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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
Disability and Work
Grant for adaptive equipment
BEST not to lose Job
Are These Disabilities?
Coronary artery disease
Severe facial disfigurement
Chronic fatigue /ME
Disability and the Surgery
You are feeling ill,
You feel you need to see a doctor today.
Get out of bed
Telephone surgery + negotiate urgent appointment
Wash & Dressed
Negotiate stairs, have breakfast
Walk down path, cross the road,
Get on bus, pay fare, get off at correct stop
Check in at reception
Respond to call system
Find Dr , communicate needs, get on couch to be examined
Got to chemist
Sign and pay for prescriptionSort out medicines
Choose and book a hospital appointment
ADL involved in seeing a doctor
Wake up – see, set, hear alarm
get out of bed
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
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
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.
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
Dependence vs. Independence
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 !!!
Pride and Prejudice
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
Sensory SS -Yew tree lodge /RNID shop (exempt VAT)
Alarms that are loud, vibrate (pillow) / flash vibrate, FIREALARMS , doorbell baby monitor gadgets
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
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
Physio, OT, Speech therapy
Tools for independence
Why can’t I have a wheelchair, then my son can push me around!
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)
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
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
Dr Elizabeth Howard
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
Medical certificate – Risk: benefit ---Therapeutic intervention ---
Forced into sick role
‘msg: work is dangerous ‘
Loss of confidence , self esteem, role in society
fear of return esp. depression
Loss of income
Delay in qualification
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
Needed for 8th day onward
( short term absence : self certificate from employer/ private )
CONSULTED that day/ previous day
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
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 !!
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.
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
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)
DS1500, Med 6 & RM7
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)
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
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
DLA vs. AA
Assessment at home or in centre
Care – Mobility – Duration of need
Cancer requiring chemo/ DXT automatic now to cover costs of illness