Reasonable adjustments in hospitals

Pauline Heslop, Stuart Read, Sue Turner, Chris Hatton, Caroline Miles

The 2010 Equality Act requires services – including health services -  to make ‘reasonable adjustments’ for disabled people so that those services are equally accessible to them. This legal requirement is especially important in the light of continued concerns about mortality amongst disabled people in hospitals. For instance, Heslop et al. (2013) showed that people with learning disabilities were dying between 13-20 years sooner than the general population, with many of those deaths avoidable and traced to insufficiencies or poor practice in health care.

We know there is also excess mortality amongst those with the most disabling forms of mental illness is not the result of higher suicide rates, but rather a combination of socioeconomic and healthcare factors as well as clinical risk. There are continued problems for certain groups of disabled people in accessing health care on an equal basis (Francis, 2012). One recommendation of Heslop et al. (2013) was for an annual audit of reasonable adjustments, with best practice shared across organisations, and it was that recommendation which led to the current project.

This project thus focused on change in organisational and service responses. We aimed to find out more about the facilitators and barriers to the provision of ‘reasonable adjustments’ within the NHS for disabled patients. The specific research questions addressed were:

a) What strategies have well-performing NHS Trusts taken to ensure the provision of reasonable adjustments for disabled people accessing hospital services?

b)How is the provision of reasonable adjustments for disabled people in hospital settings monitored?

The project consisted of  five main activities:

  • An Audit of Care Quality Commission hospital inspection reports. This involved reviewing 137 CQC inspection reports from 2015 and 2016 of hospitals that had more than 50 beds, to establish the types of reasonable adjustments that are reported.
  • An online survey (52 responses: 41 patient experience individuals working in hospitals, and 11 Healthwatch representatives).
  • Freedom of Information requests to NHS Foundation Trusts and NHS Trusts in England, regarding their adherence to Monitor (2015) criteria for people with learning disabilities.
  • Interviews (21) with disabled people about their experiences of reasonably adjusted hospital care and their ideas about how hospital services could make positive change. 
  • Four workshops in Bristol and Leeds, for disabled people and health professionals to share their good practice examples of reasonable adjustments.

The project was organised by a disabled academic with a wealth of lived experience as a hospital patient, and also benefited greatly from a pan-disability advisory group, who met several times to shape and interpret the findings as they emerged.


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