Barriers to the provision of oral health care for people with disabilities

Abstract

Both in dental care and wider healthcare services, people with disabilities face a particular range of barriers that can prevent them accessing appropriate care. These initially occur at the societal level but filter down to the clinical environment.1 The Equality Act 2010 defines a disability as 'having physical or mental impairment that has a 'substantial' and 'long-term' negative effect on your ability to do normal daily activities'.2 An estimated 16% of people in the UK are living with some form of disability be it physical, intellectual, mental, or sensory in nature.3 In 1971, Hart's 'Inverse Care Law' stated that 'the availability of good medical care tends to vary inversely with the need for it in the population served'.4 The barriers that lead to this situation are still relevant today, meaning that people with disabilities report poorer access to healthcare, which exacerbates their poorer general2 and oral health.4 Historically, language referred to peoples' disabilities instead of people, attributing problems faced to the disability rather than wider society. The social model of disability is seen as a more appropriate way of understanding the problems people with disabilities may face in receiving appropriate healthcare.5 This model describes how it is society that erects barriers - by action, or inaction - that prevent people with disabilities living a life comparable to non-disabled people. In this model, to break down barriers to care, society must adjust by making far-reaching changes from legislation through to design of cities, transport, healthcare services and beyond to ensure people living with disabilities are not disadvantaged. The Equality Act 2010 places a legal duty on organisations, including dental services, to make reasonable adjustments to reduce the barriers that may affect people accessing care.2 Through increased waiting times, restrictions of certain services, patient shielding and additional PPE, the COVID-19 pandemic has introduced additional barriers which may disproportionately affect those with disabilities.6 It is therefore more important now than ever that both general and specialist dental services consider how they can make adjustments to support people living with different disabilities. 'Reasonable adjustments' made in general dental practices can ensure that a substantial proportion of people with disabilities can be treated in primary care without need for referral to specialist services. A general practitioner may be geographically closer, and the 'normalisation' of attending with family members, in a manner as 'close as possible to the norms and patterns of the mainstream of society'7 is highly important to many. This aligns with the Commissioning Standards for Special Care Dentistry, where 'level 1' care, suitable for the majority of patients, can be provided by a general dentist, as per Table 1. 8 Table 1 Levels of care for Special Care Dentistry. Taken from NHS England8