Nurses with disabilities regularly face discrimination in the NHS, despite ongoing efforts to boost equality, an investigation by Nursing Times has found.
One nurse with a lifelong condition described how she had been told by colleagues she was a danger to herself and patients, and “should not be a nurse”.
“At its worst, this means some don’t even have the basic equipment to do their work”
Other nurses talked about job offers being withdrawn when a disability was mentioned and having to threaten court action to ensure managers made reasonable efforts to accommodate their needs.
They described their struggle to continue working in the NHS ahead of the introduction of a new Workforce Disability Equality Standard (WDES), which is designed to help trusts improve practice.
Holly Chadd, peer support officer at the Royal College of Nursing, told Nursing Times that discrimination was still a common problem experienced by disabled members.
“Unfortunately, it is common and there continues to be a stigma around working in healthcare yet having a health condition or impairment yourself,” she said.
“Common issues include concerns about whether someone is able to carry out their duties,” she said. “Doubts aren’t necessarily founded and there are presumptions made based on medical knowledge rather than listening to the individual.”
“It is just good business sense to recruit and retain disabled nurses”
Meanwhile, other factors like staffing shortages could affect managers’ ability or willingness to provide appropriate support and make “reasonable adjustments” required under disability discrimination law, she noted.
“For example, you might have a line manager that is supportive on the surface but when staffing shortages come into play they can’t necessarily uphold adjustments they have agreed to put in place or they choose not to,” she said.
One theatre nurse, who does bank and agency shifts, told Nursing Times she had given up applying for full-time roles because of the discrimination she had experienced.
The nurse, who asked for her name and details of her disability not to be disclosed, said she had experienced prejudice from early on in her training
“My abilities were questioned when I was a student,” she recalled. “A nurse came up to me on placement and said, ‘do you really think you should be training?’ I was in shock.”
Having qualified, she said she had tried and failed to secure full-time jobs despite the fact most trusts were desperate to fill vacancies.
“Part of this is about making it much more normal for people to disclose their disability”
On one occasion she was actively encouraged to apply for a full-time job at an NHS trust only to discover her application had been rejected.
“I was placed there as an agency nurse and they were that impressed with me they encouraged me to apply for a band 5 role,” she said. “I applied and disclosed my condition. I waited and waited to hear and was then surprised to find out my application had been turned down.
“When I spoke to the nurse in charge he said he’d been told by occupational health I was a danger to patients,” she told Nursing Times. The nurse did go on to work for that trust, but was not allowed to care for complex cases.
“I was put in a day case area and on flexible hours. After my first appraisal I found out the other staff were complaining about my flexible hours and saying it was unfair that I was allowed to finish at set times,” she said. “They were having none of it, so I had to leave.
“When I disclose my disability I see people’s faces change. It feels as if I am a burden and I wonder why I trained in the first place,” she said.
“In eight years of being a nurse I haven’t really progressed,” she said. “I have just being going from agency to agency to bank to agency and it’s tiring. It has got to the point where I have had enough.”
Experienced nurse Laura Dudley, who was working in orthopaedic trauma when she was diagnosed with multiple sclerosis, told Nursing Times she too had considered quitting the profession after struggling to get her employer to make adjustments for her condition.
“Often these guys left school with an unseen difficulty that was not picked up”
While her boss agreed a move from trauma to the less busy elective orthopaedics ward, she found she was still being allocated shift patterns she could not physically manage to do.
“I gave them a good six months but was still getting shift patterns that really knocked me for six. I told my manager ‘I can’t actually do it’ but she kept saying ‘You can just swap with somebody’,” she said.
It was only when she threatened to sue the organisation that her concerns were taken seriously and, even then, she said she was “made to feel I was letting my colleagues down”.
Ms Dudley, who currently works as a community staff nurse, said she was fortunate to now work for a service that was happy to accommodate her needs, allowing her to work 30 hours a week with a mid-week break.
However, she maintained many nurses with disabilities faced discrimination in the NHS due to “a cross between ignorance and lack of funds”.
“Anything that costs money is hard,” she said “At the moment I am trying to get a cushion for my chair that costs £40 but have been told I can’t have it.
“It is very short-sighted – especially when you think about how much money it takes to train a nurse,” she said. “I feel my experiences have made me a better nurse as I can truly understand what people are going through and what it means to be shown kindness and not to be judged.
“But the NHS is not very good at looking after –not just disabled staff – but experienced staff in general,” she noted.
“The NHS is not very good at looking after –not just disabled staff – but experienced staff in general”
While she is open about her condition and keen to educate colleagues, she said many nurses with disabilities were worried about saying anything for fear of the reaction.
Reluctance by staff with disabilities to identify themselves and ask for help was among key findings from research that spurred the development of the WDES. It also revealed disabled staff were more likely to report being bullied and feel under pressure to work when they were ill.
The standard, which will work along similar lines to the Workforce Race Equality Standard introduced in 2015, will see trusts collate key data to allow them to compare the experiences of disabled and non-disabled staff and then devise local action plans monitored by NHS England.
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Draft metrics, which were piloted by 16 trusts in October and November last year, cover areas including bullying, career progression and whether employers have made adequate adjustments to enable staff to do their work.
The hope is that gathering such detailed information as this will provide a clearer local and national picture of where change is needed.
At the moment, qualitative data gathered through the annual NHS staff survey “tells us there is a problem”, said Joan Saddler, co-chair of NHS England’s equality and diversity council.
“Staff with a disability whether nursing, medical or other talk about varying levels of inclusion,” she said. “At its worst this means some don’t even have the basic equipment to do their work.
“If we are not supporting every part of our workforce then that has a knock-on impact on the services we provide,” she noted.
“Employers have an interest in retaining as many talented people in the workforce as possible long-term”
She said the drive to improve the experience of disabled NHS staff was not just about retaining talented people but also about actively recruiting more people with disabilities into healthcare.
“Retention is a huge issue, but I also think we’re missing a trick when it comes to who we attract into nursing,” she said. “This is about reaching out to people we are missing at the moment.”
This could include working closely with disability organisations and other partners to enable people with disabilities to enter the profession through nursing support and nurse associate roles, she said.
Organisations like the RCN have already been involved in work on the WDES and Ms Saddler urged nurses to take part in the next phase, which includes a series of regional consultations taking place this month.
“We absolutely need nurses on the ground currently working in pressurised care environments to help shape this standard,” she said.
The final standard is due out in the autumn with the first reports on organisation-level performance due to be published in August next year.
NHS Employers’ chief executive Danny Mortimer said trusts had already done a lot of work to improve conditions for disabled staff since the introduction of disability legislation, but he acknowledged “there is more to do”.
“Employers have an interest in retaining as many talented people in the workforce as possible long-term and want to find ways in which they can – within reason – make adjustments to keep people,” he said.
When it came to “reasonable adjustments”, he noted this could include adjusting someone’s duties, giving extra support through supervision, providing equipment and adaptations to work premises such as fitting ramps.
However, he said realistically there was a limit to how much trusts could spend. “It is hard to say what would be unreasonable but some of the test around unreasonableness is financial,” he said. “It is reasonable for trusts to spend some money but they can’t spend vast sums in terms of adapting premises.”
He said the WDES would inevitably raise the profile of the disability issues, adding: “That’s the experience we had with the Workforce Race Equality Standard.
“It has very firmly put it on board agendas, it has become part of how the Care Quality Commission assess the performance of an organisation and I think the same can and will happen with WDES,” he said.
“It also – in a much more systematic way – highlights where good practice must be,” he said. “We’d expect to see variation in terms of how employers are doing and this will help those who’ve got most work to do learn from those who are further ahead.”
“A disabled person may not realise there is help out there while a manager may not know how to get equipment”
Trusts already leading the way include the University Hospital of Southampton NHS Foundation Trust, which has a long-term illness and disability network that provides advice, support and a forum for sharing concerns.
The network, which meets every other month, has around 35 members with a range of disabilities, who include nurses. It is chaired by Tina Lanning, a former midwife who moved into union and staff support roles when her rheumatoid arthritis meant she could no longer practise.
Ms Lanning said executive support had been absolutely key in driving forward improvements for disabled staff. The trust has set up a strategic disability access group, which includes the director of nursing, to ensure progress on practical measures to boost accessibility.
It has included updating disabled toilets, switching to electronically opened doors in heavily used corridors and the creation of a special fenced off area where assistance dogs can “spend a penny”.
The trust has also sponsored three members of staff to attend a leadership course run by Disability Rights UK and they have gone on to produce “top tips” leaflets on organising reasonable adjustments. In addition, the trust now also has “accessibility officer” based in the occupational health team.
“A disabled person may not realise there is help out there while a manager may not know how to get equipment,” said Ms Lanning. “Now staff and managers can go to the accessibility officer and she can do a risk assessment for the department and individual.”
As well as supporting existing staff, the trust is about to launch a pilot scheme with Autism Hampshire to provide employment opportunities to others with disabilities.
Ms Lanning said the initial focus would be on roles in patient support, portering, catering, pharmacy and pathology but there was scope to extend this to nursing support roles.
Oxford University Hospitals NHS Foundation Trust is also among those actively preparing for the introduction of WDES as part of an all-round approach to improving facilities and support for those with disabilities.
The trust has used the draft WDES metrics to give an indication of areas for improvement and is staging an event in May to find out more about the experiences of disabled staff and any barriers they face with a view to setting up its own disabled staff network.
However, chief nurse Sam Foster admitted she would like more national guidance from NHS England, especially when it came to examples of good practice.
“We have not had much from NHS England to say to senior nurses ‘This is coming – how ready are you?’” she said. “There is a bit of a gap around what good looks like when it comes to maintaining people in clinical practice who may need a bit of support.”
The Oxford trust’s staff survey data shows 78% of disabled staff feel the trust has made adequate adjustments for them.
However, it also reflects the national picture by suggesting nurses and others may not feel confident when it comes to openly disclosing disabilities.
Staff records indicate just 1.89% of the trust’s staff are disabled yet the proportion reporting a disability via the anonymous survey is 15.2%, so a key focus will be on improving the disclosure rate.
“Part of this is about making it much more normal for people to disclose their disability because if they don’t talk to us it is difficult to do anything,” said the trust’s deputy chief nurse Liz Wright, who noted it was important nurse managers were aware of the potential for “unseen disabilities”.
“For example, I’ve had a number of care assistants who have told me they have difficulty in understanding presentations because they are dyslexic but have been too afraid to declare it previously,” she said.
“We have changed our presentations to make them much more visual and talk them through rather than just having a lot of text,” said Ms Wright.
Ms Foster highlighted that the trust’s efforts had also included helping people with nursing potential to achieve basic maths and English qualifications to enable them to progress.
“Often these guys left school with an unseen difficulty that was not picked up,” she said. “We have just given out 150 care certificates to a really vibrant group of care support workers and would expect a cohort to progress to nurse associate training.”
Meanwhile, the RCN is trying to support nurses with disabilities and managers to have “open and honest conversations” via a new “disability passport” that is due to be trialled soon.
The document, which is designed to be completed jointly by a staff member and their line manager is intended to set out clearly a nurse’s individual needs, any adjustments that are needed and a timetable for reviewing those arrangements.
“The idea is that the passport is recognised throughout an organisation, so if you go into a new role or your manager changes, you don’t have to start from scratch,” said Ms Chadd.
“There is a suggested template for documenting everything, but the key thing is the employee feels safe and confident to own their disability, to go in there and talk about it, and equally the line manager feels they can ask questions, listen and understand,” she said.
Ultimately, she said employing nurses with disabilities in the first place and supporting them in their roles made sense for the health service as a whole.
“There is huge value in having lived experience of disability when you are a care giver,” she said. “But what we want to highlight is that actually it is just good business sense to recruit and retain disabled healthcare professionals.”