Natalie Bradley, Consultant in Special Care Dentistry and Clinical Director for Dentaid the Dental Charity talks about treating patients with disabilities or additional needs.
I remember trying to supervise and induct a new DCT (Dental Core Trainee) into seeing a patient with a learning disability and she looked like a rabbit in the headlights. She didn’t know how to interact with the person. If you haven’t had that experience before, it can be quite scary. How do you speak to them? Do you get down on the same level as them? How much do they understand and how do you assess that?
It can be quite daunting, but often people with disabilities get feedback that people don’t speak to them the same way that they would speak to anybody else, and it can be demeaning for them. Similarly for people who experience homelessness, they might face stigma from people who make assumptions about them because they don’t have a roof over their head.
I’ve seen many people who experience homelessness know exactly where to go in the morning to have a shower and have a well-cooked breakfast, and they don’t ‘’look’’ homeless. But when they go into a dental practice and ask for a dental appointment, the first question is, ‘What’s your address?’ which can be a big barrier for them. They’re concerned the receptionist might react, and whether it means they won’t get the same treatment as others. There are many preconceptions about homelessness, and they are very discriminatory.
Sunflower lanyard
One of the silver linings of the pandemic was increased awareness of the sunflower lanyard. This started at Gatwick Airport and was a way for people to display whether they had any additional health or assistance needs when they were going through the airport. Sometimes people have disabilities that can be less obvious than others. If someone comes along in a wheelchair it’s clear to see, they probably need a bit of additional support. If someone has epilepsy, or autism, it’s not as obvious. So, the lanyard is a discrete way people can display that they need a little adjustment or help with whatever they’re trying to access, whether that’s going to the shops or the dentist.
Practices can go onto the website and complete the training about the lanyards and how to help. They can also order sunflower manuals and things to display on reception to show they’re part of the scheme. So, if you see someone who has a sunflower lanyard you can recognise what it means and how it might be that you need to adapt or ask them how you can help support them.
Although this all feels moral, ethical, and about treating everyone the same, there is legislation in practise across healthcare that means we must look after these patients and consider their needs.
The most important piece of legislation is the Equality Act. This states, all health and social care providers need to make reasonable adjustments for those people who might need them to be able to access the service we’re providing. This might be because they have a protected characteristic, or other need and you must give an adjustment for somebody so that they can get to the dentist.
Removing barriers
People talk about equality and diversity, and it’s not about giving everybody the same level of assistance. If we did that there’d be some people for whom it would be what they need. For others, it might give them an even better advantage, but for some it might not even be adequate. So, it’s not about giving the same assistance to everybody. What we should aspire to do is remove the barriers that are in place that mean a person might be excluded from accessing a service.
An easy example is stairs and access in the dental practice. That can prove a barrier to someone with compromised mobility. It also might include things like reading and writing. How many forms do you get your patients to fill in? What happens if you have Dyslexia? Your reception team could physically be there and help support them to fill it out, but could you get easy read information that would be more appropriate for them?
Another piece of legislation to consider is the Accessible Information Standard, which came into play in 2016. This again covers all health and social care providers and means you need to ask your patients what is the best way to communicate with them. So, if you have a patient who’s deaf, there’s very little point giving them a telephone reminder system or calling them to change their appointment. So, what is the best way to communicate with that person? This is something you need to assess every time they come to see you.
What about someone who might not have a fixed address, someone who’s homeless, what’s the best way to communicate with them? In this case it’s probably an email address as it’s likely to be more reliable than a telephone number as that might relate to a burner phone that they lose or sell. Or it could be contacting somebody like a key worker or a close friend or relative with their consent to be able to share information about appointment times or to get in contact with the person. How they would prefer you to communicate with them should be recorded on all your patient’s records.
The other important update to legislation in 2022 and Health of Social Care Act is the Oliver McGowan Mandatory Training, on learning disability and autism. Again, all health and social care professionals should have had some form of training in learning disability and autism.
The golden rules from the training are ‘ask, listen, do.’ So, when you have a patient in front of you who has a learning disability, you need to ask them what they need from you so that they can be sure that they can sit in the dental chair comfortably, and can have a filling done, or tooth taken out. Also, listening to what the patient or their advocates say. So, the relatives, or carers, people who know them well, and then acting upon that and following their recommendations.
So, I recommend that and thinking about what sort of things you can do, what reasonable adjustments you can make that are quite easy to arrange, that will be the best for that patient.
About Natalie
Natalie Bradley is currently a Consultant in Special Care Dentistry and Clinical Director for Dentaid the Dental Charity. She has extensive experience of working within a community dental setting, treating special care and paediatric patients as well as out of hours care.
Natalie’s choice of speciality was influenced by her passion for treating the most vulnerable people in our society. Driven by a desire to develop strong leadership cultures and innovation, she completed a fellowship with the Office of the Chief Dental Officer and is now an NHS Clinical Entrepreneur working on solutions to help vulnerable people access dentistry.
Outside of her clinical work, she writes blogs and contributes articles for professional publications, runs a personal coaching business supporting young dentists in their careers, and is a consultant and lecturer for Dental Training Consultants.
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