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New DEEL: national framework for disability equality and etiquette

1 May 2007

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Tom Brownlie
AMSPAR Chief Executive

In spring 2003, the Department of Health (DH) and the Disability Rights Commission (DRC) started working together to improve the responsiveness of health services for disabled people. The resulting partnership has pursued several important areas of work, one of which is the Disability Equality and Etiquette Learning (DEEL) Framework for Health and Social Care in England.

This was officially launched at the end of March this year, after several years of collaboration between partner organisations, including: the DH; Skills for Health; Skills for Care; the DRC; professional bodies such as the British Medical Association (BMA), the General Medical Council (GMC), the Royal College of Nursing (RCN) and AMSPAR; educational and training providers; and groups representing disabled people.

So, what exactly is DEEL?
Disabled people rely on the attitudes of health and social care staff for their medical and support needs. However, until now there has been no single agreed framework to help guide service providers. There are several courses covering this topic, but there is no single reference point by which training or results can be measured. The DEEL framework now establishes a first point of reference in England.

“Disability” refers to anyone who has an impairment and may experience discrimination as a result. Around 11 million people in Britain have a disability – clearly a very high proportion of health and social care patients and service users.

The term “equality” is used to mean that service outcomes should be similar for disabled people. This may actually mean treating disabled people differently to achieve a similar level of service outcome to a nondisabled person.

Most people are aware that adjustments need to be made for disabled people, such as wheelchair ramps or hearing induction loops. However, vital measures such as appropriate policies, practices and procedures are often neglected with respect to how service staff respond to the requirements of disabled people.

It is vital to get these policies right, both to demonstrate good practice and to comply with the law. The DEEL framework helps service providers keep up-to-date with the current disability rights legislation, and is consistent with high levels of service quality across primary care for all patients and service users.

“Etiquette” refers to the action that staff actually take to provide equality of service outcomes for disabled people. “Etiquette” is used in preference to “awareness”, because awareness is usually about knowledge rather than actions.

“Learning” is used in preference to “training” or “education” because any method of learning is useful. Learning is also seen as an ongoing process, whereas training is often considered to be one-off courses or workshops rather than a process. The only prescription about learning methods that is suggested by DEEL is that it should involve the voice or, ideally, the presence of disabled people as trainers or educational advisers.

The DEEL national framework has three levels of competence, which are written in terms of service outcomes for disabled people. They are:

  • “Novice level” – staff are introduced to disability equality.
  • “Learner or improver level” – staff are acquiring the ability to assist disabled people with greater confidence.
  • “Competent or champion level” – staff can not only avoid discriminatory behaviours but also influence policies.

How should DEEL be used?
This framework should be used by practice managers to evaluate the level of disability equality and etiquette competence of staff. In addition, it provides a useful planning tool, enabling a strategic approach to staff development.

The skills, knowledge and competence of individual members of staff will need to be measured over a period of time, which will be best achieved if the DEEL framework is embedded through the organisation’s induction, supervision and performance management review processes.

Elements from the framework could also be included within the person specification or job descriptions for all new posts. “Novice level” is the minimum standard of disability equality competence and skill necessary to work in health and social care service provision. All employees should achieve “novice level” within 12 weeks of starting in the role. Managers should ensure that staff move to “improver level” within a set limited period of time – around one to three years. Managers should aim to achieve “competent level”.

The DEEL framework has several important benefits. First, it is firmly based upon the “social model of disability”, which is essential if it is to be acceptable to disabled people and their organisations. The social model involves empowering disabled people by giving them options for the future. This differs from the “traditional model” approach, where the emphasis is on an expectation of what can and cannot be cured while the disabled person puts their life on hold.

Secondly, the DEEL Framework is relatively simple to apply and is practical and flexible – essential if it is to prove of value to health and social care professionals.
Finally, the framework helps to ensure that resulting training is up-to-date with current disability rights legislation, including the Disability Equality Duty, which applies to public sector services.

AMSPAR is delighted to have been involved with the development of such a useful tool. We will be raising awareness of the framework with our members so they are able to put it to use in their practices and hospitals.

We will also continue to represent members as this framework is developed, and as appropriate learning materials are produced for use in medical settings. For example, over the coming months, AMSPAR members will be supplied with learning packs distributed via the RCGP.

These packs contain a DVD, Closing the Gap, and supporting learning notes that promote best practice. They follow the DRC’s high-profile formal investigation into primary care services for people with learning disabilities or mental health problems. The learning packs are fully consistent with DEEL principles, and can support learning at team meetings or at full, formal training sessions.

We look forward to the increased reliability and quality of this type of training and education, and its resulting effect on healthcare and services for disabled people throughout England.

The full DEEL framework will shortly be available on the websites of the DRC and DH, but you can obtain a consultative draft from AMSPAR, or directly from the DRC by emailing [email protected]

Association of Medical Secretaries, Practice Managers, Administrators and Receptionists
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[email protected]