Equality Act 2010 (Amendment) Bill [HL]
Debate between Baroness Flather and Baroness Jolly
Baroness Jolly (LD)
My Lords, I, too, take the opportunity to congratulate my noble friend Lord Blencathra on succeeding in getting his Bill read a second time in this House. It has given the House an opportunity to consider a very important legislative protection provided to disabled people in the Equality Act 2010.
My noble friend’s Bill seeks to amend the wording of the duty set out in Section 20 of the Act, which imposes a requirement on specified people to make reasonable adjustments for those with a disability. This ensures that those who meet the Act’s definition of a disabled person are not put at a disadvantage compared with those who are not disabled.
The Bill would require service providers and others to provide ramps for wheelchair users where there is a single step at the entrance of their building. Initially, this would apply to steps of less than six inches in height, with a longer period to allow compliance where the step is between six and 12 inches. Under the Bill, this would be a legal requirement irrespective of the physical location of the building.
I have a good deal of sympathy for my noble friend and the frustration that he feels in being unable to enter some shops and other premises. Like the noble Baroness opposite, I myself experience the same feelings when caring for my mother. She is a wheelchair user. I have to push her around on Cornish granite cobbles. The two of us—her in the wheelchair and me pushing—frequently encounter the same sort of obstacles and difficulties that my noble friend has vividly described, and of the sort that he pointed out to me when we made our tour of Strutton Ground in Westminster yesterday.
The reasonable duty is a cornerstone of the protection offered to disabled people under the Equality Act 2010. It has a wide application—in the fields of employment, service provision and the exercise of public functions—and it applies to both the public and private sectors. The adjustment duty as it applies to the provision of goods, facilities and services is anticipatory, as we have already said. The rationale for that is that while a service provider’s relationship with a customer is often transitory, it is reasonable for the service provider to “anticipate” particular adjustments, which will prevent a disabled person from being put at a substantial disadvantage in comparison to a non-disabled person. The question of whether there has been a failure to comply with the duty therefore hinges on what is reasonable.
My noble friend and I did indeed see a number of premises yesterday where reasonable adjustments had been made simply and cheaply, as well as others where they could have been made but had not been; and yet others where they would not have been feasible, at least within any proportionate cost.
I entirely accept that the use of the adjective “reasonable” in the legislation recognises the need to strike a fair balance between the needs of disabled people and the interests of service providers. The Act therefore requires a service provider only to make adjustments that are reasonable in all the circumstances of particular situations. For example, if the cost of making the adjustment would put the service provider out of business, that clearly would not be reasonable.
I should also explain that building regulations control certain types of building work, principally the erection, extension and demolition of buildings and the provision or extension of certain services or fittings, so as to ensure that buildings meet certain standards of health, safety, welfare, convenience and sustainability. For buildings in England and Wales, Part M of the Building Regulations 2010 includes a requirement to ensure that reasonable provision is made for wheelchair users to gain access to buildings, including premises used as shops.
This is where we begin to encounter difficulties with the proposal for the automatic installation of ramps in my noble friend’s Bill. Clearly, for some existing premises giving out directly on to the street, there would be significant difficulties in finding even a fairly small area to construct a ramp. For some, it might create a potential hazard for pedestrians. Yesterday, we looked at the issue of dropped kerbs where there are bobbles in the pavement. The dropped kerbs are for disabled users and the bobbles are for blind people to know when they are approaching a road. Sometimes one part of the disabled community can be served and not the other, so there is a balance. Also, some buildings open directly on to a highway that belongs to a third party, and in such circumstances it would be impossible to provide a wheelchair access ramp without cutting back into the building’s entrance floor. In some cases that could be quite an expensive operation.
The existing provisions in the Act are deliberately worded so as not to specify what an individual with obligations under the Act should do. This wording allows for greater scope in considering how best to solve the particular problem being experienced by the disabled person. We have had examples of where workarounds could not possibly fit under the “best fit” description. Specifying the remedy to a particular problem in the Act will inevitably result in proposals to have other specific remedies spelt out in it or in future technical guidance. In practice, this could risk the Act becoming a series of technical specifications which might actually be easier for employers and service providers to circumvent than the “reasonable adjustment” duty. Under the Bill, many service providers are likely to assume that building a ramp of the sort proposed will now constitute fulfilment of the duty—end of; nothing further would be required. This would result in provisions that might well suit some disabled people but not others, so I hope that noble Lords will agree that rather than changing the law, it might be helpful if we consider ways of trying to make effective use of the existing law with the duty—it is quite a powerful one—that we currently have.
Ultimately, there is the option of bringing a case against a service provider if all else fails, although I fully acknowledge that this always has to be the last resort and that many disabled people may be deterred by the effort and cost. Yet Allen v RBS, Paulley v First Group plc and some cases involving other types of disability show that it can be done. It is against this background that the Government have doubts about the need for and, indeed, the feasibility of the noble Lord’s Bill. Even if some noble Lords may not accept that the current arrangements are ideal, I hope that they recognise that the physical location of some buildings would make it impossible for businesses to build ramp access, and indeed we did see a few like that yesterday. As such, this Bill would impose a duty that is impossible to comply with.
Let me assure noble Lords that the Government have a continued commitment to disabled people, and more specifically to our belief that every disabled person has the right to have an adjustment made for them if it is reasonable. What is in contention here is the best way of achieving that aim. The Government believe that the current system is both fair and balanced, and works in the main satisfactorily for disabled people, businesses and employers.
Baroness Flather
Forgive me, but I cannot agree that the law works in a fair way. It really does not. There are so many places where things could be done quite easily, but they are not done, and if you complain, they still do not do it. Can the Minister tell us how to get these things done?
Baroness Jolly
The noble Baroness makes a fair and very good point. My noble friend mentioned the Access Association. It may be that noble Lords need to work with such organisations. However, I take the point that taking someone to court is a bit excessive, although a certain amount of naming and shaming would do no harm. I would not mind betting that the PR organisations that deal with some of the organisations which have been named today will pick stuff up in Hansard tomorrow. Actually, that will be no bad thing.
Legislation does not stay the same for ever, and indeed changes were made from the Disability Discrimination Act 1995 to the Equality Act 2010. Like other recent statutes, the Equality Act will in turn be subject to post-legislative review. In this case it will cover the period 2010 to 2015; that is, the first five working years of the Act. Under the normal rules, we can expect the next Administration to publish, as the outcome of the review, a memorandum for the relevant Select Committee, which itself may choose to take forward aspects of the review or indeed its own conclusions on whether and how the legislation has worked relative to the stated aims of the Act. I realise that this does not offer any immediate solution to my noble friend’s concerns, but hope it will reassure him that the Government, and indeed Parliament, remain mindful of the sort of problem he has raised.
The Box has just given me an answer to the point made by the noble Baroness, Lady Flather, about what action a disabled person can take if appropriate adjustments are not made. They should first approach the service provider to discuss why they feel they cannot access the service or function in question, and discuss what adjustments they require. If, following discussion, the service provider fails or refuses to make a reasonable adjustment, the disabled person could take their custom elsewhere; alternatively, they might decide to bring a case of alleged disability discrimination before the civil courts. I can see from the noble Baroness’s face that that does not satisfy her.
For the present, however, the Government are unable to support my noble friend’s Bill for the reasons that I have set out to the House.
Health: Women and Low-income Groups
Debate between Baroness Flather and Baroness Jolly
Baroness Jolly (LD)
My Lords, I, too, am grateful to my noble friend Lady Manzoor for initiating this important debate. I thank all noble Lords for their excellent and informed contributions. I agree with the noble Lord who said that an hour is just not enough to do justice to the huge canvas of inequalities that there are not only in the UK but across the world. I regret, too, that in the time available I will not be able to answer all queries from noble Lords. I promise to write to all who have taken part in this debate to answer their queries and, I hope, to make them feel more reassured.
Health inequalities are a priority that is shared by this Government and Health Ministers across the whole UK. Worldwide, concern is high on DfID’s agenda and it has been very busy over the past few years implementing millennium development goals and thinking about what should follow on from them, particularly those areas surrounding women and children. For too long, health inequalities have denied many children a good start in life, prevented people realising their full potential and weakened communities. They are deeply rooted and a scourge on society, which is unacceptable. However, the tragedy is that, for the most part, they are avoidable. As the Secretary of State has said, we want to make them a thing of the past.
Health inequalities and the poor health outcomes that result are a focus for the health system, working with Public Health England and NHS England, and backed by new health inequalities duties under the Health and Social Care Act 2012. The Department of Health is ensuring that these bodies work together to overcome these inequalities. However, I have to give a warning that successes in any of these areas are not overnight. We have to be in this for the long haul, which is why strategy is so important. These organisations are barely a year old.
Our strategic approach is underpinned by the evidence in the Marmot review. The noble Baroness, Lady Warwick, was the first of several noble Lords to highlight the importance of the 2010 report, Fair Society, Healthy Lives. It highlighted that life expectancy is spread across a social gradient, a point highlighted by the noble Baroness, Lady Royall; namely, that the lower a person’s position, the worse his or her health. It recommended that action should be proportionate to the level of disadvantage.
Following on from that paper, our public health White Paper, Healthy Lives, Healthy People, accepted the review’s recommendations and we are sponsoring the UCL Institute of Health Equity, led by Sir Michael Marmot, to help implement them. We have adopted its approach. For example, on maternal and child health we are increasing by 50% the number of health visitors by 2015 and more than doubling the number of places on the family nurse partnership programme, which supports vulnerable, first-time young mothers.
Reducing health inequalities is a core Public Health England activity. It will be set out in its business plan to be published shortly, and its health and well-being framework in June. It will identify the action that many stakeholders—notably local government—can take. NHS England set out its proposed priorities in its December board paper Promoting Equality and Tackling Health Inequalities. In addition, NICE continues to provide evidence-based guidance, and the ONS will continue to publish much important data to support our efforts in reducing health inequalities. When I sum up, I will pick up on the issues around data mentioned by the noble Baroness, Lady Warwick of Undercliffe.
The noble Baroness will know of the importance of good health for women during and after pregnancy from her time at Bradford as a previous chair of Bradford Health Authority. Bradford is second only to Birmingham in the number of infant deaths. Responding to that challenge, Bradford established an infant mortality commission, drawing together partners from all corners of the city. Action in Bradford and elsewhere has had a national impact. The health gap in infant mortality was halved between 2004-06 and 2009-11, between the routine and manual group and the whole population, which shows that local focused action can reduce inequalities.
Different communities face different health needs, and it is for local areas to identify those needs. We have sought to empower local areas by transferring public health to local government, giving £5.46 billion of funding over two years. We have made it clear that local areas must take account of health inequalities as a condition of that funding.
Some of the most extreme health inequalities are found among the most vulnerable and socially excluded women, such as street-based sex workers. Open Doors, a Hackney organisation, and the TB team at Homerton Hospital carry out late-night outreach among these women looking for cases of TB and HIV—a fatal combination—and to provide support and care for them. The Homerton TB team also provides housing for homeless people with TB for the duration of their treatment because, as my noble friend Lady Suttie has said, homelessness helps spread TB. The £10 million Homeless Hospital Discharge Fund seeks to ensure safe discharge from hospital and to break the cycle of poor health and homelessness. Public Health England is leading on developing a national TB strategy, including tackling drug resistance.
The NHS is providing a hepatitis information and testing programme in Sheffield, which offers screening for at-risk communities, including the Roma communities, and in Leeds it is seeking to establish the needs of those communities and to improve access to their services. In Salford, the NHS is working with different groups to improve the uptake of vaccines such as MMR, focusing on BME groups where the uptake is low. In Hillingdon, a specialist health visitor and trained volunteers support Afghan and Tamil women on a range of physical and mental health needs, including domestic violence.
As noble Lords will know, access to services is crucial. Women living in deprived areas are less likely to attend for breast cancer screening or present with early symptoms, which leads to lower survival rates. We cannot meet our cancer objectives without reducing these inequalities through programmes such as the National Cancer Equality Initiative, and the work of local areas such as Southwark and Lewisham in reducing inequalities in breast cancer care, and Walsall and the Isle of Wight in promoting cervical cancer screening.
Obesity has a strong social gradient among women. We are encouraging and promoting action on obesity and better nutrition through the responsibility deal and through Change4Life. There is a threefold difference in smoking in pregnancy rates between London and the north-east. Sunderland and other north-east communities, Blackpool and Dudley have responded to these inequalities and are contributing to our national ambition of reducing smoking in pregnancy rates among all women from 15%—where it is now—to 11% by 2015.
We work—with Public Health England—across government to reinvigorate action on child poverty, raise educational attainment, support families and promote work as a route out of poverty. To pick up a point raised by the noble Baroness, Lady Warwick, a study by the Institute of Health Equity has shown that one of the best things that you can do for a child is to read to them daily. Not only does that raise their educational outcomes but it also raises their cognitive ability from a very early age.
Baroness Jolly
I understand that. I am sure that there are adult education programmes across the country. The noble Baroness shakes her head. Perhaps we can have a conversation about that outside the debate.
We have focused on outcomes rather than on targets to promote action and measure progress, including through the public health outcomes framework, in line with the Marmot review proposal for a national framework of indicators for local areas to draw on to meet their own needs. This strategic approach to reducing health inequalities will help guide local action that is practical, joined up across the causes of ill health, and delivered at a scale to make a difference and improve health outcomes for all our people.
In what time I have, I shall run through points that noble Lords have raised that I have not covered. The noble Baroness, Lady Manzoor, asked about cardiovascular disease, which we know affects millions of people and is one of the largest causes of death and disability in this country. The previous Government made huge strides in this area which this Government have carried on. During the past decade, there has been a 40% reduction in under-75 mortality rates, with a narrowing in the difference between the most deprived and the least deprived areas of England.
Domestic violence is one aspect of violence against women and girls; others include sexual violence, abuse and gang violence. We also heard today at Question Time about FGM, and the Government are working on that issue.
On international health inequalities, raised by the noble Baroness, Lady Hayman, the approach to tackling health inequalities in England is recognised internationally as leading edge. Professor Sir Michael Marmot has chaired the World Health Organisation’s commission on the social determinants of health. Based on the interim analyses of the first phase of this programme, it is estimated that, during the lifetime of the project, more than 9,500 maternal lives will be saved, more than 190,000 maternal disabilities will be avoided, nearly 10,500 new-borns will be saved and more than 12,500 stillbirths will be averted.
The noble Baroness, Lady Warwick, asked about the gap of 20 years in healthy life expectancy. I mentioned earlier that local authorities have been given a £5.4 billion budget to press on that.
I have been informed that I am out of time. I am sorry. I flagged up that I doubted that I would get through all your Lordships’ points during the debate, but I will certainly write to you and answer any outstanding queries.