The FPH Specialty Registrars Committee (SRC) reasonable adjustment working group report examined the existing legal framework and guidance alongside the experiences of the reasonable adjustments process across training regions. This was done with a survey in November - December 2022 and a workshop with public health registrars held in April 2023.
A number of barriers to requesting, implementing, and monitoring reasonable adjustments were identified. The report sets out best practice guidance for the Faculty, Heads of School and Training Programme Directors to consider when making adjustments for disability and long-term health conditions as well as short-term health conditions, pregnancy and caring responsibilities. It is recognised that not all recommendations will be applicable in every situation and should be based on individual circumstances.
Existing guidance
This section summarises some of the key existing guidance. Further information can be found in the report.
Disability refers to a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on a persons’ ability to do normal daily activities. The Equality Act 2010, for England, Scotland and Wales, along with the Disability Discrimination Act 1995 and Special Educational Needs and Disability Order 2005 (Northern Ireland) describe the duty for organisations to make reasonable adjustments for disability.
Reasonable adjustments refer to making changes to the way things are done including practice, equipment and/or the environment, to remove the barriers faced by a disabled person because of their disability.
The Equality and Human Rights Commission state that "what is reasonable is ultimately an objective test and not simply what you personally think is reasonable." The test depends upon: whether the change is effective in overcoming the disadvantage, practicality, cost, if the organisation has the resources and the availability of financial support. If the decision of an organisation is challenged, the issue of whether or not the adjustment is ‘reasonable’ is ultimately a question for the courts to determine.
The 10th edition of the Gold Guide for postgraduate training applies to both medical and multi-professional public health registrars across the UK. The guide encourages postgraduate deans to appreciate that specialty training programmes may require individual reasonable adjustments to education, training and assessment methods for disabled registrars. The GMC report Welcomed and Valued sets out what local education providers should do to understand their role in supporting medical schools and postgraduate training organisations to meet their obligations to students and doctors in training while in the work environment. The GMC’s report advises that focus on ‘entitlement’ to support rather than the best method of support, is unlikely to meet GMC expectations. It recommends that reasonable adjustments should be anticipatory and advises the use of a case management model with information sharing, a gatekeeper, a support network, key contacts, confidentiality arrangements, assessment, a case conference, action plan and monitoring.
This guidance also includes that if an adjustment has been made but does not effectively overcome the disadvantage, the organisation may need to reconsider its approach — it cannot assume that making a single adjustment fulfils its duty. It recommends that action should be taken if the assessment design or implementation creates barriers for disabled candidates.
The BMA have made a number of recommendations regarding disability rights, pregnancy rights, and parental rights.
Requesting reasonable adjustments
- Provide clear pathways for requesting reasonable adjustments from recruitment onwards (including the types of reasonable adjustments that are available).
- Ensure confidentiality arrangements explain how postgraduate training organisations will manage information shared about a registrar’s disability or long-term health condition, in line with data protection legislation.
- Ensure a case manager is available (for example, a Disability Support Officer or Professional Support Unit Officer with specific expertise as required) – who can provide advice on support and next steps including funding arrangements (such as Access to Work or other funding) alongside specialist equipment procurement and installation.
Implementing reasonable adjustments
- Produce an action plan explaining the reasonable adjustments required based on the registrar’s professional assessments and agreed with the registrar.
- Establish a support network (for example, a case manager alongside the Educational Supervisor, Training Programme Director, Clinical Supervisor, Human Resources, Professional Support Unit, Disability Support Officer and/or Occupational Health as appropriate with a key contact to liaise with the registrar) – to agree how to implement the reasonable adjustment action plan, considering the responsibility and timeframe for actions. The registrar should be included in these agreements.
Monitoring reasonable adjustments
- Arrange a case conference if required (with the support network and the registrar as appropriate and in agreement with the registrar) to review the implementation of the reasonable adjustment action plan. The ARCP also provides an opportunity to discuss whether the support has been implemented, and if there are any concerns about disability related bullying or harassment.
Additional recommendations for FPH exams
Additional recommendations around adjustments for FPH assessments have also been made and shared with the relevant Faculty Officers and team. The recommendations for FPH assessments include:
- Provision of a clear pathway for requesting reasonable adjustments for FPH assessments
- Ensuring that implementation of reasonable adjustments is equitable for FPH assessments
- Ensuring that FPH monitors the effectiveness of the reasonable adjustments implemented for FPH assessments
Work remains ongoing to implement these recommendations. Further information about the FPH SRC's Reasonable Adjustment's Working Group's work including more detail about these recommendations can be found in the report.
