1. Physical Access Difficulties and challenges

2. Context The Disability Discrimination Act (1995;2005) in recent years has centred our thoughts on access to the built environment. Crown Immunity allowed institutions, including hospitals were given extra time to conform, but that timeframe has now passed. It is interesting to note that even where facilities for disabled people are exemplary, in every other aspect, little thought has been given to disabled access in the maternity wards. Some hospitals and institutions have seized the initiative to improve access for disabled people; for example, Liverpool and Milton Keynes NHS Trusts, which are cited as exemplars of good practice, are offering high standards of care and at little additional cost (RCN, 2007:26). Sadly this is not uniform across the NHS.

3. Design Apartheid (Barnes et al, 1999). This is highlighted where disabled mothers who have to negotiate steps in the community health centres for antenatal visits, baby weigh checks and cervical screening. And have to tackle the ever increasing problems of car parking. It is thought that if there were improvements in access generally this could improve maternity services overall. For example, ramps would help all mothers with pushchairs and elderly visitors. Design faults should be addressed as a matter of urgency due to litigation and risk management issues (Symon, 2006). Costs of dealing with litigation are potentially very high, even when balanced against the costs of improved access.

4. It is everyone’s responsibility to improve care It is imperative for health care professionals to highlight to managers and planners any shortfalls in the system so that resource allocation can be planned in advance. We often blame poorly designed access on the architecture of the past but we can all influence the planning of the future. Some recent Acts of Parliament and the Nursing and Midwifery Council suggest that we can be held responsible at a personal and corporate level for discriminatory practices and unequal access to information, buildings or services (DDA,1995; Equality Act, 2010; NMC, 2008). We have a responsibility to meet DDA legislation (Dimond, 2000).

5. Definition of accessibility may be open to scrutiny Disabled people can be treated less favourably than others on grounds of their disability, or where there is failure to make "reasonable adjustments" for disabled people to access services. Some hospital have addressed this by identifying a member of staff whose job included checking that specific disabled parents’ needs were anticipated. (Wates 2004:viii and RCN 2007) In some hospital the maternity unit was the only area that did not provide facilities for disabled people. ( Wates, 2003)

6. Inaccessibility in the built environment “one of the most significant problems for disabled people relates to physical obstacles and barriers in the built environment such as inaccessibility to wheelchair users which prevents disabled people’s ease of access to a range of places and denies disabled people the right to determine where they want to go”. (Shakespeare 1998:279) This is tantamount to an infringement of civil liberties.

7. A universal design? Universal design would provide the basis of inclusive architecture. (Barnes 2002) Designing systems which accommodate patient and staff safety issues often results in many areas having restricted access with codes and intercom system. This can be very confusing for those with sensory impairments or are inaccessible at wheelchair height.

8. RCN (2007) highlights how access can be improved to those with a sensory impairment - making sure corridors and toilets are not blocked by equipment - using text messages with a mobile telephone to communicate with a person with hearing impairments - accessing wards areas by using a call bell that was low and has a light to help with access. Sources to help you Royal National Institute for the Blind (RNIB) Royal National Institute for the Dead (RNID) CHANGE ( a leading national human rights organisation led by Disabled People) SCOPE (for people with cerebral palsy) supply literature and a list of resources to help parents & health professionals.

9. Do you consider that maternity services are physically accessible to disabled women? Consider this quotation ….. “ all the places where reproduction is monitored have been developed in the absence of disabled women, and this invisibility is reflected in the attitudinal and often inaccessible physical environment of infertility clinics, antenatal classes, antenatal wards, labour wards, postnatal wards and baby clinics -almost all the spaces where the surveillance of reproduction, birthing and mothering takes place. Yet in Western society, hospital has become the taken for granted space for childbirth yet it is a place from which some disabled women have been physically excluded." (McFarlane 1996:160)

10. References Barnes, C. Mercer, G. and Shakespeare, T. (1999) Exploring Disability; A Sociological Introduction Cambridge Polity Press. Confidential Enquiry into Maternal and Child Health (2011) www.cmace.org.uk Denny, E and Earle, S. (Eds) (2010) Sociology for Nurses 2 nd edition, Cambridge, Polity Press Dimond, B (2000) The Human Rights Act 1998; implications for practice British Journal of Midwifery 8(10):616-618 Disability Discrimination Act (2005) (1995) London, HMSO www.drc- gb.org/Governmentwww.drc- gb.org/Government Equalities Office (2010) Equality Act www.equalitiesgov.ukwww.equalitiesgov.uk

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