services .............................................................................................................. 56 Chronic Pain .................................................................................................................... 57 Sensory Loss................................................................................................................... 58 Accessible Communication, Ease of Access and the All-Wales Standards for Accessible Communication ............................................................................................................... 59 Social Isolation, Loneliness and Depression .................................................................... 61 Stigma, Privacy and Loss of independence ..................................................................... 62 Eye Tests, Knowledge of Eye Disease and Diagnostic Issues ......................................... 63 2 Lack of investment in Speech and Language Therapy .................................................... 64 Sensory Loss by Geography and Social Category ........................................................... 64 Chronic and Long-term Conditions .................................................................................. 64 Delays, Awareness and Diagnostic Issues .....................................................................