Tackling workplace prejudice and building a disability-inclusive NHS

Individuals with disabilities and chronic conditions often face discrimination on both a personal and institutional level. Sadly, such discrimination is pervasive in the NHS.

Workers with disabilities are a valuable part of the healthcare profession because of their unique insights into patient care. Therefore, it is particularly concerning that employees with disabilities reportedly experience higher levels of discrimination than any other protected characteristic group within the NHS (Moore et al, 2019). Healthcare workers with disabilities face unique barriers and challenges as they study, train and work in a system that was not designed to accommodate their requirements. For example, the British Medical Association (2020) found that 77% of doctors and medical students with disabilities fear prejudice if they disclose a disability or long-term health condition. All healthcare professionals have the ability to address these concerns by raising awareness of hidden disabilities and challenging negative attitudes.

Challenges faced by healthcare workers with disabilities 

Obtaining a healthcare-related role in the first place can be more of a challenge for individuals with disabilities, with non-disabled job applicants being 1.23 times more likely to be recruited (Moore et al, 2019).

Under the Equality Act 2010, a person is considered to be disabled if they have a physical or mental impairment that has a substantial and long-term impact on their ability to carry out daily activities. The Act requires employers to make reasonable adjustments, such as providing assistive equipment or flexible working hours, for employees with disabilities. However, according to a survey by the British Medical Association (2020):

• Only 55% of doctors and medical students with disabilities who required reasonable adjustments reported that they had obtained them
• Only 26% agreed that their place of work or study’s sickness absence policies took their disability or health condition into account
• Almost half (47%) felt pressured to return to work before they were well enough
• 40% felt they had to use their annual leave to attend appointments related to their disability or condition
• 42% of consultants and 38% of specialist and associate specialist doctors reported that they had experienced bullying or harassment in their workplace as a result of their disability

One of the aims of the above survey was to investigate the experience of NHS workers with disabilities that may be hidden or fluctuating. It was found that only around one-third (36%) of doctors and medical students felt that their organisation was disability-friendly, and many reported feeling uncomfortable when disclosing their disability at work. This was similar to a previous study by Stephenson (2018), which found that many nurses were reluctant to disclose their disability at work because of concerns that they will be seen as less able to carry out their duties.

Existing interventions 

Research has shown that improving disability inclusion can increase the performance of healthcare organisations, making such initiatives beneficial for both individuals and organisations as a whole (NHS Employers, 2019a).

In 2015, NHS England launched the Learning Disability Employment Programme in an attempt to increase employment opportunities for people with learning disabilities (NHS England, 2015). So far, this initiative seems to have had a positive impact on recruitment processes.

• One NHS trust identified the need for social engagement on a dementia ward and designed a role specifically for individuals with learning disabilities, which led to the selection of a successful candidate
• This added value to the department by freeing up staff to focus solely on clinical aspects of care, while also providing a career opportunity to a worker with a disability (NHS Employers, 2019a)
• Other initiatives include the UK Government’s (2020) Disability Confident scheme, which aims to facilitate the employment of 1 million more disabled people by 2027 and increase understanding among employers of the benefits that disabled people can add to a workforce
• The above scheme has resulted in some progress in the NHS, with 94% of NHS trusts participating in the programme in 2019
• Consequently, the proportion of staff with disabilities who felt that adequate adjustments had been provided for them increasing from 67.1% to 72.8% (Moore et al, 2019)

Actions to take 

The areas of action that are considered top priorities by the British Medical Association (2020) and the Learning Disability Employment Programme (NHS Employers, 2019a) are as follows:

• Pledging to support diversity in the workplace (NHS Employers, 2019b)
• Creating centralised budgets for funding reasonable adjustments, streamlining processes to access adjustments and developing clear timescales for each stage
• Tailoring job specifications towards people with disabilities and creating an easy-to-read version as a reasonable adjustment for applicants
• Considering alternative interviewing techniques, such as getting the interviewee to carry out a task to demonstrate their skills
• Creating more flexible career and training pathways and more opportunities for remote and flexible working
• Introducing a separate disability leave policy to ensure that adjustments are made for disability-related absences, such as medical appointments
• Improving support for health workers with disabilities returning to work, including phased returns
• Increasing awareness of hidden and fluctuating disabilities and long-term health conditions and challenge negative attitudes to disability in medical education, training and workplaces
• Establishing staff networks for those with disabilities
• Facilitating training to ensure that managers and staff know how to prevent and address harassment and abuse of colleagues with disabilities

Conclusions

Despite the NHS’ existing disability-inclusive efforts, there is still a long way to go to create a system that takes the needs of employees with disabilities into account. Raising awareness of hidden disabilities, establishing staff networks to increase support, initiating training to address discrimination and improving access to reasonable adjustments should be prioritised for healthcare leaders.