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TX: 23.07.03 - HOW ACCESSIBLE IS HEALTHCARE?



PRESENTER: WINIFRED ROBINSON


ROBINSON
All this week on You and Yours we're investigating how accessible Britain really is for disabled people and today we're looking at access or perhaps rather in-access to healthcare. Rumours and anecdotes abound but what are the facts? The evidence is that people with learning disabilities or mental illness do get treated differently to other people. As Carolyn Atkinson reports the medical profession stands accused of discriminating against these groups of people when it comes to their physical healthcare.

ATKINSON
A recent high court case involving a 17-year-old boy with kidney failure has drawn attention this problem of equal access to healthcare. The teenager, who also has autism and severe learning difficulties, saw his case taken to court after being told he could not go on the kidney transplant list. But the judge decided this was blatant discrimination. Elizabeth Batten is the lawyer who represented the family.

BATTEN
The hospital were arguing that it would not be right to offer a transplant to the young man because he would find the treatment necessary for transplant so unbearable because of his learning disabilities and his autism that it would not be right to offer it to him. They also said that because he had a fear of needles he could not cope with alternative means of dialysis and therefore that when his current catheter sites ran out and they were becoming infected he should be allowed to die.

ATKINSON
This case was presided over by the leading judge Dame Elizabeth Butler-Sloss, her decision that the boy should not be treated differently to anyone else is seen as ground breaking. However, his chance of getting an organ remains slim because so few kidneys become available for transplant no more than 35 per cent of people on dialysis are even put on the waiting list. They're chosen on the basis of strict criteria like age or social circumstance and kidney specialist Dr Martin Raftery says it's right that learning disabilities like autism or mental illness are taken into account.

RAFTERY
The mental illnesses can be important for two or three reasons. One is that sometimes the mental illness requires drug treatment which would not mix very well with the anti-rejection treatment. So the two treatments would interact in a way which is dangerous. The second is that with kidney transplants or any organ transplant if you miss your medication it's likely that the graft will be rejected and lost. Now that obviously has to form part of the assessment you make of the patient before you put them on the transplant list.

ATKINSON
According to the Royal College of Psychiatrists as many as six million people have some form of mental illness ranging from eating disorders to psychosis and the charity Mencap puts the number of people with learning disabilities at 1.5 million. As lawyer Elizabeth Batten says this represents a growing group of people who could face discrimination when it comes to healthcare.

BATTEN
Doctors, particularly those less familiar with mental illness, don't exercise their normal powers of judgement, maybe it's unwarranted assumptions that they make because of that lack of familiarity that blinker them to the true picture.

ATKINSON
And we've discovered several examples of this type of discrimination. Carolyn Wilson is in her thirties and waiting for a bowel colostomy operation. She was due to have the op in March but it was cancelled because there was no bed. Since then her mental history of self harm and one suicide attempt a number of years ago has been discovered and as a result she says her operation's now been postponed indefinitely leaving her in agony.

WILSON
I feel I'm being judged because of what I did. In the last two days I've more or less been in bed. I have to be near a toilet. I take about 11 different medicines a day which all of them I'll be able to come off after having this operation.

ATKINSON
And there are more examples. One woman with mental illness found a psychiatrist was called when she was having a potentially life threatening asthma attack, doctors had decided she was simply over-anxious. And someone who found she was pregnant was told she wouldn't be able to cope and claims to have been forced into having an abortion. I've also been told that some elderly patients with dementia are being refused flu jabs. Recent research by Central Liverpool Primary Care Trust discovered that women with learning disabilities like Down's Syndrome are not being recalled for cervical smear tests or breast cancer screening. Maureen Sayer is a senior health promotion officer who worked on the study.

SAYER
There is an assumption that some of the women are not going to be sexually active and in fact this isn't true. It is vital for doctors to look at the individual, not just at the fact that the woman has a learning difficulty. A lot of the women are very proactive and want to be screened and obviously that is their right to be screened.

WILLIS
I think there is discrimination and that's wrong in itself.

ATKINSON
Dr Michael Willis chairs the ethics committee of the British Medical Association.

WILLIS
Having said that we have to make it absolutely clear that the fundamental approach that the doctor must first of all make is a careful clinical assessment, that's followed by good communication with the patient to explain in detail why that particular assessment has reached that particular conclusion, in other words do you give treatment, do you not give treatment, what are the factors that are making you decide whether to offer treatment or not?

ATKINSON
But lawyer Elizabeth Batten doesn't think it's just a case of patients misunderstanding why they're being refused treatment, she thinks discrimination is rife.

BATTEN
We have been aware on a number of occasions of patients who haven't received the treatment they should have received for their physical illness because their symptoms are treated as a feature of their mental illness and that has led either to late diagnosis or complete failure of treatment - we've even had clients who've died in that situation.

ROBINSON
The lawyer Elizabeth Batten ending that report by Carolyn Atkinson.





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