Analysis

COVID-19 and coping with a disability: supporting staff to keep doing their jobs

Reasonable adjustments have been affected by the pandemic, but shielding is not the only option

Reasonable adjustment assessments have been disrupted by the pandemic, but shielding is not the only option

  • Many nurses with disabilities or long-term conditions have been forced to shield in the pandemic, but for some this has led to feelings of professional isolation
  • Occupational health appointments and assessments have been affected due to the pressures on healthcare services, and some staff report feeling pressured to return to work as normal
  • The steps employers can take to enable nurses with disabilities or long-term conditions to continue to work, whether from home or through redeployment

The COVID-19 pandemic has been stressful and exhausting for all nurses, however those with disabilities have faced particular challenges.

Reasonable adjustment assessments have been disrupted by the pandemic, but shielding is not the only option

  • Many nurses with disabilities or long-term conditions have been forced to shield in the pandemic, but for some this has led to feelings of professional isolation
  • Occupational health appointments and assessments have been affected due to the pressures on healthcare services, and some staff report feeling pressured to return to work as normal
  • The steps employers can take to enable nurses with disabilities or long-term conditions to continue to work, whether from home or through redeployment
A woman who is shielding, standing staring out of a window wearing a face mask
Picture: iStock

The COVID-19 pandemic has been stressful and exhausting for all nurses, however those with disabilities have faced particular challenges.

Community staff nurse Laura Dudley, who has multiple sclerosis, was working in a district nursing team for a Scottish NHS board before the coronavirus crisis. When Scotland’s first lockdown was announced, she was told to go home and shield.

Shielding and being removed from work can feel like being ‘forgotten’

‘I was just sent home with nothing to do,’ Ms Dudley says. ‘It was frustrating and depressing. I felt unsupported – it was like I had been forgotten.’

28,349

people on the NMC register in March 2020 reported having a disability

Source: NMC

Many others have found themselves in a similar position, says RCN peer support officer Holly Chadd, who coordinates the college’s Peer Support Service for members with disabilities and health issues.

Nurses with conditions that have never got in the way of them doing their jobs before have suddenly found themselves unable to work or struggling due to requirements for personal protective equipment (PPE), she says.

Varying levels of employer support for staff with disabilities

RCN members with disabilities paint a mixed picture of the support they have received from employers.

‘Some have had a great experience while others have had a difficult time,’ says Ms Chadd. ‘The picture is the same as outside the pandemic – it is down to the skills, experience and empathy of line managers and, to some extent, the broader organisation.’

Under equality legislation, employers are required to make ‘reasonable adjustments’ to enable people with disabilities and health conditions to continue working.

At the start of the pandemic, in particular, ‘a lot of good practice went out the window’, says Ms Chadd.

Challenges facing disabled healthcare staff at work

Research from before and during the crisis shows NHS staff with disabilities report more bullying and harassment in the workplace than non-disabled colleagues.

The NHS Workforce Disability Equality Standard (WDES) is a set of measures allowing organisations to compare experiences of disabled and non-disabled staff, designed to help tackle disparities.

The latest data gathered as part of the NHS Staff Survey conducted in late 2020 show staff with disabilities continue to report high levels of discrimination at work.

More than a quarter (25.7%) said they had experienced harassment, bullying or abuse from colleagues in the past year, compared with 16.8% of non-disabled staff.

Disabled staff were also significantly more likely to report being harassed, bullied or abused by managers. The data shows 31.3% of disabled staff felt pressure from their manager to come to work, compared with 23% of non-disabled colleagues.

What is a disability?

  • A condition that affects someone’s ability to carry out normal day-to-day activities
  • Disabilities can be mental or physical conditions
  • They may be hidden or visible
  • Long-term conditions classed as disabilities include heart disease; stroke; diabetes; musculoskeletal conditions; lung or respiratory conditions; mental health conditions, including depression and anxiety; learning difficulties and neurodiverse conditions such as autism and dyslexia; visual, hearing and speech impairments; HIV; multiple sclerosis; cancer

Source: Understanding Disability, NHS Employers

Alternative roles for staff who are shielding

Ms Dudley was eventually given a role she could do from home and is now helping coordinate vaccinations for people who are housebound.

Laura Dudley, community staff nurse
Laura Dudley

She has accessed counselling via occupational health and her employer recently started up a weekly virtual peer support group for staff who are shielding.

Ms Dudley has had her two COVID-19 vaccinations. However, she is not yet certain when she will be able to return to her regular job.

‘Even though I want to go back, it’s quite daunting because I’ve been off for a while and will be a bit rusty,’ she says.

Stigma remains for nurses with a disability

It is hard to give an accurate figure for the number of nurses with disabilities working in the UK.

Approximately one in five (20%) people of working age has some kind of disability. However, the latest equality and diversity data from the Nursing and Midwifery Council show just 4% of registrants – about 28,350 nurses, midwives and nursing associates – report having a disability.

This suggests many nurses with disabilities choose not to disclose them or do not see themselves as disabled.

This is not surprising, according to nurse Bethann Siviter, who says there continues to be a stigma attached to having a disability within the nursing profession.

‘There was a bias against disabled nurses going into the crisis and no crisis makes bias better,’ she says.

Bethann Siviter, nurse
Bethann Siviter Picture: Neil O'Connor

Ms Siviter, who has a rare form of cancer and uses a wheelchair, was running a nursing home, but retired from that role at the start of 2020 when she realised the pandemic was imminent.

While shielding, she has been helping other disabled people – including some nurses – understand their employment rights.

She says many nurses with disabilities have pushed themselves to keep on working during the crisis at the expense of their own health and well-being.

‘Many have kept their mouths shut about the fact they have health problems and disabilities because it’s an “all hands on deck” mentality,’ she says.

‘They have continued working when they probably shouldn’t and have driven themselves into the ground.’

Nurses with a disability who may need extra breaks or time off for appointments have also experienced less empathy and understanding from overstretched colleagues, Ms Siviter says.

She believes some will inevitably end up leaving the profession due to the added strain on their physical and mental health.

How to support staff to work from home

Access to support has been patchy, with services including occupational health appointments and assessments for ‘reasonable adjustments’ being put on hold and long waiting lists for others such as mental health support.

Karen Hampson, junior sister
Karen Hampson

Meanwhile delays in treatments, therapy, screening and other health services are also having a serious impact on some nurses’ ability to work.

Junior sister Karen Hampson has a range of neurological conditions and movement disorders and experiences fatigue and chronic pain.

She has regular treatment to control her symptoms but much of it was cancelled in the pandemic, affecting her ability to do her full-time role as a care pathway facilitator, which involves travelling between two hospitals.

However, Ms Hampson, who also has a tumour on her spine and was diagnosed with endometrial cancer before the first lockdown, was determined not to take time off sick.

31.3%

of NHS staff with disabilities say they have experienced pressure from a manager to come to work

Source: NHS 2020 Staff Survey

She has been supported by her trust to continue working five days a week from home. This included securing remote access to electronic records, installing IT and other specialist equipment at home and receiving supervision via Zoom. ‘They weren’t sure about it at the beginning but I made it work,’ she says. ‘If I can do it, anyone can.’

Ms Hampson hopes to continue working in this way, at least part-time, once the pandemic recedes.

‘Some nurses are being told they can’t work from home. My message for management is “Have you looked far enough into the opportunities?”’ she says.

Supporting staff with disabilities: tips for colleagues and managers

Keep in touch Ensure you keep in contact with team members who are shielding or working from home, says staff nurse Laura Dudley. ‘We’re not seeing our colleagues and may not be in contact with our team, so it’s important someone checks in with you once in a while,’ she says.

Be creative about redeployment The RCN’s Holly Chadd urges managers to work with staff to find ways they can continue working while restrictions remain in place. ‘Look at their skills and experience and try and think outside the box,’ she says. ‘Look beyond your service and traditional roles to where there are gaps and people can be useful.’

Be proactive in securing extra support Managers can play a vital role in ensuring staff with disabilities get additional support or adjustments, especially now, when services may be harder to access, says nurse Bethann Siviter. ‘Listen to your staff, ask them what they need and use the systems you have in place to escalate issues on their behalf,’ she says.

Don’t pressure people to return to work Difficulties in accessing treatment and other services may make it harder for some nurses to return to their regular roles immediately. ‘They should not be made to feel guilty if they can’t come back to work straight away,’ says care pathway facilitator Karen Hampson.

Recognise the value of staff Above all, managers need to recognise the value of staff with disabilities at a time when staffing shortages have been thrown into sharp relief. They are not only expert nurses but expert patients too, says Ms Siviter. ‘Workforce data shows disabled members of staff are less likely to call in sick or leave a job than those who are not disabled,’ she adds.

How could a ‘passport’ system for staff help?

NHS health passport

One tool that can help managers and nurses discuss the options is a ‘passport’ document that enables staff to record details of their condition and any adjustments or adaptations they need.

Health Education England and NHS Employers have devised a ‘health passport’, alongside guidance for managers.

The RCN has also produced guidance – due to be reviewed this year – on the use of ‘disability passports’, which includes a suggested template.

‘It’s about having open, honest and constructive conversations between the manager and the individual,’ says Ms Chadd.

As the health service emerges from the pandemic, there are likely to be ongoing backlogs in services and treatments that will continue to affect staff with disabilities.

There are also concerns that people may be put under pressure to return to work too soon.

Other challenges include the fact nurses are among those suffering the effects of long-COVID. ‘We’re seeing more members affected,’ says Ms Chadd, who says the Peer Support Service has set up a dedicated Facebook group.

Innovations that have come from the pandemic

76.6%

NHS staff with disabilities who say employers made reasonable adjustments so they could carry out work

Source: NHS Staff Survey Results

Positive developments during the pandemic include the fact nurses have been supported to work flexibly, says Ms Chadd.

The crisis has also led to innovations that could help staff. For example, a PPE innovation team at NHS England and Improvement is working with RCN members and others to develop high-grade PPE that allows people to see each other’s faces.

This could make all the difference to nurses with hearing impairments who rely on lip reading, and also open up new opportunities – such as work in operating theatres.

‘A lot of organisations for disabled people are saying “Let’s not go back to normal” as some great things have come out of the pandemic,’ says Ms Chadd.

‘We need to keep the good bits at the same time as doing more to ensure inclusive and diverse workforces.’

How to get the support you need at work

  1. Contact your union As a first step, nurses with a disability or long-term condition should contact their local union representative or get in touch with their union direct, advises RCN peer support officer Holly Chadd. ‘We can help ensure they are clear on their rights and responsibilities, how to challenge employers and the support available locally,’ she says
  2. Speak to your trust’s equalities, diversity and inclusion lead All NHS trusts will have a manager or team responsible for equality, diversity and inclusion, who can provide information on trust policy and employment law. Many trusts also have staff disability networks or forums, which provide support and can signpost you to further help
  3. Access support on offer through work Nurses may be nervous about disclosing health problems and asking for help, says junior sister Karen Hampson, but staff should make the most of the support available. ‘Get referred to occupational health because they’re there to support you,’ she says
  4. Present constructive solutions Nurses know their workplace, skills and strengths, so should take the initiative and suggest ways of working that would suit them, recommends Ms Chadd. ‘People often think their line manager will have all the answers, but they don’t, so it can be to your advantage to steer things the way you want them to go,’ she says. If your line manager is concerned your proposal will not work, then suggest a trial period or review date.
  5. Join the RCN Peer Support Service The group offers a range of support, including a closed Facebook group and disability coaching service. ‘We have been sharing good and bad experiences and it’s a great place to see what might be possible for you from other people with a similar condition or disability,’ says Ms Chadd. The service offers guidance for nurses and managers on removing disabling barriers at work
  6. Other sources of support Access to Work is a government scheme that can cover costs for some adjustments at work. The government-funded Access to Work Mental Health Support Service, provided by the charity Remploy, is free to any employee with depression, anxiety, stress or other mental health issues affecting their work. The Disability Law Service provides free advice on employment and disability discrimination law

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