Category Archives: Disability

Wheelchair Selection

Physical therapists equate buying a first wheelchair to buying a car. It can be just as complicated because there are so many different options, making it very confusing. Add to this the painful emotions that are often connected to getting a first wheelchair for some people. All this can make it an overwhelming experience.

There is much more to a wheelchair than it looks. Unfortunately, provided with a wheelchair that was ordered/purchased on their behalf, and a newly injured person has no idea as to what measurements and features are ideal for their specific situation. As a result, people are often given a chair that is not properly set for them from the beginning. There are some things to consider that should influence your decisions when buying your 1st wheelchair.

Wheelchair users vary in age, gender, body type, and reason for using a wheelchair, potential activities within the wheelchair, where the wheelchair will be used, and preferences. It is important to consider all these things, as well as the fact the user will be using this wheelchair for approximately 5 years, before moving on to the next chair.

The Wheelchair Evaluation Process

Some questions that should be considered before speaking to an evaluation team:

Where will the chair be used most?

At home? At school/office? Outside? Where the wheelchair is used determines the type and size of the tyres needed.

How will the user get the wheelchair and themselves from location to location?

Whether the user independently pushes themselves, or is pushed by someone else, will determine the type of tyres used as well, also the height and weight of the chair.

How much of the day will the person be in the wheelchair?

If the user will spend most or all of the day in the chair, it is very important to ensure they are as comfortable as possible, while still having the freedom to move as needed.

How will the user transfer from the wheelchair to other locations?

Whether the user is able to move in and out of the chair themselves will play a factor in the height of the chair and seat. The seat may need to be low enough to encourage independent getting in and out. Alternatively, it may need to be higher so a caregiver can lift the user easily.

Will a folding frame or rigid frame be required?
It is necessary to consider any transportation requirements for the chair and user. If the user will not need to remain in the chair all day, and plans to travel with the chair fairly often, it may be worth considering a folding wheelchair that can fit in the boot of a car. While foldable wheelchairs frames are more flexible, generally they are heavier than rigid frame wheelchairs. Rigid framed wheelchairs are better on hard surfaces. Another plus about rigid wheelchairs is that they come in various colours, whereas folding wheelchairs look like the types that are seen in hospitals. Another factor to consider is how independent the user will be. To collapse a folding wheelchair and place it in a vehicle, it is necessary to be standing. If the user is unable to stand, they will not be able to put their chair into the car without help. A rigid wheelchair can be quickly broken down by removing the wheels, and then put into the backseat.

These are just a few questions to consider starting things off. The variety of options and features available to wheelchair users can help ensure a good fit. Discuss any special considerations with Karma Mobility to avail the wheelchair that ably fits the need.

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Much has been written about the Work Capability Assessment, including the fact that it was deemed as being fatally flawed by the Work and Pensions Select Committee : ‘The flaws in the Employment and Support Allowance system are so grave that simply “rebranding” the assessment used to determine eligibility for Employment and Support Allowance the Work Capability Assessment by appointing a new contractor will not solve the problems, says the Work and Pensions Committee in a report published in July 2014.’

The Work Capability Assessment was introduced by the New Labour government in 2008 and was exclusively conducted by Atos Healthcare until March 2015. The assessment is mandatory for recipients of Incapacity Benefit being migrated to the Employment and Support Allowance and for all new ESA applicants. Following much controversy, Atos Healthcare announced that they would withdraw early from the Department for Work and Pensions contract to conduct the Work Capability Assessment,

The plan to ‘dismantle the welfare state’ was first suggested by the 1982 Thatcher governmentand has been relentlessly pursued by successive United Kingdom (UK) governments. Hence, in the Coalition government’s response to the select committee’s evidence,5 the Minister for Disabled People, Mark Harper MP, disregarded the very detailed information provided by the Work and Pensions Select Committee report that clearly listed the many serious problems still faced by those who must endure the Work Capability Assessment, to access the ESA benefit.

Government resistance to funding long-term out of work illness/disability benefits followed the 2005 publication of the monograph: The Scientific and Conceptual Basis of Incapacity Benefits by Gordon Waddell and Mansel Aylward6, followed by the 2006 report: Is work good for your health and well-being by Gordon Waddell and Kim Burton.7

What is constantly overlooked is that both these influential reports were commissioned by the DWP. They were both produced when Aylward and Waddell were funded by Unum Provident Insurance at the Unum Provident Centre for Psychosocial and Disability Research at Cardiff University, with funding by the American corporate insurance giant, Unum Provident, from 2003-2009. Aylward is listed as the DWP Chief Medical Adviser until April 20058 and is identified as being appointed as the new Director of the Centre from 2004.9

The influence of Unum Provident Insurance is demonstrated in the memorandums provided for past WPSC reports10 that clearly list the transformation of Incapacity Benefit to Employment and Support Allowance. The requirement to ‘resist diagnosis’, ‘revise the ‘sick note’, ‘encourage the Government to focus on ability and not disability’, ‘change the name of Incapacity Benefit’ and ‘benefits not to be given on the basis of a certain disability or illness but on capacity assessments’ have all come to pass as Unum Provident Insurance have influenced UK Government welfare policy since 1994.11

“At UnumProvident we have a non-medical, enabling model of rehabilitation and we are working with our partners at the UnumProvident Centre for Psychosocial and Disability Research at Cardiff University to better understand what places people at risk of long-term or chronic illness. Further information about this model can be made available to the committee”. (item 24) Supplementary memorandum submitted by UnumProvident9

The Scientific and Conceptual Basis of Incapacity Benefits  was, essentially, the blue print for the future introduction of the Work Capability Assessment, using a discredited bio-psychosocial model of assessment as planned following the New Labour conference in November 2001: Malingering and Illness Deception,12 with Aylward as a contributor and ‘malingering’ very firmly planted as being the motivation for claimants of disability benefits. Guilty until proven innocent was the mind-set that continues to this day. ‘And the methodology used by Waddell and Aylward is the same one that informs the work of UnumProvident.’

The 2001 New Labour conference12, together with the 20056 and 20067 reports commissioned by the DWP, led to the 2006 Green Paper: A New Deal for Welfare: empowering people to work – an independent assessment of the arguments for the proposed Incapacity Benefit reform.13  The Scientific and Conceptual Basis of Incapacity Benefits was the main reference used to justify future drastic welfare reforms, which was exposed by Emeritus Professor Alison Ravetz as being seriously flawed.14  On closer examination, it appears that this entire body of work  is largely self-referential – that is, it appeals for validation to itself and is framed within the same political and policy agenda… It is not research undertaken in the spirit of open enquiry. It is commissioned research and, as such, pre-disposed towards ideologically determined outcomes.

Not to be confused with a medical assessment, the Work Capability Assessment is described as a ‘functional assessment15 using an IT tick-box questionnaire and totally disregarding diagnosis.

The influential 2007 report by the unelected David Freud,16 promoted the use of the private sector in welfare reforms when adviser to the New Labour Party and before being appointed as the Minister for Welfare Reforms in 2010 by the Coalition government. Subsequently, the Work Capability Assessment was sub-contracted to Atos Healthcare in 2008 and according to the General Medical Council, Atos Healthcare ‘have total immunity from all medical regulation.’17,18

The Work Capability Assessment uses a manipulated biopsychosocial  model of assessment, designed in consultation with Unum Provident Insurance17,18,19,20 and is a replica of the discredited healthcare insurance assessment model historically used by Unum Provident Insurance to resist funding insurance claims.21 The LiMA IT programme used for the Work Capability Assessment was designed by Atos Origin IT Ltd, the parent company of Atos Healthcare, for exclusive use for DWP assessments.22

The original 1977 biopsychosocial model of assessment was attributed to psychiatrist George Engel.23 Engel’s biopsychosocial hypothesis was to consider the social and psychological factors, together with the biological factors impacting on illness. It was an unproven theory that needed research. Ten years ago Professor Christopher Butler and colleagues produced a paper demonstrating that the bio-psychosocial model of assessment was ‘found wanting’ and inadequate. ‘Medically unexplained symptoms: the biopsychosocial model found wanting24 was referring to the original Engel biopsychosocial hypothesis.

Yet, a manipulated version of the Engel biopsychosocial assessment model, emphasising the possible psychological factors of disability and disregarding the biomedical factors, is used by Unum Provident Insurance and by the DWP as a method of removing as many chronically sick and disabled people as possible from funding, or preventing access to it.17,18,19,20,21

Unum Provident Insurance were fined $31.7 million in 2003 in a class action law suit in California for running ‘disability denial factories’18 and $15 million in 2005 by the California Department of Insurance Commissioner, John Garamendi, who stated that Unum Provident is an outlaw company. It is a company that has operated in an illegal fashion for years…’25,26

By 2006 the State insurance commissioners of 48 American States approved a settlement in an investigation of the Unum Provident Corporation that required the healthcare insurance giant to reconsider 200,000 claims and to pay $15million in fines27 whilst not forgetting, at the same time as these fines in America for malpractice, the company were funding Aylward and Waddell at the Centre at Cardiff University.

Unum Provident Insurance changed its name to Unum Insurance in 2007 to distance itself from increasing negative publicity for identified malpractice. Yet, the only opinions considered by the DWP regarding the benefits of work and the assessment model used to assess disability benefit claimants are those of Aylward and Waddell, whose research was sponsored until 2009 by Unum (Provident) Insurance; identified by the American Association of Justice in 2008 as the second most discredited insurance company in America.28

In January 2007 Professor John Langbein of the Yale School of Law produced a paper identifying the ‘The Unum Provident Scandal29 that exposed Unum’s practice of disability denial, and in November 2007 BBC News reported that the British government were being advised by an American insurance company with a reputation for ‘racketeering’.30

Employees interviewed on the Dateline program disclosed that the claims that were “the most vulnerable” to pressures for bad faith termination were those involving “so-called subjective illnesses, illnesses that don’t show up on xrays or MRIs, like mental illness, chronic pain, migraines, or even Parkinson’s.”

The Dateline story pointed to an internal company email cautioning a group of claims staff that they had one week remaining to “close,” that is, deny, eighteen more claims in order to meet desired targets.

 

Concerns have been expressed in a government inquiry regarding Aylward’s long association with Unum (Provident) Insurance, including links with the American corporate insurance giant when Chief Medical Adviser at the DWP from 1996 – 2005. To date there has been no formal investigation following the evidence by Professor Malcolm Hooper to the 2005 Gibson Parliamentary Inquiry.31:

‘There would also appear to have been a clear financial conflict of interest and possible breach of Civil Service protocol, in that a senior Civil Servant such as Aylward could not have been unaware while he was in post at the DWP that Unum Provident was already financing his next employment, which would allow him to indulge in his existing conviction that syndromes such as ME/CFS are affected by ‘cultural’ factors and are ‘behavioural’ in nature. It is also a matter of concern that a senior Civil Servant accepted sponsorship from a company with Unum’s track record.’

After various freedom of information requests, the DWP published the mortality figures of the claimants who had died in 11 months in 2011 whilst claiming Employment and Support Allowance,32 with 10,600 people dying in total and 1300 people dying after being removed from the guaranteed monthly benefit, placed into the work related activity group regardless of diagnosis, forced to prepare for work and then died trying. Following the public outrage once the figures were published, the DWP have consistently refused to publish updated death totals.

Unum (Provident) Insurance exposed their significant influence in the memorandum following the publication of the Welfare Reform Green Paper. Their influence has also been exposed since 2011 by the Disability News Service,33 with reports by the British Medical Association34 and the Royal College of Nursing 35 that confirmed that the Work Capability Assessment was causing ‘preventable harm’ as chronically sick and disabled people now starve to death in the UK.36

Constant toxic rhetoric by the Secretary of State and various DWP Ministers from the Coalition government, supported by the national press quoting their often extreme comments, have successfully convinced the British public that vast numbers of chronically sick and disabled people are ‘shirkers and scroungers’ and disability hate crimes are the highest ever recorded, as identified in a 2014 bulletin by the Home Office:  ‘Hate Crimes, England and Wales, 2013/1437

CONCLUSION

Fifteen years ago Unum Provident Insurance was exposed in Parliament in the 1999 Permanent Health Insurance debate,38 where MPs identified the suffering of constituents as Unum Provident Insurance refused to pay out on income protection insurance policies. Given this company’s proven record of sustained misconduct and recorded malpractice over many years, one must surely enquire as to why this company have been advisers to the UK government on welfare reforms for the last 20 years.

The constant reference to ‘disabled people’ by DWP Ministers, whilst disregarding those with catastrophic illnesses, adds to the ongoing human suffering of the most vulnerable people in the UK. They are far too ill to consider working39 but they now live in fear of claiming the income related benefit needed for their very survival, as the Coalition government consider all Employment and Support Allowance applicants as potential malingerers, thanks to Professor Aylward’s influence, regardless of what can be a devastating diagnosis.40

REFERENCES:

  1. W&P 2014: ESA needs fundamental redesign, says MPs: July 2014 DWP Work & Pensions Select Committee  23rd July 2014: News release
  2. CROSS M: 2013: demonized, impoverished and now forced into isolation: the fate of disabled people under austerity. Disability and Society Journal DOI:10.1080/09687599.2013.808087
  3. W&P 2014: Work and Pensions Committee – First Report: The ESA and WCA Full report.
  4. The Guardian: 28th Dec 2012: Margaret Thatcher’s role in plan to dismantle welfare state revealed 
  5. DWP 2014: November, p4: Government Response to the House of Commons Work & Pensions Select Committee’s Report on Employment & Support Allowance & the Work Capability Assessment, First Report of session 2014-15 
  6. The Scientific & Conceptual Basis of  Incapacity Benefits. Gordon Waddell & Mansel Aylward 2005  ISBN: 9780117035843
  7. Waddell & Burton 2006: Is work good for your health and well-being? Gordon Waddell & A Kim Burton
  8. Institute of Primary Care & Public Health –  Professor Mansel Aylward
  9. Supplementary memorandum submitted by Unum Provident following the publication of the Welfare Reform Green Paper 2006
  10. Memorandum submitted by UnumProvident (EDP 03)
  11. Private Eye: In the back: Welfare reform – mutual benefits Issue 1302 – 11th November 2011
  12. Rutherford J 2007: New Labour, the Market State and the End of Welfare Soundings Journal: 2007:  Issue 36   summer 2007
  13. DWP:2006: A new deal for welfare: Empowering people to work
  14. Ravetz A: 2006: March: Green Paper: A New Deal for Welfare Centre for Disability Studies, Leeds University
  15. Litchfield P: 2013, p7: An independent review of the WCA, year 4, 2013
  16. Freud D: 2007, p5: Reducing dependency, increasing opportunity: options for the future of welfare to work. An independent report for the DWP by David Freud. May 2007 page 5. ISBN: 978 1 847 12 193 6
  17. Stewart M: 2011: Welfare Reform – Redress for the disabled 
  18. Stewart M: 2010: Atos Healthcare or Disability Denial Factories 
  19. Jolly D: 2012: A Tale of Two Models: Disabled people vs Unum, Atos, Government and disability charities
  20. Stewart M: 2012: Government use the might of American insurance giant to destroy UK         safety   net.     
  21. Bach M: 2011: UNUM and Business: how Unum have influenced UK Government policy to the detriment of disabled people.
  22. Bach M: 2013: LiMA tick box assessment 
  23. Engel G:1977: The need for a new model: a challenge for biomedicine. Dr George Engel  Science Journal; 8th  April 1977, Volume 196 number 4286 p 129-136
  24. Butler C, Evans M, Greaves D, Simpson S 2004: Medically unexplained symptoms: the biopsychosocial model found wanting.  The Journal of the Royal Society of Medicine:: JRSM 2004, 97:219-222 
  25. Unum Complaints: An Outlaw Company” – Online Lawyer Source 
  26. LA Times: 2005: State fines insurer, orders reforms of disability cases.
  27.  State Insurance Commissioners reach settlement with Unum Provident:  Insure.com
  28. The ten worst insurance companies in America. The American Association  of  Justice 2008
  29. Langbein J: 2007: p1318 The Unum Provident Scandal – The Yale Law School 
  30.  Government advised by ‘racketeers’ BBC News 6th   Nov 2007
  31. Hooper M: 2005: Concerns about a commercial conflict of interest underlying the DWP handbook entry on ME  and CFS The Gibson Parliamentary Inquiry – Dec 2005
  32. DWP: July 2012: Incapacity  Benefits: Deaths of  recipients 
  33. Disability News Service: Feb 2013: Unum bragged about ‘driving government thinking’ on incapacity benefit reform
  34. BMA: 2012: Scrap WCA doctors demand at the annual representative meeting. The British Medical Association
  35.  The Royal College of Nurses Congress: Disability assessmentsThe  Royal  College of       Nursing Congress April 2013
  36. The Guardian: Vulnerable man starved to death after benefits were cut 
  37. Hate Crimes, England and Wales, 2013/14 p9 – Home Office Statistical Bulletin
  38.  Permanent Health Insurance debate; House of Commons, Westminster Hall, 21st December 1999. 
  39. Mental Welfare Commission for Scotland: Who benefits? The benefits assessment and death of Mrs DE. Investigative report.
  40. Stewart M 2014: UK Government refuse to accept responsibility for crimes against humanity.

This was first published on Researchgate

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Switching from “one size fits all” to a personalised approach based on free open source kitchen  design software could dramatically slash the annual cost of adapting the homes of elderly patients on their discharge from hospital.

Research from occupational therapy and computer science academics from Brunel University London shows that more than half of the costly equipment from shower chairs to grab rails installed in their homes for such patients is ever actually used.

The Brunel solution could also speed up the whole process of pre-discharge home visits by occupational therapists (OTs) relieving hospitals of “bed-blocking” elderly patients who are healthy enough to go home at a further cost of more than £500 a night.

Explained Dr Arthur Money, who led the team: “Pre-discharge home visits are routinely carried out to make sure the transfer from hospital to home is safe for the patient.

“But there are issues not only with the speed of the process but the lack of shared decision making which leads to more than half of assistive equipment installed not having been used when OTs make follow-up visits.”

He added: “While some adaptations may fall into the not-needed-yet-but-will-be-category, many patients end up with equipment they don’t understand how to use or is useless because it is installed at the wrong height.

“And many patients find the home visit itself demoralising, daunting and anxiety provoking. Our software turns the home visit into a collaboration between patient and OT.”

Dr Atwal (left) and Dr Money

Dr Atwal (left) and Dr Money

OT lecturer Dr Anita Atwal says the software also helps bridge the information gap where elderly people are not quite sure what a piece of equipment is or does but are reluctant to show their ignorance to an expert.

“As OTs one of the most striking lessons from the research is when older people were placing items of what to us is part of our everyday work in the wrong places – quite clearly not understanding what the equipment was for.”

Fellow Brunel OT lecturer Lesley Wilson added: “It also became clear that while the hacked interior design software is a great tool for both patient and OT it needs to be used in a partnership approach.

“Older people using it hands-on in our study were very clear they saw it as a great tool but one to be used together with their OT. And many have already encountered versions on the High Street from estate agents to kitchen design outlets.”

The team plans further developments to the software in the next phase of the research including the ability to introduce the patient into their adapted virtual home by building accurate to real-life scale avatars.

Said Dr Money: “Just in the same way as different people want a different kitchen counter height items such as grab and hand rails need to be installed at a comfortable height for the patient.  Introducing avatars will help OTs get that aspect right.”

Using the Technology Acceptance Model to explore community dwelling older adults’ perceptions of a 3D interior design application to facilitate pre-discharge home adaptations

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Personal budgets are in the headlines after Pulse published research based on FOI requests to CCGs.  The headline on BBC’s Today programme was “Treats instead of Treatments” and the line promoted by Pulse was that Personal Health Budgets (PHBs) lead to inappropriate ‘non-evidenced based’ spending by the NHS. The examples provided included a summer house, a Wii Fit consul, an iRobot, holidays, horse-riding, music lessons and a sat nav device; or as Pulse put it in their scare headline:

“NHS allows patients to splash cash on holidays, summer houses and Wii Fits.”

Interestingly this shock headline generated the most intense media interest in the idea of a personal budgets in my career. I have been working on these ideas since 1990, and invented the concept of personal budget.  I have seen how powerful it can be for people to have more control, choice and creativity in their lives; although I’m also very aware of how good ideas can come unstuck and be corrupted.

Thomas Edison once said of innovation, “The worst is to come, for it takes about seven years to convert the average man to the acceptance of a solved problem.” However I think that when it comes to the welfare state seven years is something of an under-estimate. Government can both resist and distort innovations, and the normal rules of human behaviour don’t apply when you are dealing with vested interests of the civil servants, politicians and the professional establishment. As Robert Townsend put it:

“It’s a poor bureaucrat who can’t stall a good idea until even its sponsor is relieved to see it dead and officially buried.”

However, once Government does get hold of an idea then everything changes. After the New Labour Government became enthused by these ideas in 2005 I watched them, quite naturally, slip from my control, and that was a humbling experience. So it was interesting for me to find myself defending personal health budgets on the BBC and Sky when they are now being implemented by a Government that I despise.

Looking at the report by Pulse in detail is also interesting, both for what it reveals and for what it hides. It provides a useful indication of the overall level of spending on PHBs, estimated at £123 million per year for 2015-16, which is just over 0.1% of NHS spending. Yet I suspect that the amount spent on things Pulse deems inappropriate must be minuscule, and I could find no relevant data.

Furthermore we learn that the number of people using PHBs is 4,800, which suggests an average package cost for individuals of £25,600. This is a significant sum and it probably reflects the fact that PHBs have been targeted on those people with most significant needs, often people on continuing care packages. However, this fact, and the significant needs of those using PHBs, was not mentioned in the report.

Another interesting point raised by Pulse was the fact that, in a survey of more than 1,500 patients by the Patient Information Forum, more than half of patients with long-term conditions felt they would be ‘unable to make decisions’ on spending a PHB. I must admit to be confused here. Surely this means that a significant number of people do feel ready to make such decisions. That sounds like a great starting point for an emerging innovation like PHBs. There is clearly significant interest and demand already.

The Pulse report also touches on some of the real issues, for example: How do we define who is eligible and what level of funding should be made available? Dr Brian Fisher rightly suggests these issues are critical and that without the necessary controls PHBs could become unaffordable. However I doubt this is the main risk for the current programme. Progress in implantation remains slow and getting a PHB is far from easy. If funding levels are successfully set around current norms then the programme will continue to generate efficiencies – not increased costs. However effective implementation will be vital if efficiency is to be guaranteed.

In contrast to this, Pulse also argues that these individual arrangements may lead to the opposite problem – increased cost-cutting. In the UK’s current context I suspect this is the bigger risk. Monolithic and institutional services are much harder to cut and much easier to defend; and while the 30% cut to social care in England may not have been caused by the use of personal budgets it certainly certainly hasn’t help to defend social care from this assault.

However the one example of cost-cutting provided by Pulse is problematic. Pulse cites a day centre that was forced to close because its funding had been put into personal health budgets. I must say this sounds quite odd to me. NHS money isn’t labelled in advance like this. Surely if the money ear-marked for personal health budgets (0.1% of spend) could not be used to fund the day centre then some of the other (99.9%) NHS spending could have been used? It sounds to me like somebody’s been making up excuses:

“Sorry, we just had to close your day centre so as to fund these wacky personal health budgets.”

In reality there was clearly not enough support from within the CCG to justify funding the day centre. More importantly, this touches on a profound weakness in the Pulse argument. If personal health budgets are of any value then they must allow people to change how money is currently used. If money is used differently then it cannot be used on the things that it was spent on in the past. Is this really a bad thing? Do services have a divine right to exist? Moreover, while Pulse questions the evidence base of PHBs, what is the evidence base for mental health day centres? People do not use day centres because it is a carefully thought through and personalised solutions to their needs. People use day centres because that is where the system has historically invested money.

The final major criticism mentioned by Pulse (although interestingly not picked up by any of the media I spoke to on the day) was the ideological question: isn’t personalisation just a right-wing neoliberal idea? Now, personally, this is the most puzzling criticism for me. I am still struggling to understand how shifting socio-economic power to disabled people or to people with long-term health conditions is right-wing. I still don’t understand why leaving power with the NHS bureaucracy or medical establishment is left-wing. We’ve got something very muddled here.

Of course I can see that there is a severe danger that the current trend to ‘target’ ‘means-test’ and ‘privatise’ may be used to undermine the principles of the NHS. However I suspect that the real risk comes from the 8-9% of NHS spending that has already been privatised to the likes of Virgin.  It is private companies, not citizens and patients, who will eventually undermine the NHS, if we choose to let them.

Behind the headlines and the arguments what is clear is that many in the medical establishment are not convinced of the benefits of PHBs and are now willing to be much more aggressive in their resistance to their expansion. So, the question we must ask is why? I can see at least two possible hypotheses:

  1. Senior doctors and others are genuinely concerned with the well being of the welfare state. They wish to defend the principles of free and universal services and to reduce inequality and poverty in the UK and they genuinely believe that personal health budgets threaten the welfare state.

OR

  1. Senior doctors don’t want to share power with patients. They are worried they will lose control and that ordinary citizens will have more control individually and may start to ask more challenging questions collectively.

Both these hypotheses would explain the extreme scaremongering that we find in the Pulse report. I hope the first hypothesis is true. For if it is the first hypothesis that is true then, over time, more and more doctors will see the benefit of personal health budgets and will understand that it doesn’t have to threaten the NHS but can be part of extending the principles upon which the NHS was built. Personal and citizen empowerment is what the NHS should be about.

Moreover if these current fears reflect a real commitment to social justice then I expect to see the BMA and other leading professional bodies come into alliance with disabled people, trade unions and with the braver charities, in order to challenge the current Government’s vicious attack on the welfare state. We will see active protests to:

  • The selling off of the NHS
  • Deep cuts to social care and the means-testing of social care
  • Cutting benefits, especially for disabled people and people who are sick

One interesting test is coming up soon, for the UK Government is currently being investigated by the UN for breaching the human rights of disabled people. I look forward to clear and powerful statements by the BMA supporting the rights of disabled people to have the resources that are necessary for them to be full citizens – whether those resources come from the NHS or from elsewhere.

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A long-awaited information standard was launched on July 3 by NHS England that will improve healthcare for millions of people has been welcomed by Action on Hearing Loss (formerly RNID).

The standard requires all NHS and adult social care organisations to meet the communication needs of people with a disability, impairment or sensory loss by 31st July 2016, including the one in six people living with a hearing loss. It will include making sure patients get information in suitable formats and that, if needed, support from British Sign Language (BSL) interpreters is guaranteed.

A survey of over 600 people with different levels of hearing loss to explore the experiences they have when accessing healthcare found:

  • One in seven respondents (14%) had missed an appointment because they had missed being called in the waiting room.
  • more than one-quarter (28%) of people with hearing loss had been left unclear about their condition because of communication problems with their GP or nurse
  • 68% of profoundly deaf British Sign Language (BSL) users asked for a sign language interpreter for a GP appointment but did not get one. 41% of BSL users left a health appointment feeling confused about their medical condition because they couldn’t understand the interpreter.
  • One in seven missed an appointment – the NHS estimates this costs £14 million in England every year due to missed appointments.

Roger Wicks, Action on Hearing Loss’s Director of Policy and Campaigns, said:

“It is vital that everybody understands the information and advice they receive from their GP or hospital. The Accessible Information Standard is the first time the NHS has provided clear guidance on what people with hearing loss and deafness should expect from health and social care services, and what staff should provide. So long as it’s properly implemented, it will enable patients to access services, to understand information they are given, to manage their own health and to participate fully in decisions about their treatment – things that many of us take for granted. While it can’t be denied that these adjustments will come at a cost, it’s now time for providers to acknowledge hearing loss for the serious health issue that it is, and to reap the benefits of enabling proper access.”

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Anyone who has had repetitive strain injury will tell you how painful and chronic it is. If you’re currently suffering from this type of injury, there is hope. Here’s how to work around it, recover, and become stronger.

Legal Considerations

Maybe you haven’t approached your employer just yet about your pain. If you’ve injured yourself at work, however, you need to get on it. Even if you don’t think that the response will be a positive one, you need to at least make an attempt.

This establishes a record of the incident. When you injure yourself on the job, your employer is legally responsible for you and there is employer’s liability insurance that covers it. When you don’t report it, however, the insurance can’t cover any of your medical treatments.

If your employer puts up resistance, it’s not the end of the world. You can (and should) seek legal assistance. According to www.slatergordon.co.uk, slips and falls, repetitive strains, and other injuries aren’t all that uncommon anymore.

With employers putting strict deadlines on jobs, expecting more out of their employees, and pushing every project harder, there’s a higher risk for injury.

And, if your employer isn’t willing to accept responsibility, a lawyer may be more persuasive than you can be.

Preventative Measures and Self-Help

Repetitive strain injuries, or RSIs, have a wide range of symptoms which include pain and tenderness in the muscles and joints. You’ll probably notice symptoms the most when you’re engaging in demanding activities that caused them.

Even if you don’t know exactly what caused your injury, the pain will help you deduce that.

Some symptoms include a sharp or dull ache or pain, stiffness, tingling, numbness, cramps, or weakness.

The pain might get worse over time, which might make you think you’ve suffered a serious injury. It may be so bad that you’re unable to do regular housework, not to mention your job.

Preventative measures focus on avoidance and active treatments. Splitting up work and doing tasks in different orders, rather than concentrating on one job for two or three days at a time, or doing the same tasks every day, in the same order, can help alleviate symptoms.

In other words, mix things up at work and don’t follow the same old routine – that’s how you got injured.

Work with your employer to find alternative ways of doing things. Periodically look at distant objects through a window if you spend a lot of time staring at a computer screen. For every 20 minutes you’re looking at a computer screen, look outside at least objects in the distance for at least a minute or two.

This helps relax the eyes.

Learn to touch-type at work if you work on a keyboard. This method uses all of your fingers an thumbs and enables you to look up at the screen instead of craning your head down to look at your fingers on the keyboard.

Finally, take regular breaks from work. For every hour you spend sitting, stand for 5 to 10 minutes.

Treatment

Medical treatment isn’t necessarily a last-ditch effort or option, but it does involve more work. You will need to get treatment when your RSI becomes intractable. A physiotherapist or occupational therapist can help relieve discomfort, design corrective exercises, and help with massage, acupuncture, chiropractic care, and a multitude of other modalities.

Jonathan Creswick is an experienced healthcare professional. He is always willing to share his tips and insights online. You can find a number of different articles written by him on different websites.

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A recent article in the Guardian drew attention to the BBC’s current efforts to increase the numbers of disabled people on and off-screen. Tania Motie and Tanni Grey-Thompson argued that there are three stereotypes applied to disabled people – we are heroes, scroungers or brave victims. The BBC, they wrote, has a role in challenging this, and that:

Sophisticated, multi-faceted, authentic portrayal influenced by disabled people will really help to break down barriers and allow disability to become part of the DNA of our society.

This reminded me of how, 23 years ago, in 1992 – which like 2015 was also a general election year – the BBC launched a series of programmes made with and about disabled people, together with a booklet and poster advertising.  The series and the booklet were called Disabled Lives:we wanted to call it Disabling Society but Channel 4 had got there first with their own series that same year. The initiative resulted from an Advisory Group made up of disabled people brought together by the BBC to help them  develop programmes which challenged the stereotypical and unrealistic ways in which disabled people’s lives were portrayed.It sounds familiar doesn’t it? But there were some differences.
The key difference is that, in 1992, disability was increasingly being identified as a civil rights issue, whereas today public debate is dominated by arguments and counter-arguments about whether we are ‘scroungers’ or ‘vulnerable’.The 1992 booklet said that it, and the BBC series of programmes, was about:

one of the most exciting civil rights issues of our times, the right of disabled people to participate equally and fully in the communities in which we live….Today, there is a growing movement of disabled people who insist that our lives have value and that we want to be treated as equal citizens with equal rights.

This was before the Disability Discrimination Act which was finally passed in 1995 after many years of campaigning.  The programmes and the publicity gave a voice to this demand for an end to discrimination, but also emphasised the importance of changing the dominant cultural representations of disabled people, arguing – as Elspeth Morrison (one of the Advisory Group’s members) put it:

If we have no representation of ourselves other than those images used in charities’ advertising, crippled witches in children’s books, brave and tragic media stuff, theatre and film’s metaphorical use of disability as social inadequacy, social decay – if there is no expression of life as we live, it, how do we begin to validate ourselves and learn about each other?

One of the photographs (taken by David Hevey) used in the booklet and in the posters  – was of the Direct Action Network holding up a bus in Manchester.  No buses were wheelchair accessible at that time and access to public transport was an important part of the campaign for anti-discrimination legislation. Independent living (having choice and control) was also a key focus, for people with the whole range of impairments and across all ages. The Independent Living Fund had been established in 1988 and more and more people with high levels of support needs were accessing it and starting to live the kind of lives their non-disabled peers took for granted. In general, more disabled people were demanding, and getting, their entitlements to support to enable them to go about their daily lives.

Organisations of disabled people (as opposed to the charities speaking for disabled people) were increasing in number and influence in the early 1990s, reflected in the fact that the people on the  BBC’s Advisory Group were mainly from organisations of disabled people.  The initiative encompassed Deaf people, people with physical and/or sensory impairments, people with non-evident impairments and health conditions, people with learning difficulties, mental health service users and older disabled people.  As People First (the organisation of people with learning difficulties) said:

  • We are for difference
  • For respecting difference
  • For allowing difference
  • Until difference
  • Doesn’t matter anymore.

In the early 1990s, the most influential stereotype of disabled people was of us as objects of pity, as tragic victims who, at best, could be admired for ‘overcoming’ against all odds, at worst were considered to have lives not worth living.  The response of a government Minister to one of the petitions calling for anti-discrimination legislation was to say that he didn’t believe employers discriminated against us, rather they felt sorry for us.

Nevertheless, in 1992 things were shifting.  In the run-up to the general election, the Conservative Party (in government since 1979) devoted a specific section in its Manifesto to commitments to disabled people, celebrating that:

Under the Conservatives, more disabled people than ever before are getting the help they need and deserve. Since 1979, the number receiving Attendance Allowance has more than trebled; the number receiving Mobility Allowance has risen six fold; the number receiving Invalid Care Allowance has risen 25-fold. Today we spend some £12,000 million a year on benefits for long-term sick and disabled people. Even after allowing for inflation, that is 2½ times as much as Labour spent in the 1970s.

The Tories promised to introduce “new disability benefits [Disability Living Allowance and Disability Working Allowance] which will, in the next Parliament, bring extra help to at least 300,000 people. By 1993-94 these and other improvements will mean that we will be directing an extra £300 million a year to long-term sick and disabled people.” They were proud of the “great success” of the Independent Living Fund and gave a manifesto commitment to maintaining it.
The Labour Party had very little to say about disabled people in their 1992 manifesto. There was a nod to ‘training’ opportunities, to health services for people with long-term conditions and to better community services for people using mental health services and for people with learning difficulties.  The Liberal Democrats’ manifesto had more, committing them to introduce a Citizen’s Income with a specific disability component, human rights legalisation (to include disability) and a Charter of Rights for disabled people.
In those days, very few people argued that too much was spent on disability benefits. Very few people thought that disabled and sick people were making false claims for out of work or disability benefits.
In fact, in 1992 the Conservative government felt that not enough disabled people were being helped and introduced new benefits for which more people were eligible.  Today the Coalition government argues that too many people are receiving help with the additional costs associated with impairment and disability. The Disability Living Allowance – which the Conservative government of the early 1990s was proud to introduce – has been abolished and replaced with Personal Independence Payment with the aim of reducing the budget by 20% and accompanied by such long delays in responding to claims that a Judicial Review has been granted of the process.

In 1992, the government were proud of the Independent Living Fund and vowed to keep it.  Today, they have abolished it and many people with high support needs are at risk of losing the ability that ILF funding gave them to live ‘ordinary lives’. In 1992, disability was a civil rights issue and we were on our way to getting the Disability Discrimination Act, enacted by the Conservative government in 1995.  Today, access to justice under the legislation has been severely undermined by cuts in legal aid,  and the introduction of fees for taking a case to an Employment Tribunal.

In 1992, public debate was about whether disabled people were to be pitied as the objects of charity and needed to be ‘looked after’, or whether we should have equal rights to access education, employment, independent living.  Today, public debate is about whether we are avoiding our responsibilities to seek employment and need conditions and sanctions to get us ‘off benefits’, or whether we are ‘vulnerable’.   Instead of recognising the additional support, and the removal of barriers, which are required in order for us to access the same opportunities as others, we are – in order to avoid being labelled as ‘scroungers’ –  once again forced into the role of tragic victims, where the legitimacy of our requirements is to be measured by how ‘vulnerable’, ill and/or impaired we are.

So if we are to avoid being identified as ‘scroungers’, we have to prove how ‘vulnerable’ we are made by our impairments, illness and/or age.  Yet ’vulnerability’ is created by the society in which we live – by lack of appropriate support, and by prejudicial attitudes. ‘Vulnerability’ is created, for example, by removing benefits from someone because they failed to fulfil conditions which illness, impairment and/or poverty made difficult for them to do. ‘Vulnerability’ is created by threatening to stop providing support to enable someone to go to the toilet when they need to. ‘Vulnerability’ is created by a lack of suitable, affordable housing for a family affected by illness and disability.

Tackling discrimination, removing barriers, providing appropriate support which gives us choice and control in our lives – none of these are on the agenda for public and policy debate anymore. Instead, our social worth is to be measured by whether we are ‘hard-working’, which means engaged in productive labour.  Other important social roles – looking after others, bringing up children, contributing to our friends, families and communities – are not deemed worthy of support or celebration.
The BBC’s current initiative – all these years after the 1992 initiative – to increase the numbers of visible, ‘happen to be’ disabled people on screen and to increase their employment off screen is laudable.  But we also need to change the language of public discourse about sick and disabled people.
In particular, we need politicians, and all those participating in public debate in the run up to the election in May, to change the way they talk about disabled people.  We need to revisit the language and images the disability movement tried so hard (with some considerable success) to promote during the 1980s and 1990s – language which returns to some of the hopes reflected in the BBC’s booklet all those years ago:

Disabled people are fighting for a society which celebrates difference, a society which does not react to physical, sensory or intellectual impairments, or emotional distress,, with fear and prejudice.  We want a society that recognises the difficulties we face, but which also values us for what we are.

Our hopes for the future are based on the justice of our wish for control over our lives, the strength of our demands for equal participation, the passion of our belief in the value of our contribution to the communities in which we live.

First published on Jenny Morris blog

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Leading an independent and fulfilled life is vital for all. As you get older or if you suffer from health problems, independence becomes increasingly more important. Mobility aids are a solution.

How to retain independence

The first thing to remember is that those whose life has changed as a result of age, illness or accident will be scared. They’ll worry about their future, how they will cope with their new lives, and the challenges and the problems that they may encounter. You should, therefore, help them to realise that even though they may need to adjust their lives, change, though inevitable is also viable. One way in which you can do this is to suggest that castors from Tente UK, can be fixed to beds and chairs in order to make these items of furniture more manoeuvrable. If your loved one is waiting to return home from hospital, then draw up a care plan for independent home living with the relevant care team.

Independence is possible for all

One way of coping with diminished walking ability, is to look at mobility aids. A recent article, published on The Economic and Social Research Council website, suggests that ‘ wellbeing is driven by psychological and social factors such as independence and social interaction, rather than income, education or home ownership.’ If your loved one has problems walking, or is scared of falling, a wheeled walker may be a solution. Wheeled walkers have brakes, so your loved one will feel in control of this appliance. These mobility aids are safer than walking sticks; and they can also be folded away, when not in use.

Mobility scooters are cool

Anyone who wants to lead an independent life, but has walking problems will want to invest in a mobility scooter. These wonderful machines will allow you freedom of movement and complete independence. Admittedly some drivers tend to use the scooters as if they were taking part in the Le Mans 24 hr race, but on the whole, these appliances will allow you the power to do what you want, when you want, and that’s important.

Stairlifts stop accidents

If you know someone that lives in a multiple storey house, and you are concerned about their ability to negotiate the stairs, then a stairlift is the answer. An article on the Age UK website suggests that these are the safest tools for anyone with mobility problems to make full use of the whole of their home. Younger family members may also find the stairlift useful if they have had too much to drink and want to reach their bedrooms, but that’s another matter entirely.

Caring for your loved ones at home

It’s difficult caring for a loved one who has mobility challenges. Before you rush out and buy any mobility aids, spend some time talking and listening to them. Find out what the priorities are. Ask for a physiotherapy assessment from the professionals. The best present you can give anyone is a hug and a cuddle.

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I am honoured to have been invited to write a response to Andy Burham’s recent speech on his vision for an integrated health service, in relation to how it affects disabled people. Before I begin I think I should assist in avoiding any confusion by explaining I am not that Simon Stevens, the one in control of health services in England. Instead, I am an independent disability consultant with 20 years experience of social care as a service user and someone working in the field in many ways.

Labour is promising a fully integrated health and social care system hailed as one service that meets everybody’s needs. It should be firstly noted this is very different to the parallel ‘National Care Service’ they were proposing just before the last election. While the integration of health and social care looks logical and promising, for disabled people of working age particularly, this concept could be quite damaging.

To understand this, it is important to explain some context. Labour left Government in 2010 when personalisation was the key theme of social care policy. It must be understood that personalisation was a professionals friendly step-down to full independent living as defined by the old disability movement. At this time, personalisation was already a disappointment to most as professionals have watered it down to meaningless words, but it was better than nothing.

The last 5 years has seen Winterbourne and the rise of the carers movement as the right of carers appears to have been given priority over service users by this Coalition government. At the same time, a new and vocal ‘sick and disabled’ movement has grown out of the opposition to the welfare reforms, demanding welfare over inclusion and independent living, leaving many disabled people, particularly those with high support needs, out of the political agenda. This means Labour has lost its historical links with the independent living agenda as it now simply sees disability as a welfare issue as it promises to deliver Iain Duncan Smith’s reforms better than he could.

This means the integration agenda could be a convenient opportunity to retire personalisation as the priority appears now to be reducing hospital admissions and bed blocking, rather than a quality of life as social beings which people require to be included and active citizens. The priorities scare me because it has the potential to undo social care and under the control of health, potentially revive long-stay hospitals as a convenient way to cheaply manage people.

Social care is not just about preventing falls or allowing quicker hospital discharges. If we add the ever growing power of the carers movement, which has mostly squashed independent living out of the agenda, I predict things can only get worse for disabled people unless there is a major shift in the culture of health and social care towards independent living and including social based outcomes. It is highlighted by Andy Burham’s remark that ‘severely’ disabled children now live longer and may even need adult services. This is a very odd thing to say as it is firstly totally out of date as there is not a sudden crisis in the transition between child and adult services, a problem that has always existed. But more worrying is that it shows some welfarist prejudice, as he suggests children with high support needs just need warehousing, under the direction of their carers (as no one has parents anymore), to continue into adulthood as the need for a decent education and employment opportunities appears to be irrelevant.

Labour’s policy is confirming the general welfarist thinking on disabled people in terms of those fit for society and employment opportunities, and those who are unfit for society. When Labour still wants to ‘look after’ old people like they are all war heroes without a mind of their own, it is clear disabled people who require social care are automatically deemed unfit for society, mindless objects of pity who will be controlled by this integrated system.

I want Labour to be fully committed to independent living and inclusion for all regardless of age, but I fear they will simply set up a new and improved Independent Living Fund, reinforcing the two tier system we have now where only those who demand independent living gets it, where people like myself remain ‘lucky’, while the rest are warehoused or left as the property of their families.

Enablement and Empowerment are cornerstones of an effective and cost efficient health and social care system, but when professionals fight to keep their jobs and control of their piece of the cake, costly disempowerment will continue to be the order of the day and so any new money will simply be swallowed up by empire building. This means that unless Labour is willing to replace the engine of the new “NH&SCS”, as opposed to simply giving it a new spray job, it will be business as usual in this new game of musical chairs.

I fear Labour’s plans are going to potentially destroy social care in terms of personalisation and independent living, as its bigger brother, Health, takes centre stage making all the demands. Unfortunately, it is a bit late for this election to go back to the drawing board to design a better policy!

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As something you use every day but cannot see, your ears are often taken for granted. However, according to Action on Hearing Loss, there are currently ten million people in the UK alone experiencing complete or partial deafness, a figure set to grow to 14.5 million by 2031.

Whether you’re a frequent concert-goer or keen conversationalist, it is important to do what you can to protect your ears. With that in mind, we have provided the following tips to help prolong your hearing:

Turn your headphones down

MP3 players on a loud setting normally register a volume of around 112dB. With studies showing that noise levels of 105dB can cause significant damage to the delicate hairs of the inner ear if endured for more than 15 minutes each week, turning your headphones down is an easy way to reduce the chance of injury, and make sure to take regular breaks.

Stay vigilant to other conditions

Hearing specialists Amplifon recently ran a study that showed the links between diabetes and hearing loss. Onset deafness is a symptom of many other conditions, including strokes, Meniere’s disease and meningitis. If you suspect that an underlying condition is causing an effect on your ability to hear, it is important to get a diagnosis as quickly as possible to avoid any irreversible damage.

Avoid prolonged exposure

Hearing loss or deafness is particularly common among musicians or people who work regularly with loud equipment on construction sites or shooting ranges. If your occupation requires prolonged exposure to loud noises, it is important to wear the appropriate ear protection for the job – simple foam earplugs may not be enough for particularly loud environments. Try a noise-cancelling in-ear model, or consider getting silicone or acrylic plugs that can be moulded to your exact fit.

Clean carefully

One of the most common causes of hearing damage is people poking cotton swabs or pointed objects into their ears to clear wax. Despite best intentions, these objects can easily perforate your eardrum, which can cause serious infection complications or even complete deafness. If you’re worried about wax build up, seek professional advice or use eardrops to clean the area naturally.

Have regular check ups

Lots of people find that they do not realise how bad their hearing has got until it’s too late, especially in old age. It is important to have hearing tests as often as you would visit the GP or Optician, detecting any issues before they have a severe impact on your wellbeing. Hearing test can be booked easily through your nearest pharmacy and doctor’s surgery.

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Until you experience it, a lot of people don’t know the facts about hearing loss. It’s not just a sign of age and it’s not just serious hearing loss that requires a hearing aid. If you’re worried about your hearing or just want the facts, take a look at hiddenhearing.co.uk.

Here are some hearing loss myths and misconceptions debunked once and for all.

Hearing loss only affects old people

Hearing loss can affect people of all ages. While it can be a factor of getting old, there are plenty of people in different age ranges who are affected by hearing loss.

I have one good ear

A lot of people with hearing problems who believe they have one good ear in reality have two bad ears, where one is slightly better than the other. Most types of hearing loss affect both ears and 90% of patients need two hearing aids.

It’s better to live with a little hearing loss than to have a hearing aid

A lot of people feel that a hearing aid will make them look old or handicapped. The truth is that untreated hearing loss will be more obvious than a hearing aid. The technology has come a long way from those bulky hearing aids we often think of. In fact, most hearing aids now are barely visible.

Only people with serious hearing loss need hearing aids

Hearing aids can improve all sorts of hearing loss, even minor conditions. It’s best to get your hearing checked if you think you have a problem because a hearing aid might improve your quality of life substantially.

Hearing aids are uncomfortable

This isn’t necessarily the case. If you invest in a good quality hearing aid, fitted by a professional, you’ll be able to get one that fits discreetly and comfortably.

For people who have used hearing aids in the past and not liked them, the technology is moving quickly. Give hearing aids another try and speak to a professional about your options.

A lot of people wear hearing aids that are barely noticeable.

Hearing loss is just a sign of my age

Regardless of whether it’s normal, you can still be treated for it. Don’t suffer just because you think hearing loss is something comes with old age. Get your hearing tested and see what treatments are available.

Hearing loss cannot be helped

Once upon a time it used to be that your GP would tell you that some kinds of hearing loss couldn’t be helped – nerve damage in one ear, for example – but technology has come on leaps and bounds since then. Nowadays the majority of people can be helped with hearing aids.

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We all love driving. The wind in our hair, the cool breeze on our cheeks, we drive so we can move from one place to another. It is the most convenient way of traveling—you get to decide where you go and how you get there. No fares, no delayed bus schedules, no hassles. Learning to drive can offer us the most freedom, responsibility and maturity from any of the skills we learn in life.  However, if you have an underlying health condition, you must check whether it can potentially affect your driving, or if it already is doing so. We all love driving but not at the expense of our safety and the safety of the people we may be carrying in the backseat.

How to know if your condition will affect your driving

If your health condition is affecting your extremities such as your hands, arms, feet, or legs, then there is a good deal of risk that it might affect your driving. Some health conditions affecting the back and the neck can likewise pose a risk to your driving fitness. Some diseases or health conditions will not have a drastic effect on the initial stages. However, as the disease progresses, if may catch you by surprise when one day you are no longer able to drive. It is best to consult your doctor as to your driving fitness as the disease progress to avoid any untoward incident.

Age-related diseases

Most health conditions that negatively affect driving fitness come with advance age. As a person ages, the skills needed to drive, as well as those needed to prevent or avoid accidents on the road, deteriorates with age. Your eyesight suffers and your hearing becomes impaired as you grow older. This negatively affects your ability to react quickly and correctly to every situation while driving.

There are a few diseases that come with age. Parkinson’s disease affects a person’s balance and ease of movement, greatly limiting the ability to control the steering wheel. Macular degeneration is a condition of the eye that results to distortion of central vision making it difficult for the person to read street signs, traffic signals, and other road hazards. Diabetes, a common disease among the elderly, leads to sleepiness, dizziness, and loss of focus, which can lead to drastic results if it happens while driving.

What to do

If you find that a previous condition has worsened or that you have developed a condition that will affect your driving skills, you must report this to the DVLA or Drivers and Vehicle Licensing Agency. Some conditions that are required to be reported include strokes, epilepsy attacks, physical disabilities, visual impairments, and other neurological health conditions. You must also consult your doctor on whether you are fit to drive. If your doctor decides that you are unfit for driving, you must surrender your license to the DVLA. Failure to surrender opens you to threat of fine, or worse, criminal prosecution if you figure in an accident while driving and you hurt someone else such as your family members, passengers, or pedestrians. Remember the adage—it is better to be safe rather than be sorry.

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