Health inequalities that people with disabilities faced before COVID-19 (and they faced many) were exacerbated by the pandemic. Of those who died from COVID-19 in the first year of the pandemic, 60% were people with a disability. People with learning disabilities were eight times more likely to die of COVID-19 than the general population (Office for National Statistics (ONS), 2021). This is a reflection of various inequalities that disabled people continue to face in British society (Kavanagh et al, 2022). COVID-19 leaves a legacy, it is essential that healthcare services address the poor mental health and social isolation of people with disability so that the inequalities occurring early in the pandemic do not become further entrenched.
Outcomes for disabled people are measured across areas of life that include education, employment, social participation, housing, wellbeing, loneliness and crime. The ONS (2022) recognises that disabled people are more likely to live in poverty, have less access to education and employment and experience poorer ratings of personal wellbeing compared with non-disabled people. Disabled people have been disproportionally affected by over a decade of austerity and extensive reforms to the welfare system, these have increased the risk of poverty and in turn impacted people’s health. In England the number of organisations supporting people with disabilities has declined significantly due to funding cuts and other challenges, reducing the ability to confront structural inequalities that disabled people face (Harrison and Lazard, 2021).
Listening to, and learning from, people and communities can enable services to begin to challenge and address inequalities by generating an understanding of the barriers that people face when they are accessing health and care services and codesigning person-centred, effective, sustainable services. Those people who use health and care services are best placed to know what is working and what it is that could be improved.
The Health and Care Act 2022 places a duty on NHS organisations to focus on the promotion of health and wellbeing, improving the quality of services and making efficient use of resources. This includes an overt focus on the need to address health inequalities, and to improve services for people with disabilities. Integrated care systems and place-based partnerships provide real opportunities that can ensure disabled people’s voices are heard, listened to and acted on (Fenney et al, 2022).
It is essential that people with disabilities are engaged in designing and planning health and care system responses that meet their needs, ensuring that they are at the centre of all that is done. Authentically acknowledging and involving disabled people in service developments means that nurses and health and care organisations must listen to disabled people. Adopting a social model methodology (a model demonstrating how the challenges that disabled people face are caused by how environments are designed, as opposed to a person’s impairments or health conditions), providing staff with support along with valuing the expertise of disabled people and giving priority to their involvement, are the key elements.
All staff, from administrative staff and clinicians to commissioners and leaders, must have a deeper understanding of disability. Disability is everyone’s business. Education and training opportunities should be designed and delivered using a partnership approach with local disabled people’s organisations delivered at induction and as a part of ongoing continuing professional development.