On the fringes?

The mainstream media gives disabled people precious little coverage

Disability is regarded by many commentators as being a fringe concern and we receive precious little coverage in the mainstream media, in comparison with many other sections of society.

On the one hand, disabled people would not welcome the obsessive treatment that is given to Islam by the national press, but it would be nice for our existence to be at least acknowledged once in a while.

This neglect is compounded by the attitude of many employers and service providers, who resent making changes to their business practices for what they see as a tiny minority of the population.

In many cases, the only time that we are discussed is to ask the question, ‘Have disability rights gone too far?’ It is surely premature for the backlash to begin before widespread acceptance has yet been achieved.

It is a truism that there are far more disabled people than most people expect and there is an oft-quoted statistic that one in five of the UK population qualify for protection under the Disability Discrimination Act.

However, this figure is easily dismissed by assuming that most of these people have impairments which are regarded as relatively minor, such as back problems, dyslexia or depression.

Such a view is highly patronising and seriously underestimates the extent of exclusion faced by members of these groups. In any case, even if we grudgingly ignore them, the ‘disability problem’ stubbornly fails to disappear.

For example, 3% of British people have visual impairments that cannot be remedied with glasses, 2% use wheelchairs, and 1% will be diagnosed with schizophrenia in their lives.

We are not hiding. These numbers seem surprising because very few organisations have workforces even remotely reflecting these proportions, and most high street shops cannot be accessed by a lot of disabled people.

Even if there was a reason to visit the city centre, many people are completely unable to get there by public transport. Meanwhile, the total collapse of community cohesion combined with a general inability to cope with unusual behaviour causes many people with mental health difficulties to become socially isolated.

Although the encounters that we have on a day-to-day basis can sometimes be a reliable indicator of the composition of society, in this case they produce a dangerously distorted picture. I have given up any hope that TV with ever do enough to correct this perception.

When it is argued, to choose one example, that websites need not be made accessible to blind people, because not many of them use the internet, this is a clear case of putting the cart before the horse.

To quote a sentimental Kevin Costner film, ‘If you build it they will come.’ Being located in a deep pit, the Eden Project did not find it easy to provide access, but it has been rewarded with thousands of extra visitors, and the number of wheelchairs on show is a striking contrast to other tourist attractions. To someone who is not used to it, they seem to be everywhere.

It will only be possible to get a realistic perspective of the size of the disabled population when the same can be said of every single building in the country. Just one inaccessible shop does more to create segregation than a million veils.

As a child, I was very successful in my schoolwork but found it difficult to make friends. I went to Cambridge University but dropped out after a year due to severe depression and spent most of the next year in a therapeutic community, before returning to Cambridge to complete my degree. I first identified myself as autistic in 1999 while I was studying psychology in London but I was not officially diagnosed until 2004 because of a year travelling in Australia and a great deal of NHS bureaucracy. I spent four years working for the BBC as a question writer for the Weakest Link but I am now studying law with the intention of training to be a solicitor. My hobbies include online poker and korfball, and I will be running the London Marathon in 2007. I now have many friends and I am rarely depressed but I remain single.
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All doctors kill people – and the threat of prosecution is bad for everyone

We must recognise the reality of medical practice: just because a doctor makes a mistake, that doesn’t mean they’ve all broken the law. 

On 15 November the Court of Appeal quashed the 2013 conviction for gross negligence manslaughter (GNM) of a senior consultant surgeon in London, David Sellu. Sellu, who had completed his prison term by the time the appeal was heard, will never get back the 15 months of his life that he spent in jail. Nor will the personal and family trauma, or the damage to his reputation and livelihood, ever properly heal. After decades of exemplary practice – in the course of the investigation numerous colleagues testified to his unflappable expertise – Sellu has said that he has lost the heart ever to operate again.

All doctors kill people. Say we make 40 important decisions about patients in a working day: that’s roughly 10,000 per annum. No one is perfect, and medical dilemmas are frequently complex, but even if we are proved right 99 per cent of the time, that still leaves 100 choices every year where, with the benefit of hindsight, we were wrong.

Suppose 99 per cent of those have no negative consequences. That’s still one disaster every 12 months. And even if most of those don’t result in a fatal outcome, over the course of a career a few patients are – very regrettably – going to die as a result of our practice. Almost invariably, these fatalities occur under the care of highly skilled and experienced professionals, working in good faith to the very best of their abilities.

If one of these cases should come before a crown court, the jury needs meticulous direction from the trial judge on the legal threshold for a criminal act: in essence, if a doctor was clearly aware of, and recklessly indifferent to, the risk of death. Sellu’s conviction was quashed because the appeal court found that the judge in his trial had singularly failed to give the jury these directions. The judiciary make mistakes, too.

Prosecutions of health-care professionals for alleged GNM are increasing markedly. The Royal College of Surgeons of England identified ten cases in 2015 alone. This must reflect social trends – the so-called “blame culture”, in which we have come to believe that when a tragedy occurs, someone must be held responsible. In every one of these cases, of course, an individual’s life has been lost and a family left distraught; but there is a deepening sense in which society at large, and the police and Crown Prosecution Service (CPS), in particular, appear to be disconnected from the realities of medical practice.

Malpractice investigation and prosecution are horrendous ordeals for any individual. The cumulative impact on the wider health-care environment is equally serious. In a recent survey of doctors, 85 per cent of respondents admitted that they were less likely to be candid about mistakes, given the increasing involvement of the criminal law.

This is worrying, because the best way to avoid errors in future is by open discussion with the aim of learning from what has gone wrong. And all too often, severely adverse events point less to deficiencies on the part of individuals, and more to problems with systems. At Sellu’s hospital, emergency anaesthetic cover had to be arranged ad hoc, and this contributed to delays in potentially life-saving surgery. The tragic death of his patient highlighted this; management reacted by putting a formal rota system in place.

Doctors have long accepted the burden of civil litigation, and so insure themselves to cover claims for compensation. We are regulated by the General Medical Council, which has powers to protect patients from substandard practice, including striking off poorly performing doctors. The criminal law should remain an exceptional recourse.

We urgently need a thorough review of the legal grounds for a charge of GNM, with unambiguous directions to the police, CPS and judges, before the spectre of imprisonment becomes entrenched for those whose only concern is to provide good care for their patients. As Ken Woodburn, a consultant vascular surgeon in Cornwall who was accused and acquitted of GNM in 2001, has said: “You’re only ever one error away from a manslaughter prosecution.”

This article first appeared in the 01 December 2016 issue of the New Statesman, Age of outrage