General Election Briefing #2

Disability Equality Scotland: General Election Briefing #2

Who We Are

Disability Equality Scotland (DES) is a member-led, Disabled People’s Organisation (DPO), working towards the inclusion and accessibility of all disabled people across Scotland in all of society.

Our work is based on a human rights approach, and we share the collective voices of disabled people to inform and influence policymaking decisions. We adhere to the social model of disability and are a proud member of the Independent Living Movement. DES also acts as the umbrella body for the Scottish Access Panel Network.

National Health Service and Social Security Reform:

Delivering a Compassionate Society

When DES undertook a poll concerning the general election priorities of our members, the future of the National Health Service (NHS) and Social Care sector was a key priority for disabled people.

The NHS founding principle of being free at the point of need is a cross-cutting belief across the political spectrum. In light of the COVID-19 pandemic and the changing demographics of Scotland, there is much debate about how the NHS and Social Care system should address these challenges.

Recent months have also seen the United Kingdom (UK) Government bring forward plans to reform the interface between social security and employment, when an individual is sick, or unable to work due to their impairments. Throughout the election campaign so far, we have seen parties set out their stall as to how they respond to the increases in

 

Access to Dentistry[1]

Our research undertaken in March 2023, found that 62% of respondents had been able to access NHS dental treatment in the previous year. The remaining 38% said they hadn’t.

There was a recognition that waiting times for treatment had gotten longer and this had been coupled with an increase in the number of dentists going private. As a result of more private practices, it has become more difficult for people to get an appointment unless they can afford to pay.

Furthermore, due to the treatment backlogs from the pandemic, as a result of cancellations people are having to wait longer for treatment.

However, when patients attend appointments, some disabled people are unable to access the surgery due to physical barriers and poor transport infrastructure. This lack of accessibility to the practice itself is wholly unacceptable. Disabled people told us:

“I had been struck from the records for my old practice because it was wheelchair inaccessible, and I hadn’t attended.”

“It has been difficult to get to the dentist, not because of COVID-19, but because of the lack of transport and problems with Motability.”

“My practice for NHS treatment does not have very good links to public transport so I sometimes have to rely on family to me there.”

 

NHS Pressures

While NHS Scotland is the remit of the Scottish Government, decisions about healthcare funding and patient experience are salient issues for all disabled people across the UK.

Our members survey from January 2023 reflected that 95% of respondents were worried about the pressures placed on the NHS.[2] In particular, the pressures placed upon staff are at the front of people’s minds. These pressures are related to workload, stress levels and having the appropriate resources to carry out duties. One member highlighted that:

“They are over-worked and under paid and they deserve more recognition for what they do.”

As a result of this, NHS staffing levels and staff retention are becoming an issue, which then intensifies the pressure for current staff and has a direct impact on patient wellbeing – including disabled people. Staff are over-stretched and unable to provide adequate care for patients with an insufficient number of beds and extremely long wait times – particularly so in emergency care.

It is however important to recognise that this is a problem that has been present long before now and that over-stretching is also present within outpatient care and general practice. Members informed us that:

“I have been a patient left in a corridor with a drip in for over 10 hours so have personal experience. The only time I saw staff was to change my drip, no food or even water was provided. I would not wish others to suffer the same or worse, however I know I’m certainly not alone. The NHS needs to be looked at because in no way does it do what it was set up to do.”

“While I am concerned about the pressure on the NHS at this point in time it is the same every year at this time and is nothing new… If this keeps going the way it is just now it is very likely that the system will collapse at some point in time during the Winter over the next few years.”

These concerns were shared by a large number of respondents to our survey. The (NHS) long waiting times and unsatisfactory standard of care is pushing disabled people towards private health treatment – despite this creating significant financial strain – or towards not seeking the medical help and intervention that they require.

This trend cannot be allowed to continue, and it underscores that for all patients, the NHS needs greater financial support from the public purse and that this has to be provided under the fiscal framework and block grant to the Scottish Parliament.

 

National Care Service and Social Care Challenges

There is much current debate around the National Care Service (NCS) and what this should look like. In 2021, DES members were asked if they thought that a NCS would improve Social Care in Scotland – with 79% saying that they thought it would.[3]

Our research shows that disabled people have various concerns around the delivery of the National Care Service and – while this is a devolved matter – decisions made regarding the social care system in England, influence the finances available to the Scottish Parliament.

Members told us that in terms of delivery of the service their main worries were:[4]

• A joined-up approach, while welcome, may run into challenges due to the lack of connection between services and service providers.
• That everyone can receive the same standard and quality of care. Respondents told us that the differences that existed between private care providers meant that those requiring support may not have the flexibility of service to deliver based on locality.
• One member pointed out that there are challenges retaining staff and having enough people entering the profession.

We note as well that the UK Government’s recent immigration changes exempted social care workers from the increases in the minimum salary threshold. However, this was caveated with a ban on bringing dependents and family members with them.[5] The assumption behind these proposals was to control net UK migration. Evidence from the Financial Times newspaper reflects that there was a 76% reduction in the number of health and care visas issued in the first 4 months of 2024.[6]

Given the staffing challenges facing the social care sector, careful reflection is required on how to overcome this challenge in the medium and longer term, especially given that Scotland has an ageing population, and more people may require social care in the future.

Due to the Covid pandemic and staffing challenges facing the social care sector, delayed discharge of patients is becoming an increasing concern for disabled people and communities across Scotland. Recent statistics from Public Health Scotland show that in April 2024, the length of delay is 28 days – which is greater than the 24 days in March 2024.[7]

The persistence of this issue means that people who are able to go home are held in hospital, with the most common reasons given for delays being health and social care-related reasons.[8] This, compounded by demographic and staffing challenges within the social care sector, leads us to conclude that in the medium to longer-term, there is a ‘ticking time bomb’ facing social care services in Scotland and how they are delivered.

While we do not have a solution, disabled people are rightly concerned about what this could mean for them personally – or loved ones longer term – if they were to need the support of the social care system.

All candidates should be fully aware of the above challenges, and we would urge those who are duly elected to ensure that due recognition and affirmative action is taken to defuse the time bomb facing our social care services.

 

NHS Privatisation

Throughout all our research there is a consistent thread of opposition to the privatisation of the NHS by any political party. Respondents told us that it feels there is a push towards a privatised British healthcare system, which continues to deprioritise improving the current NHS in terms of funding.

Moving towards a privatised system would be especially detrimental for disabled people and instead any incoming government must value and rebuild the current system. DES calls on all prospective parliamentary candidates to take all possible steps to ensure that the NHS is protected from privatisation and remains free at the point of use for all citizens.

Our members also urge candidates to be mindful of the impacts any changes to NHS funding in England will have on the monies available to the Scottish Government to spend on the NHS in Scotland.

We also reinforce our members’ collective view that the National Care Service must be a not-for-profit and universal just like the NHS. We do recognise however, that there are private social care providers who do help deliver care. These businesses must be regulated in such a way to ensure that they comply with the principles espoused by our members.

 

Work Capability Assessment Proposals

In November 2023, in the Autumn Statement, the UK Government brought forward proposals to change the Work Capability Assessment (WCA) and to reform its application for people claiming health-related Universal Credit (UC) and Employment and Support Allowance (ESA), to take effect from 2025.

DES responded to the WCA consultation in October 2023 and have subsequently written to the Scottish Government’s Cabinet Secretary for Social Justice and the incumbent Secretary of State for Work and Pensions, prior to the election being called. Furthermore, we also sent a copy of our consultation response to the Scottish Members of Parliament (Westminster) and the Members of the Scottish Parliament.

When consulting on the UK Government’s WCA proposals, disabled people were unequivocal in their response. They vehemently disagreed with the proposed changes to the WCA put forward by the UK Government, due to the harm that they would do to disabled people.

There was agreement that social security systems must have conditionality, but that any future system, or programme of work preparation activities, must be co-designed with disabled people and/or disabled people organisations (DPO). Any programme of work preparation must adhere to the right of agency as set out in the respective United Nation (UN) charters. When assessing possible activities, this must be done with recognition of the barriers which disabled people face and that due regard is given to the disabled person’s experience and skills as a baseline.

The premise that every disabled person can work from home was not accepted, as employers have already rolled back on work-from-home provisions and that a full work-from-home approach applies to a relatively small number of actual vacancies.

A summary of our full response can be found here: Your Say on Disability: Our Response to the Work Capability Assessment – Disability Equality Scotland

We would urge candidates standing for election to commit to:

• abandon the WCA proposals put forward by the UK Government;
• the WCA assessment and support system being co-designed with disabled people, following international best practice and to comply with the UN Charters on Human Rights and the Rights of Persons with Disability.

 

Fit Note Reform[9]

The UK Government recently announced a call for evidence on ‘Fit Note’ reform. In May 2024, we consulted with our members on the proposals and 61% of respondents said that they had previously had to apply for a ‘fit note’.

When members interacted with the system many found this to be a positive experience due to the support they received from their general practitioner (GP). Respondents highlighted that:

“My Dr knew my medical history and I didn’t have to explain it every time I needed it extended. He’s been my Dr for a number of years and knows me as a person.”

“GP was good. I had serious physical health issues and could not work for many months. My GP kept in contact with me and I felt was best placed to understand all of my concerns about returning to work.”

“The GP always made this easy and left me feeling   supported and safe.  It also keeps less scrupulous employers from pressuring you.”

“Asked for one spoke to my Dr and the benefits and pit falls, ended up being kept off work for another two weeks as rushing back would have caused more lasting injury.”

The most common reason people cited that the process went well, was the trust that they had in their GP and the fact that their GP understood their condition/illness, alongside their medical history.

Additionally, when asked who should make the decision on whether someone needed a ‘fit note,’ respondents were overwhelmingly of the view that this should be their GP (91%) compared to an independent health care staff member (4%.). The primary reasons people said it should be their GP, was:

• that their GP know them well;
• their GP was the most qualified person and;
• their trust in the GP.

Members were strongly opposed to independent healthcare staff fulfilling the role of their GP due to:

• concerns around targets being set as part of contracts.
• previous experiences when interacting with private contractors who were asked to do assessments for benefits such as Personal Independence Payment (PIP).

Specific concerns expressed included:

“Disabled people have already been at the receiving end of so-called healthcare professionals from the private sector when being assessed for PIP. This has already got a disastrous track record in discriminating against disabled people so what difference with the similar system do except to discriminate, yet again, against disabled people.”

“Companies who operate for a profit should have absolutely no say on an individuals current or future health this should be the sole purpose of a patients general practitioner.”

“Look what happened when the DWP had private healthcare firms making decisions for people to receive PIP, DLA, etc. It was and remains farcical. The Government need to increase the GP’s so that Fit Notes are completed by someone who has a higher chance of knowing the individual and how much their ill health affects them.”

“Doctors are qualified to say what is wrong with you. It should not be done by people at a private company who will probably have targets to hit.”

We also asked our members when the correct time was to get advice on the management of a condition:

• 49% said that when someone receives their ‘fit note’ they should receive advice and;
• 40% said that it should be via a meeting between the person, their GP, and their employer.

Overall, our members told us that they were very much opposed to the proposals contained within the call for evidence. We would urge candidates standing for election to commit to:

• Retaining GP’s abilities to issue a ‘fit note’ to any person requiring it.
• Consideration of a refreshed approach to the point at which support, and advice is received to include discussions between a disabled person, their employer, and their GP.
• A moratorium on the role of private companies being contracted/ sub-contracted to make decisions around fitness for work and any associated social security assessments.

 

Further Information

For further information on any aspect of this briefing paper, please contact us via research@disabilityequality.scot

[1] Weekly Poll Access to Access to Dentistry, Disability Equality Scotland, 2023, (Unpublished data)

[2] Weekly Poll- Pressure on the NHS – Disability Equality Scotland

[3] Weekly Poll – National Care Service (Week Beginning 5 April 2021) – Disability Equality Scotland

[4] Weekly Poll – National Care Service: Access to Care and Support (Week Beginning 4 October 2021) – Disability Equality Scotland

[5] Changes to legal migration rules for family and work visas in 2024 – House of Commons Library (parliament.uk)

[6] Visa applications from care workers drop sharply as UK migration curbs bite (ft.com)

[7] Delayed discharges in NHSScotland monthly – Figures for April 2024 – Delayed discharges in NHSScotland monthly – Publications – Public Health Scotland

[8] Table 1 Standard delay reasons; Delayed discharges in NHSScotland monthly – Figures for April 2024 – Delayed discharges in NHSScotland monthly – Publications – Public Health Scotland

[9] “Fit Note Reform: UK Government Consultation”; Disability Equality Scotland, 2024. This section is a published analysis of data.  (Data not published on website.)