Architectural apartheid

With a combination of careful thought, determination and technical ingenuity, any building can be ma

There’s no doubting the fact that, since the introduction of the Disability Discrimination Act in 1995, access to buildings has improved substantially in the UK. I’ve noticed the change myself. Back in the 1980s, if I made an enquiry about wheelchair access, there was a 50-50 chance the answer would be no. Now it’s almost always yes. A theatre in Shaftesbury Avenue that I couldn’t attend when I first moved to London in 1999, can now accommodate wheelchair users.

Not everything is rosy. Many small shops and restaurants still pose a problem, and a ridiculous proportion of London cinemas still don’t have access to all their screens. (You can bet that the movie I want to see is showing on a screen I can’t reach. I’ve lost count of the number of films I’ve missed for this reason.) But generally-speaking, access has increased, and almost all large venues now have wheelchair facilities. Even the SS Great Britain, Brunel’s magnificent ocean-going liner in Bristol, has been expertly restored in a way that enables crips to go on board.

What is needed now is a commitment to providing not just access but equal access. I’ll explain what I mean by this using examples I came across at university. My college library was built relatively recently and yes, it had disabled access. But what irritated me was that the ramp was placed to the side of the main entrance, despite the fact there was plenty of space to position it in the centre, thus avoiding the need for steps altogether.

Why is it, I wonder, that architects still insist on using steps and then add a ramp almost as an afterthought? Why don’t they make their designs inclusive by deciding that a ramp will be the primary or only means of entering a building?

Once up the library ramp I then had to use a separate door because the main door was a revolving one – something I found odd and frustrating. You wouldn’t have separate doors for black people and white people, so why have different entrances for disabled and able-bodied people? What made it even more annoying was that this side door could only be opened using a remote control device.

And if the remote control failed to work, which it did frequently, I then had to wait while my assistant entered the library via the revolving door to ask a member of staff to open the side door for me. Thankfully the library had a porch which stopped me getting wet if it was raining. When I queried why a revolving door was necessary in the first place, I was told that it reduced the amount of dust reaching the books. Well, this explanation certainly didn’t reduce my blood pressure.

The most severe case of what I call ‘architectural apartheid’ could be seen in my faculty building, which was also a modern construction. As you would expect, the staircase for reaching the upper floors led off the entrance foyer. Yet bizarrely, the lift was installed at the opposite end of the building and could only be reached by a different entrance. So to attend a lecture on the first floor, a friend and I would have to enter the building one way while everybody else went the other way.

It may seem like a small issue, and I suppose I should just be grateful that the faculty had bothered to incorporate a lift at all in those pre-DDA days. However, being forcibly split up from my fellow students, even if it was for a relatively short duration, certainly didn’t help me to feel integrated.

It’s important to note that I graduated more than 10 years ago and since then my college and the university have made a considerable effort to provide ‘equal’ access. (I was about to write “taken considerable steps” but that’s probably not the most appropriate phrase in this context!). For example, work has taken place to enable wheelchair users to use the same route into the college dining hall as other students, rather than the ‘tradesmen’s entrance’ I had to use in my day. My old university is no worse in access terms than any other institution and the staff I met there were keen to offer disabled students the facilities they need. And it goes without saying that separate access is obviously preferable to no access at all. At a college reunion last year, it gave me great pleasure to see that the porters’ lodge had acquired a ramp, despite the fact it was around the back.

Of course, providing equal access is easy if you’re designing an edifice from scratch. Nevertheless, it’s also entirely possible with old buildings, even in the most unpromising circumstances. Recently I was invited to a drinks reception at the Institute of Civil Engineers in Westminster. This imposing building has a flight of steps up to its main entrance and in the past I’ve always had to use an unprepossessing door tucked away down a dingy side street. However, this time I was told in advance that the institute had installed a new lift for wheelchair users and I was assured I would be able to use the front entrance like everyone else.

On my arrival, I looked for any traces of a lift but there was no sign of one. Confusing indeed. At that moment, a member of staff came out to meet me. He pressed a button and suddenly the right half of the steps started retracting one by one, silently and smoothly, into the side of the building, just like something from Harry Potter. This movement revealed a platform lift which raised me up to the level of the main entrance. And once I had vacated the lift, the platform descended once again to pavement level and the steps miraculously reappeared.

Now, being a professional cynic, it takes a lot to impress me these days. But even I had to admit, this was pretty cool. What a clever piece of technology. To anybody walking past, those entrance steps just looked like any normal steps. It just proves that, with a combination of careful thought, determination and technical ingenuity, any building can be made accessible – and it can be done without segregating disabled people in the process.

PS: Regular readers of this column will know that I have an interest in (obsession with?) Doctor Who. So I’m delighted to tell you that the forthcoming Doctor Who exhibition in London has wheelchair-access. I’ve always wanted to be photographed with a Dalek…

Victoria Brignell works as a radio producer with the BBC. After reading classics at Downing College, Cambridge, she undertook journalism training at Cardiff University. She lives in West London and is 30 years old and is a tetraplegic wheelchair-user.
Christopher Furlong/Getty Images
Show Hide image

Want to know how you really behave as a doctor? Watch yourself on video

There is nothing quite like watching oneself at work to spur development – and videos can help us understand patients, too.

One of the most useful tools I have as a GP trainer is my video camera. Periodically, and always with patients’ permission, I place it in the corner of my registrar’s room. We then look through their consultations together during a tutorial.

There is nothing quite like watching oneself at work to spur development. One of my trainees – a lovely guy called Nick – was appalled to find that he wheeled his chair closer and closer to the patient as he narrowed down the diagnosis with a series of questions. It was entirely unconscious, but somewhat intimidating, and he never repeated it once he’d seen the recording. Whether it’s spending half the consultation staring at the computer screen, or slipping into baffling technospeak, or parroting “OK” after every comment a patient makes, we all have unhelpful mannerisms of which we are blithely unaware.

Videos are a great way of understanding how patients communicate, too. Another registrar, Anthony, had spent several years as a rheumatologist before switching to general practice, so when consulted by Yvette he felt on familiar ground. She began by saying she thought she had carpal tunnel syndrome. Anthony confirmed the diagnosis with some clinical tests, then went on to establish the impact it was having on Yvette’s life. Her sleep was disturbed every night, and she was no longer able to pick up and carry her young children. Her desperation for a swift cure came across loud and clear.

The consultation then ran into difficulty. There are three things that can help CTS: wrist splints, steroid injections and surgery to release the nerve. Splints are usually the preferred first option because they carry no risk of complications, and are inexpensive to the NHS. We watched as Anthony tried to explain this. Yvette kept raising objections, and even though Anthony did his best to address her concerns, it was clear she remained unconvinced.

The problem for Anthony, as for many doctors, is that much medical training still reflects an era when patients relied heavily on professionals for health information. Today, most will have consulted with Dr Google before presenting to their GP. Sometimes this will have stoked unfounded fears – pretty much any symptom just might be an indication of cancer – and our task then is to put things in proper context. But frequently, as with Yvette, patients have not only worked out what is wrong, they also have firm ideas what to do about it.

We played the video through again, and I highlighted the numerous subtle cues that Yvette had offered. Like many patients, she was reticent about stating outright what she wanted, but the information was there in what she did and didn’t say, and in how she responded to Anthony’s suggestions. By the time we’d finished analysing their exchanges, Anthony could see that Yvette had already decided against splints as being too cumbersome and taking too long to work. For her, a steroid injection was the quickest and surest way to obtain relief.

Competing considerations must be weighed in any “shared” decision between a doctor and patient. Autonomy – the ability for a patient to determine their own care – is of prime importance, but it isn’t unrestricted. The balance between doing good and doing harm, of which doctors sometimes have a far clearer appreciation, has to be factored in. Then there are questions of equity and fairness: within a finite NHS budget, doctors have a duty to prioritise the most cost-effective treatments. For the NHS and for Yvette, going straight for surgery wouldn’t have been right – nor did she want it – but a steroid injection is both low-cost and low-risk, and Anthony could see he’d missed the chance to maximise her autonomy.

The lessons he learned from the video had a powerful impact on him, and from that day on he became much more adept at achieving truly shared decisions with his patients.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide