Research on the experience of staff with disabilities within the NHS workforce

NHS England has commissioned a primarily quantitative research project, focusing on the experiences of staff with disabilities working within the NHS, drawing upon two national data sets:
• The 2014 NHS staff survey, completed by 255,000 staff, reporting their experiences of working in the NHS
• The Electronic Staff Record (ESR), comprising data on the entire NHS workforce, gathered for workforce planning, personnel and wage payment purposes.
The research tender required a focus on the following issues:
a. What is staff with disabilities’ representation at all levels of the NHS and covering different types of disability?
b. Why is there a disparity between the proportion of staff who declare a disability on the Electronic Staff Record System and of those who declare a disability on the anonymous NHS staff survey?
c. How well are staff supported who become disabled during the course of their employment? Is there a process for recording this on the staff survey?
d. What are appraisal rates for staff with disabilities compared to non-disabled staff?
e. Do staff with disabilities have similar levels of access to training and development as non-disabled staff?
f. How well do NHS organisations make reasonable adjustments for staff with disabilities, from the recruitment process to the end of employment?
g. What difference does the ‘two ticks’ symbol make to recruitment and employment?
h. What are the numbers of staff with disabilities who are the subject of employment processes and procedures, for example disciplinary and capability processes?
i. What are the turn-over, retention and stability rates for staff with disabilities within the NHS?
Key findings are:
Staff with disabilities’ representation at all levels of the NHS and covering different types of disability
Levels of reported disability are around 17% in the NHS Staff survey, and around 3% in the ESR. Neither data set allows for more specific analysis between different types or degrees of disability. The most likely reasons for the disparity between reported levels of disability are:
1. Differences in definition of disability used in the two data sets
2. Differing conditions for self-disclosure (NHS staff survey is anonymous)
3. Time of disclosure (ESR reports disability at the time of staff appointment, and is not reliably updated)
Differences in quality of support between staff with and without disabilities
There was not a specific survey question that addressed this issue, but it was possible to identify a number of questions that the report argues can be taken as acting as ‘indicators’: What are the levels of bullying and harassment?; How far do staff feel ‘Pressure to work when feeling unwell’?; Do staff feel their organisation acts fairly with regard to career progression? Relative to non-disabled staff, staff with disabilities felt more bullied, in particular from their managers (12 percentage points more); more pressure to work when feeling unwell (11 percentage points more); and less confident that their organisation acts fairly with regard to career progression (8 points difference). The report concludes that, relative to non-disabled staff, staff with disabilities rate themselves as substantially less well supported.
Appraisal rates
Rates of appraisal between staff with and without disabilities were broadly comparable. However there were substantial differences in how the value of appraisal was rated. Staff with disabilities are less satisfied with the effects of their appraisal. 7 percentage points fewer felt that appraisals improved their performance. Moreover, 9 percentage points more disabled staff report that their appraisal left them feeling that their work is not valued by their organisation.
Experience of training
The NHS staff survey indicates that most staff had training within the last 12 months and only 5 - 25% staff received no training in each specified topic. There is very little disparity between disabled and non-disabled staff in the proportion not receiving training in any of the topics, or in their satisfaction with the training.
Reasonable adjustments
The NHS Staff survey asks if ‘employer has made adequate adjustment(s) to enable you to carry on your work’. 40% respond ‘Yes’, 14% ‘No’ and 46% ‘No adjustment required’. The proportion responding ‘No’ varies substantially depending on the Trust involved, from a low of 5% to a high of 41%. The proportion also varies by ethnicity, with white British staff with disabilities expressing the lowest rate of dissatisfaction with the adjustments their employer made, while all other ethnic categories have consistently higher rates. The relatively small groups of Bangladeshi and ‘Other black background’ staff have the highest rates of dissatisfaction.
Job satisfaction
Staff with disabilities rate themselves as more dissatisfied with the recognition, support, responsibility and opportunities they have in their jobs, even though there is no difference in the satisfaction they report in the quality of care they give to patients. Staff with disabilities felt less recognised for their good work undertaken (8 percentage points fewer); they felt less supported by their immediate managers (5 percentage points fewer); they felt less supported by their work colleagues (3 percentage points fewer); they were more dissatisfied with the levels of responsibility they had been given (4 percentage points fewer); they felt they had less opportunity to use their skills (5 percentage points fewer); and finally, they were substantially less satisfied with their level of remuneration, and they thought they were valued less highly by their organisation for the contribution they were making (both 9 percentage points fewer).
What difference does the ‘two ticks’ symbol make to recruitment and employment?
The evidence from previous studies suggests that the Two Ticks award does not make a great deal of difference in terms of an organisation’s awareness of disability issues or in its capacity to address any inequalities or inadequacies in practice. We found in our study that the great majority of Trusts now have ‘Two Tick’ status. Using the NHS Jobs website, Trust websites and other evidence available online, as well as a DWP list, an estimate was made of the current ‘Two Ticks’ status of every Trust. 18 of 244 (7%) Trusts were found to not have the award. A comparison was made between Trusts with and without the ‘Two Ticks’ award of the extent to which staff who declare a disability report that their employer failed to make ‘adequate adjustments’ to enable them to carry out their work. Although in our study, there was a consistent finding that Trusts that have the ‘Two Ticks’ award have marginally higher average rates of ‘adequate adjustments’ reported by staff with disabilities, the difference is small, the number of ‘No award’ Trusts is small (just 1 in the case of Ambulance and Community Trusts) and the range among all Trusts is very large (from 5% to 41 %). Given also that the overall performance of Trusts was poor with respect to a variety of issues summarized above, such as levels of bullying and harassment, impact of appraisal etc., it would seem that ‘Two Ticks’ status achieves relatively little in terms of improved performance against these metrics.

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