THE SOCIAL MODEL VS MEDICAL MODEL
APPROACH
69. At present, unless the definition of disability
is met there can be no discrimination claim under the DDA. The
current definition is extremely complex, save in certain narrowly
defined circumstances; it requires proof that an individual has
an impairment which has a substantial and long-term adverse impact
on their ability to carry out day to day activities.[69]
Ever since the DDA was passed there has been a strong body of
criticism about its definition of disability on the basis that
it derives from the 'medical model', focusing as it does on the
functional limitations of an individual. Most submissions to this
inquiry argue that the 'medical model' should be replaced by a
'social model' approach.[70]
70. The social model of disability identifies 'disabling
barriers' rather than 'impairment' as the problem to be tackled.
Disabling barriers are the attitudinal, economic, and/or environmental
factors preventing certain people from experiencing equality of
opportunity because of an impairment or perceived impairment.
A disabled person might say, therefore, "My impairment is
the fact that I can't walk; I am disabled by the fact that the
local authority building is accessed only via a flight of stairs."[71]
71. In June 2006 the Disability Rights Commission
(DRC) recommended to the Government that the DDA's definition
of disability should be changed to one which gives protection
from discrimination to everyone who has (or has had) an impairment
without requiring the effects of that impairment to be substantial
or long-term. The DRC's recommendation for change followed a request
from the Joint Committee on the Draft Disability Discrimination
Bill for the DRC to review the definition. The Committee argued
that: "if the Government are to achieve their aim of comprehensive,
enforceable civil rights for disabled people against discrimination
in society or at work then the current inadequacies in the DDA
definition must be addressed. Many of the deficiencies would,
we believe, be overcome by focusing disability anti-discrimination
legislation on the act of discrimination, and not the extent of
the impairment."[72]
The DRC's public consultation revealed strong support for
such a shift in approach.[73]
72. However, DWP states that: "For the purposes
of anti-discrimination legislation, the Government considers that
it is appropriate to maintain the current approach to models of
disability, which draws on different models for different purposes.
The basic principle of the legislation is that it is asymmetrical,
in that generally it protects only disabled people. Consequently,
it is necessary to define who is a disabled person for the purposes
of the Act and the Government considers that an essentially 'medical'
model provides the most appropriate means of doing so."[74]
73. The Minister, Maria Eagle, told us: "We
are not planning on changing to a total social model. We are going
to make some changes. For example, we are going to remove the
capacities bit from the current DDA definition which should make
it easier for people to show that they meet the definition, although
we are not changing the definition in the DDA completely."[75]
She added that disabled people "will have to show that they
fit within the definition if it is disputed by their opponent
whether or not they fit within the definition, yes. It will be
slightly easier for them to do it, but yes, that will still be
there."[76]
74. The EHRC believes that the Government failed
to address the current inadequacies in the DDA definition of disability,
proposing only minimal change relating to removing the current
list of 'capacities'. The EHRC, amongst other submissions, proposes
that the definition of disability should be changed completely,
according to the social model. The Local Government Employers
state "This model does not deny the existence of impairment
but [
] changes the focus on to what aspects of the working
world can be proactively adapted and changed."[77]
The Employers' Forum on Disability states that "using the
social model of disability, employers are better able to make
reasonable adjustments."[78]
It adds that "DWP may find the business rationale for becoming
disability confident, which presents the benefits to the business
of taking a social model approach, a useful communications tool
when setting out to engage employers on this agenda."[79]
75. The Minister argued that "the DDA definition
is relatively well known in our law and understood by those who
have to deal with it in the courts, and there is some merit in
not changing it unless there is a really good reason to change
it."[80] However,
the EHRC argues that the social model approach would make it much
easier for everyone to understand when someone is entitled to
protection from discrimination. [81]
Mr Azad of the National AIDS Trust argued that :
"The social versus medical model debate can
seem very academic or philosophical I think, but for people living
with HIV it is an extremely practical issue. [
] Is hepatitis
C a disability? I would argue that that may be a matter of debate
in a court and could significantly disadvantage people who are
infected in that way if they do not have any current functional
problem as a result of their infection, even though discrimination
can certainly apply in their case. I think that gives you one
example from our perspective of a social model which may cover
more people but that is because they need to be covered."[82]
76. CBI members agree that "the current definition
of disability creates uncertainty and in some cases the only way
to determine whether a person is disabled is to go to tribunal."[83]
Cloisters and the Discrimination Law Association state that where
it is unclear whether or not an individual meets the definition
- and this is relatively common - they will be "put to proof",
which will usually mean an extensive witness statement explaining
what they can and cannot do; an expert medical report; and a hearing
at which the claimant will be cross examined.[84]
77. In addition, Cloisters argue, it can also cause
difficulties for employers. Both sides incur medical expert expenses
which establish the nature of the impairment and the employer
is then left with a decision as to cross examining on whether
the impairment has more than minor or trivial adverse effects
on the claimant's ability to carry out normal day to day activities.
However that evidence very often relates to matters that take
place in the home, to which the employer has no access. Thus the
net effect is to draw out proceedings and to increase the stress
they create.[85] Citizens
Advice adds that it has "long been concerned about the flaws
in the process and the quality of medical assessments and the
decisions based upon them."[86]
78. Currently there is no protection for people with
short-term but severe conditions, or those with long-term conditions
which do not have a substantial adverse impact on day to day activities.
Cloisters and the Discrimination Law Association stress that the
definition is particularly problematic for people with mental
health issues, given the requirement that the effects of an impairment
must be 'long-term' (ie likely to last or have lasted for more
than 12 months). "If, for example, an individual has depression
which has lasted for only two months but an employer refuses to
employ/promote them because of this, there is nothing that they
can do under the current Act."[87]
79. Cloisters also state that there is the difficulty
of predicting the likelihood of duration. This must be judged
at the time of the act of discrimination. "In many mental
health cases it is simply not possible to say at that time what
the duration is likely to be. However the current law (and its
interpretation) suggests that these predictive factors are relevant."[88]
Unison argues that "To protect some disabled people from
discrimination but not others because their impairment is less
significant only serves to create a hierarchy that perpetuates
discrimination of a vulnerable section of our society."[89]
80. Most submissions argue that the focus of attention
should shift from the medical condition of an individual to a
consideration of whether or not discrimination is occurring and
the need or otherwise for a reasonable adjustment and whether
treatment is fair. For example, Mr Crowther of the EHRC explained:
"we were referred a situation by an MP of a
constituent who had one eye and wanted to join the fire service
in his local area. He was aware that there were serving firemen
and women with such impairments but he failed the fitness test
and he wanted to bring a claim of discrimination. The paradox
in the Act was that they would have had to have proved that having
one eye meant that he had a substantial and adverse effect on
his ability to perform a normal, day to day activity and would
undermine the whole basis of the claim that he was making."[90]
81. The EHRC also argues that the social model approach
would bring the law into alignment with best practice. For employees
who develop impairments or health conditions, good practice is
to respond to any problems as soon as they become apparent, not,
for example, to allow lengthy periods of sick leave to elapse
before enquiring whether or not steps can be taken to enable an
employee to return to work. In such cases, waiting until it is
clear that an employee meets the DDA definition (by having an
impairment which has a substantial adverse impact for 12 months
or more) before putting in place reasonable adjustments undermines
the chances of a successful outcome.[91]
82. The CBI argues that the proposal to extend the
definition of disability to protection against discrimination
on the grounds of any 'impairment', regardless of level or type
of impairment, would mean that anyone, with potentially any level
or type of impairment (lower back pain, sore foot, stress etc),
could make a discrimination claim. "Our members are concerned
that this approach would trivialise disability rights and discredit
the legislation by opening it to abuse. [
] While there would
be no need to determine whether someone was disabled, far more
people would be able to ask for reasonable adjustments and there
would be less clarity about the extent to which these would have
to be accommodated. [
] In reality, not all requests for
reasonable adjustments can be met. Resources will always be finite
and people who are in need of more or expensive adjustments may
not receive them if employers receive an increased number of requests
for adjustments from employees with minor or even severe but short-term
ailments."[92]
83. Mr Crowther acknowledges that the social model
approach "potentially [
] broadens the reach of the
Act but what it does really is focus the attention onto the barrier
or the discrimination of somebody's experience rather than interrogation
of the impairment they have. Clearly it still provides safeguards
against unrealistic claims or the legislation being abused. Similarly
with the reasonable adjustments duty and where, in order to bring
a claim, somebody would have to prove that they experience substantial
disadvantage."[93]
Ms Casserley of the Discrimination Law Association added that
"if you have a definition that is based on impairment what
you do is get to the heart of the matter which is the treatment
and whether or not the treatment was justified if it is disability
related, for example, or whether it was on the grounds of someone's
disability. That should be the focus of anti-discrimination legislation."[94]
84. We believe
that for the purpose of direct and disability-related discrimination
the social model - protection from discrimination to everyone
who has (or has had) an impairment without requiring the effects
of that impairment to be substantial or long-term - should apply.
The focus should be on whether or not the treatment of an individual
was justified, or whether it was on the grounds of their impairment.
It is inequitable to protect some disabled people from discrimination
but not others because their impairment is less significant.
85. However,
for the third discrimination ground - the failure to make reasonable
adjustments - a medical model approach must be retained. This
will ensure clarity for business about the extent to which they
have to make adjustments and ensures that the most vulnerable
receive the support they need.
The role of the Equality and
Human Rights Commission, the Government Equalities Office and
the Office for Disability Issues
86. The role of the EHRC is set out in Part 1 and
relevant Schedules of the Equality Act 2006. DWP states that the
Government will look to the EHRC to issue appropriate codes of
practice and guidance on the new Act and to carry out its various
enforcement, supportive and promotional activities. The EHRC is
planning to launch a series of inquiries into inequality in a
number of sectors.[95]
87. The TUC states that the former Disability Rights
Commission took some important early steps to promote enforcement
and compliance with the Disability Equality Duty in the first
year, providing helpful advice and guidance on the duty, checking
whether public bodies had produced equality schemes, and carrying
out more in-depth checks of the schemes produced by central government
departments, strategic health authorities and regional development
agencies. It argues that:
"This kind of activity must be continued by
the EHRC and it must be provided with the resources to enable
it to carry out this work. There are concerns, however, that the
EHRC has not properly followed up on some of the earlier work
done by the previous Commissions. The Single Duty will make even
more demands on the EHRC and so it must be provided with sufficient
resources to lead on this work and to form effective partnerships
with other bodies to promote compliance and enforcement."[96]
88. The Disability Charities Consortium agrees that
the Monitoring the Disability Discrimination Act research
by the former DRC provided a strong evidence base to help identify
barriers around the implementation of the DDA, and to inform action
to make it easier for disabled people to challenge discrimination.[97]
The Disability Charities Consortium would like the ODI and the
EHRC to continue this type of research. It also urges the EHRC
to engage more with the disability community, noting that the
numbers of calls to their Helpline compared to the Disability
Rights Commission's helpline have dropped significantly.[98]
89. The Employers' Forum on Disability states that
EHRC has a unique role as the only public organisation that has
responsibility for all equality and diversity strands.[99]
Mr Harrop of Age Concern and Help the Aged stressed that "we
should think about [
] the opportunity that having the new
Act brings. Events do create awareness so it is very important
that the Government and EHRC use this as an opportunity to shake
up public debate and raise awareness of both existing legislation
and the new rights that are coming."[100]
90. It is paramount
that the Government and the Equality and Human Rights Commission
(EHRC) monitor the implementation and progress of the single Equality
Act effectively. The EHRC has a unique role as the only public
organisation that has responsibility for all equality and diversity
strands. It needs to ensure that none of the rights under the
current strands are diminished under a single Equality Act.
91. The ODI has been set up to help the Government
to deliver on the commitment made in the report, Improving
the Life Chances of Disabled People. The report says that
by 2025, disabled people should have the same opportunities and
choices as non-disabled people and be respected and included as
equal members of society. The ODI acts as a champion for disabled
people within government. It works with all Departments to help
them better understand and meet the needs of disabled people.[101]
92. DWP states that the ODI is working to ensure
that disability is properly reflected in the new Act, and that
opportunities are taken to harmonise approaches where possible
whilst also ensuring that there are distinct provisions for disability
within the Equality Bill where appropriate. It is also working
to ensure that the commitment that there should generally be no
erosion of existing levels of protection for disabled people is
delivered. The Department states that the ODI's role regarding
the Equality Bill after it has received Royal Assent will be decided
in due course.[102]
93. Employers' Forum on Disability understands the
role of the ODI to be to monitor government policy as it affects
disability across all government departments. This makes it in
some sense an internal disability audit office. However, in practice
it seems that other government departments regard ODI as having
exclusive responsibility for disability. This leaves ODI, a relatively
small department, taking the lead on disability across all policy
areas including employment, education and housing.[103]
The Employers' Forum on Disability is also concerned that the
separation between the Government Equalities Office (GEO) and
the ODI will mean that disability issues will not be adequately
understood or dealt with within equality legislation:
"A good example of this is the ODI consultation
on the Malcolm case. This consultation was led by ODI.
However, in discussion with ODI it was apparent that the consultation
responses were simply informing ODI's work with Government Equalities
Office on the Equality Bill. This division makes it difficult
for employers to represent their views to relevant officials and
Ministers. It also means that there are conflicting messages going
to employers. There appear to be mixed messages emerging from
DWP, Government Equalities Office and BERR about the equality
agenda. Disability is variously positioned as an issue about equality,
talent and business performance, welfare reform or a source of
additional regulatory or financial burdens on business. This is
unhelpful when trying to promote change within employers."
[104]
94. Although the GEO leads on the Government's overall
policy and legislation on equality issues, other Departments still
lead on various aspects of equality legislation. The Department
of Communities and Local Government continue to lead on race and
faith policy (other than in respect of certain equality matters)
including PSA 10 on race equality and community cohesion. DWP
lead on disability policy and legislation (ODI) and on age policy
(older people) including PSA17. The Department for Business, Enterprise
and Regulatory Reform, which leads on employment rights, has responsibility
for some specific aspects of discrimination law in the workplace
- age, religion or belief and sexual orientation - but not policy
more generally. The Department for Children, Schools and Families
(Department for Innovation, Universities and Skills for further
and higher education) and the Scottish and Welsh Governments are
responsible for equality law and policy in the field of education,
and for children and youth policy. The Ministry of Justice leads
on human rights law and policy and on the Gender Recognition Act.
The Office of the First Minister and Deputy First Minister leads
on equalities legislation and policy within Northern Ireland,
as a devolved matter.[105]
95. The Employers' Forum on Disability states that
the division of responsibility within government departments is
confusing and undermines the effectiveness of any single equality
legislation. To address this, it calls for a Minister for Equality
and Human Rights: "It would send a powerful message to the
nation were the government to appoint a Minister for Equality
and Human Rights with a seat at the cabinet table."[106]
96. Citizens Advice agrees that there needs to be
better policy co-ordination on equality and disability issues
across Whitehall. It recognises "the benefit of retaining
the Office for Disability Issues as part of the Department for
Work and Pensions as a focal point within Government for co-ordinating
disability policy and ensuring that the recommendations from the
strategy report Improving Life Chances of Disabled People
are implemented."[107]
It adds that "The Government Equality Office should be allowed,
and encouraged, to engage on all of the PSAs that relate to socio-economic
inequality as well as those dealing directly with the six discrimination
grounds, ensuring the interaction between the two is recognised
in the steps taken to achieve targets and measure progress."[108]
97. The division
of responsibility for equality issues within government departments
is confusing and risks undermining the effectiveness of any single
Equality Act. The Government Equality Office (GEO) should lead
on equality matters after the single Equality Act comes into force.
To co-ordinate disability policy across Whitehall effectively,
the GEO needs specialist expertise on disability, as currently
provided by the Office for Disability Issues (ODI). The GEO should
also lead on all of the PSAs that relate to inequalities and discrimination.
5 Ev 204 Back
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Q 1 Back
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Ev 230 Back
10 45,000
public bodies across Great Britain are covered by the Disability
Equality Duty (DED), which came into force in December 2006. The
DED is meant to ensure that all public bodies - such as central
or local government, schools, health trusts or emergency services
- pay 'due regard' to the promotion of equality for disabled people
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Q 218 Back
12
Ev 64 [Michael Connolly] Back
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Ev 204 Back
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Ev 64 [Michael Connolly] Back
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Ev 198 Back
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Q 243 Back
29
DDA 1995, s 24(3). Back
30
Ev 66 [Michael Connolly] Back
31
[2008] UKHL 43, respectively [80] and [102]. Back
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Ev 66 Back
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Ev 200 Back
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Ev 69 Back
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Eversheds HR e-briefing no 371: The ECJ confirms the Disability
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38
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39
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40
Ev 60 [NAT], Ev 62 [Michael Connolly], Ev 82 [TUC], Ev 90 [DCC],
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Ev 151 [EHRC] Back
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Ev 69 [Michael Connolly] Back
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Ev 69 [Michael Connolly] Back
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Ev 70 [Michael Connolly] Back
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Q 182 Back
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Ev 130 Back
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Ev 129 Back
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Ev 133 Back
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Ev 187 Back
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Work and Pensions Committee Valuing and Supporting Carers
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Q 178 Back
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Q 183 Back
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Equality and Diversity Forum Multi-dimensional discrimination:
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63
Equality and Diversity Forum Multi-dimensional discrimination:
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Equality and Diversity Forum Multi-dimensional discrimination:
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Ev 120 [Cloister], Ev 171 [DLA], Equality and Diversity Forum
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Ev 120 [Cloister], Ev 171 [DLA], Equality and Diversity Forum
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Ev 62 Back
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Ev 120 [Cloisters] & Ev 171 [DLA] Back
69
Ev 146 [EHRC] Back
70
Ev 59 [National AIDS Trust], Ev 81 [PCS], Ev 89 [TUC], Ev 120
[Cloisters], Ev 127 [The Law Society], Ev 144 [Employers' Forum
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71
Ev 114 [Cloisters] Back
72
http://www.parliament.the-stationery-office.co.uk/pa/jt200304/jtselect/jtdisab/82/8205.htm#a10
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Ev 146 [EHRC] Back
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Ev 204 Back
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Q 232 Back
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Q 233 Back
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Ev 90 Back
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Ev 144 Back
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Ev 145 Back
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Q 235 Back
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Ev 146 Back
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Q 33 Back
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Ev 228 Back
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Ev 115 [Cloisters] & Ev 165 [DLA] Back
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Ev 115 Back
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Ev 196 Back
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Ev 115 [Cloisters] & Ev 165 [DLA] Back
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Ev 115 Back
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Ev 162 Back
90
Q 4 Back
91
Ev 146 Back
92
Ev 228 Back
93
Q 4 Back
94
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95
Ev 205 [DWP] Back
96
Ev 86 Back
97
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Ev 205 Back
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Ev 145 Back
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Ev 231 Back
105
Government Equalities Office Annual Report and Resource Accounts
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Ev 196 Back