The Disability Rights Commission’s
Formal Investigation into Fitness
Standards in Social Work, Nursing
and Teaching Professions: Report
on the Call for Evidence
Chih Hoong Sin, Janice Fong, Abul Momin and Victoria Forbes.
Disability Rights Commission
3rd Floor
Fox Court
14 Grays Inn Road
London WC1X 8HN
Publication date: September 2007
Table of contents
Acknowledgements ....................................................................... 7
Glossary ........................................................................................ 8
Chapter 1 – Background to the Formal Investigation Call for
Evidence ..................................................................................... 11
1.1 Introduction ........................................................................ 11
1.2 Aims and objectives ........................................................... 12
1.2.1 Section A ..................................................................... 12
1.2.2 Section B ..................................................................... 12
1.2.3 Section C..................................................................... 13
1.2.4 Section D..................................................................... 14
1.3 Procedure .......................................................................... 14
1.3.1 Database ..................................................................... 14
1.3.2 Main questionnaire ...................................................... 14
1.3.3 Questionnaire for other regulated health professions .. 15
1.3.4 Welsh versions ............................................................ 15
1.3.5 Reminders ................................................................... 15
1.3.6 Response .................................................................... 15
1.3.7 Additional documents received from Inquiry Panel
process ................................................................................ 16
1.4 Analysis ............................................................................. 16
1.5 Structure of report .............................................................. 17
Chapter 2 – Opinions about regulatory frameworks (Section A) .. 19
2.1 Perceptions of regulatory frameworks ................................ 19
2
2.1.1 Types of regulations mentioned................................... 20
2.1.2 Regulations perceived to be unclear ........................... 22
2.1.3 Concepts / terminology perceived to be vague (in
relation to some groups and not others) ............................... 24
2.1.4 Implications for practice unclear .................................. 28
2.1.5 Task-specific assessment of competence, and
reasonable adjustments ....................................................... 31
2.2 Perceptions of the impact of regulations ............................ 34
2.2.1 No perceived impact, or unclear .................................. 34
2.2.2 Perceived positive impact ............................................ 35
2.2.3 Perceived mixed impact .............................................. 38
2.2.4 Perceived negative impact .......................................... 42
2.2.5 Impact on disabled people in relation to stages of career
............................................................................................. 45
2.3 Conclusion ......................................................................... 46
Chapter 3 – Statistics and disability/impairment questions (Section
B) ................................................................................................ 50
3.1 ‘Not applicable’ .................................................................. 50
3.2 No response ...................................................................... 51
3.3 No statistics collected ........................................................ 51
3.4 Organisations that collect statistics .................................... 52
3.4.1 Description of statistics ................................................ 52
3.4.2 Collecting information by impairment categories ......... 54
3.4.3 Collecting disability information that can be crossreferenced with other demographic variables ....................... 57
3.5 How ‘disability’ statistics are collected ................................ 57
3.5.1 Asking DDA-type disability questions .......................... 58
3
3.5.2 Asking health-type questions ....................................... 59
3.5.3 Using more than one type of ‘disability’ question ......... 60
3.5.4 Asking ‘impairment’ questions ..................................... 61
3.5.5 Asking both ‘disability’ and ‘impairment’ questions ...... 63
3.6 Perceived utility of asking ‘disability’ questions .................. 64
3.7 Purposes of asking disability questions .............................. 67
3.8 Whether disclosure is optional ........................................... 70
3.9 Conclusion ......................................................................... 70
Chapter 4 – Research on the experiences of disabled people
(Section C) .................................................................................. 73
4.1 ‘Not applicable’ .................................................................. 73
4.2 No existing research .......................................................... 73
4.3 Relevant research commissioned or conducted ................. 74
4.3.1 Profession-generic research not specifically on disabled
people .................................................................................. 74
4.3.2 Profession-generic research specifically on disabled
people .................................................................................. 75
4.3.3 Organisation-specific research on disabled people ..... 77
4.4 Research that is not commissioned or conducted by
responding organisations ......................................................... 80
4.5 Uses of research ................................................................ 84
4.6 Conclusion ......................................................................... 84
Chapter 5 – Non-statutory guidances (Section D) ....................... 86
5.1 Overview of response ........................................................ 86
5.2 Disability discrimination...................................................... 87
5.2.1 Organisations with distinct disability policy mentioning
disability discrimination......................................................... 87
4
5.2.2 Organisations mentioning disability discrimination in
other policies and procedures .............................................. 90
5.2.3 Victimisation and harassment ...................................... 94
5.2.4 Mentioning the DDA .................................................... 96
5.2.5 Summary ..................................................................... 99
5.3 Equal opportunities .......................................................... 100
Statement:.......................................................................... 101
5.3.1 Summary ................................................................... 105
5.4 Reasonable adjustments ................................................. 106
5.4.1 Specific guidance on making reasonable adjustments
........................................................................................... 107
5.4.2 Other discussions of reasonable adjustments ........... 109
5.4.3 Summary ................................................................... 111
5.5 Health and fitness criteria and their implementation ......... 112
5.5.1 Needing to meet health and fitness / fitness to practice
criteria set by relevant regulatory bodies ............................ 112
5.5.2 Discussion of how assessment of health and fitness sits
with reasonable adjustment ................................................ 114
5.5.3 Issues around health and safety, and risks ................ 116
5.5.4 Procedures in relation to health and fitness issues .... 118
5.5.5 Summary ................................................................... 119
5.6 Disclosure of disability and/or health ................................ 120
5.6.1 What are individuals being asked to disclose? .......... 121
5.6.2 Is it optional? ............................................................. 122
5.6.3 Is purpose made clear? ............................................. 124
5.6.4 Format of disclosure .................................................. 126
5
5.6.5 Stage disclosure relates to ........................................ 126
5.6.6 Procedures for dealing with disclosure ...................... 127
5.6.7 Summary ................................................................... 128
References ................................................................................ 131
Appendix A1 – Main questionnaire (English version) ................. 134
Appendix A2 – Main questionnaire (Welsh version) .................. 141
Appendix A3 – Questionnaire for other regulated health
professions (English version) .................................................... 148
Appendix A4 – Questionnaire for other regulated health
professions (Welsh version) ...................................................... 151
Appendix B – Summary of statistics provided ............................ 154
6
Acknowledgements
The team would like to thank Caroline Johnston who was involved
in setting up the call for evidence exercise at the beginning and
ensured a smooth handover. The tireless support and
encouragement from Monica Kreel and Agnes Fletcher are also
gratefully acknowledged, particularly in reading endless drafts of
chapters and offering invaluable comments and feedback.
Last but not least, the team would like to thank all the
organisations that responded so positively to this call for evidence,
thereby contributing immensely to the success of the Formal
Investigation as a whole.
7
Glossary
AGCAS
Association of Graduate Careers Advisory
Services
ALAMA
Association of Local Authority Medical Advisors
BAAT
British Association of Art Therapists
BASW
British Association of Social Workers
BATD
British Association of Teachers of the Deaf
BDA
British Dietetic Association
BGUC
Bishop Grosseteste University College
BMA
British Medical Association
CCW
Care Council for Wales – established by the
Care Standards Act 2000
CfE
Call for evidence
CoD
Council of Deans
DDA
Disability Discrimination Act
DED
Disability Equality Duty
DfES
Department for Education and Skills
DLO
Disability Liaison Officer
DoH
Department of Health
DRC
Disability Rights Commission
ECU
Equality Challenge Unit
FI
Formal Investigation
GDC
General Dental Council
GMC
General Medical Council
8
GOSH
Great Ormond Street Hospital
GSCC
General Social Care Council For England –
established by the Care Standards Act 2000
GTC
General Teaching Council
GTCE
General Teaching Council for England
GTCS
General Teaching Council for Scotland
GTCW
General Teaching Council for Wales
GTTR
Graduate Teacher Training Registry
HESA
Higher Education Statistics Agency
HPC
Health Professions Council
ICP
The Institute of Chiropodists and Podiatrists
IoE
Institute of Education
ITT
Initial Teaching Training
LTHT
Leeds Teaching Hospitals Trust
NASUWT
National Association of Schoolmasters Union of
Women Teachers
NHS
National Health Service
NHSSPABGOHS NHS Scotland Peer Audit and Benchmarking
Group in Occupational Health and Safety
NMAS
Nursing and Midwifery Admissions Service
NMC
Nursing and Midwifery Council
NUT
National Union of Teachers
OCNO
Office of the Chief Nursing Officer, Welsh
Assembly Government
OH
Occupational Health
9
RCN
Royal College of Nursing
RCP
Royal College of Physicians
RCR
Royal College of Radiologists
SEED
Scottish Executive Education Department
SEHD
Scottish Executive Health Department
SENDA
Special Educational Needs and Disability Act
2001
Skill
National Bureau for Students with Disabilities
SPSS
Statistical Package for the Social Sciences
SSSC
Scottish Social Services Council established by
the Regulation of Care Act (Scotland)
UCAS
Universities and Colleges Admissions Service
UoBrad
University of Bradford, Social Work Department
UoBright
University of Brighton, Institute of Nursing and
Midwifery
UoD
University of Dundee, School of Nursing and
Midwifery
UoK
University of Kent, Social Work Department
UoN
University of Nottingham, School of Nursing
10
Chapter 1 – Background to the Formal
Investigation Call for Evidence
1.1 Introduction
The call for evidence (CfE) is a key component of the Formal
Investigation (FI) and complements the evidence gathered in other
strands of the FI. More specifically, the CfE targets key national
organisations such as regulatory bodies, professional bodies,
government departments, higher education institutes, disability
organisations and trade unions for information not gathered
elsewhere in the FI.
Four broad categories of information are solicited by the CfE:
 Organisations’ perceptions of the impact of regulations
governing one or more of the professions (Section A);
 The extent to which organisations collect statistics on
disabled students and employees, and the way statistics are
collected (Section B);
 The extent to which organisations have commissioned or
conducted research on the experiences of disabled
students/employees and whether the research has been
used to influence policy/practice (Section C); and
 Non-statutory guidance that may have been produced as
further/additional guidance for a particular organisation or for
groups of other organisations (Section D).
The CfE was issued in the form of two questionnaires: (a) a ‘main’
questionnaire sent to organisations soliciting responses to all four
sections; and (b) a shorter version sent to organisations
associated with other regulated health professions1. This shorter
1
These are the thirteen professions regulated by the Health
Professions Council (HPC). The HPC professions are currently art
therapists, biomedical scientists, dieticians, occupational
therapists, operating department practitioners, orthoptists,
paramedics, physiotherapists, prosthetists and orthotists,
radiographers and speech and language therapists.
11
version of the questionnaire solicits responses to Section A only.
All versions of the questionnaire (including Welsh versions) are
reproduced in Appendices A1 to A4.
1.2 Aims and objectives
The aims and objectives of the four sections of the CfE
questionnaire are as follows.
1.2.1 Section A
Section A complements the review of legislation and regulatory
framework (henceforth referred to as the ‘legal review’)
commissioned as part of the FI (Ruebain et al 2006).
While the legal review assesses objectively the statutory
frameworks against the Disability Discrimination Act (DDA),
Section A focuses on perceptions of these frameworks. It:
 solicits opinions from key stakeholders about the extent to
which these frameworks may or may not have an impact on
disabled people; and the reasons for this;
 identifies whether there are particular groups of disabled
people who are perceived to be more likely to be affected by
the regulatory frameworks, and the reasons for this; and
 solicits opinions about whether regulatory frameworks are
compatible with the DDA, and the reasons for this.
1.2.2 Section B
During the background scoping phase prior to the launch of the FI,
the DRC conducted a rapid review of relevant existing literature
(Sin et al 2006) and identified the fact that while aggregate figures
exist on disabled people’s qualifications (Grewal et al 2002), entry
into higher education (NAO 2002), entry into the job market
(AGCAS 2005), employment rates in general (DRC 2006a) and in
the public sector (DRC 2004a); there is a paucity of and confusion
about numbers in specific professions and organisations. There is
also acknowledgement from some organisations that existing data
are based on individuals who self-declare and may therefore
understate the incidence of disability (Hurstfield et al 2004).
12
The objective of the set of questions contained in Section B of the
CfE questionnaire is to allow an assessment of:
 the extent to which organisations collect relevant statistics on
their disabled employees, registrants and/or students;
 how organisations go about collecting such information;
 what the information tells us, and whether information is
collected in a way that allows disability to be crossreferenced to other demographic variables such as gender,
age, ethnicity etc.
1.2.3 Section C
The rapid literature review conducted as part of the background
scoping additionally concluded that “While there is some anecdotal
evidence available, there is a severe paucity of published material
that has subjected this topic to scrutiny in a robust manner. Where
available, coverage is patchy and focuses primarily on particular
sub-groups or on an individual stage in the qualification and
employment trajectory. No coherent overview emerges” (Sin et al
2006, p. 20).
The objective of Section C is thus, partly, to:
 provide an update of the background review that was
conducted in March 2006;
 provide a useful check as to whether our initial conclusions
about the paucity of available evidence are borne out in
reality, particularly since organisation-specific material is
often hard to identify and access as much of this material
may not be published in any form.
In addition, where relevant research is identified through the CfE,
there will be an assessment of:
 the extent to which any relevant research has been used to
inform policy and practice in order to make a difference to
the experiences of disabled people studying, qualifying,
registering and working in the three professions.
13
1.2.4 Section D
Section D, similar to Section A, complements the legal review
(Ruebain et al 2006). While the legal review looked at the statutory
frameworks and guidance, Section D of the CfE focused on nonstatutory guidance that may have been produced as
further/additional guidance for a particular organisation(s) or for
groups of other organisations. It aims to assess the type of
information contained within non-statutory guidance relating to:
 disability discrimination;
 reasonable adjustments;
 equal opportunities statements;
 health/fitness criteria, and information outlining the
procedures for implementing these criteria; and
 policies and procedures concerning disclosure of an
individual’s impairment and/or long-term health condition.
1.3 Procedure
1.3.1 Database
A database of key organisations relevant to the CfE, with names of
identified individuals as far as possible, was compiled and
circulated to the FI steering group for comments on 21 September
2006. The database of contacts was finalised on 25 September
2006.
1.3.2 Main questionnaire
The main questionnaire was sent out electronically to 189 email
addresses of Chief Executives or Directors of organisations. A few
were sent to generic email addresses in lieu of an identified
recipient.
23 of the 189 email addresses were found subsequently to be
incorrect. These were checked between 27 September and 4
October 2006 and questionnaires were re-sent to the updated
addresses. 3 failed to work. In total, questionnaires were sent out
to 186 email addresses.
14
1.3.3 Questionnaire for other regulated health
professions
This was sent out electronically on 3 October 2006 to 46 email
addresses. 5 email addresses did not work and had to be checked.
Questionnaires were re-sent to these on 4 October 2006.
1.3.4 Welsh versions
Welsh translations of both questionnaires were sent out on 17
November 2006 to organisations based in Wales.
1.3.5 Reminders
All organisations were sent a reminder email on 7 November 2006.
50 organisations deemed to be key to this FI were contacted by
phone between 21 and 25 November 2006, encouraging them to
return a completed response.
1.3.6 Response
As at 4 May 2007, the response rate for the main questionnaire
was 15 per cent (28 out of 186) while that for the shorter
questionnaire was 26 per cent (12 out of 46). It is important to note
that for the purpose of the CfE, the main targets are primarily the
regulatory bodies and, secondarily, organisations involved in the
implementation of fitness requirements (eg HEIs, employer
organisations etc). The overall response rate is skewed by the fact
that the CfE was also issued to a large number of disability
organisations, most of which did not respond to the CfE. Table 1A
illustrates the distribution of response.
15
Table 1A: Distribution of responses by profession and
country base
T
N
SW
ORHP
T,N,SW
Britain
1
1
1
8
2
England
3
4
3
0
0
England
& Wales
2
0
0
0
1
Wales
1
1
1
0
0
Scotland 2
2
1
1
0
UK
1
0
3
0
1
Note: T = teaching, N = nursing, SW = social work, ORHP =
other regulated health professions
A quarter of all responses originated from organisations relating to
the teaching profession, with a very similar proportion from
nursing. 15 per cent came from social work organisations.
1.3.7 Additional documents received from Inquiry
Panel process
A number of organisations that were invited to respond to the CfE
were subsequently invited to attend witness sessions as part of the
Inquiry Panel phase of the FI, whether or not they responded to
the CfE. Prior to, or following their oral evidence many of these
organisations sent additional written information, including policy
documents, research papers, views on the regulations and
statistics. These have also been analysed and are included in this
report.
1.4 Analysis
Upon receiving completed returns, responses were uploaded into
a program called NVivo 7. This is a software program for
managing and facilitating analysis of qualitative data. As the CfE
solicits most information in a structured and semi-structured
manner (with some open-ended questions), content analysis was
16
conducted looking at the development of themes within somewhat
pre-defined categories of interest for the purpose of this FI. The
importance of themes was first established through repetition of
coding (Priest, Roberts and Woods 2002) and subsequently
through interrogating interpretations and establishing saturation
(Richards 2005).
To facilitate analysis in a team context, a series of structured
codes were designed, drawing on the key topics of inquiry. The
coding structured was designed to facilitate some flexibility in the
creation of new codes to reflect emerging themes that have not
been identified previously (see Sin 2007 for an example of this
strategy).
The analysis team met regularly to discuss coding and
interpretation in order to minimise inter-coder variance and
enhance the reliability of analysis (Ford, Oberski and Higgins
2000).
1.5 Structure of report
This report contains a further 5 chapters and 2 sets of appendices
in addition to this first chapter. They are:
 Chapter 2, presenting findings on respondents’ perception of
regulations and their impact on disabled people as well as
perceived compatibility of regulations in relation to the DDA;
 Chapter 3, presenting findings on the extent to which
organisations collect disability statistics, what the statistics
demonstrate, how statistics were collected, the existence
and types of disability and/or impairment questions, the
perceived utility of asking these questions, the purpose of
asking these questions, and whether disclosure is optional;
 Chapter 4, presenting findings on the extent to which
organisations have conducted or commissioned research on
the experiences of disabled people, whether research is
organisation-specific or profession-generic, what the
research tells us, and whether research is used to improve
policy and/or practice;
 Chapter 5, presenting findings on the types of non-statutory
guidance provided by responding organisations, the extent to
17
which they deal with issues relevant to disability and
disability equality, and the manner in which these issues are
dealt with;
 Chapter 6, conclusions;
 Appendices A1 to A4, reproducing all versions of the main
and shortened questionnaires, including Welsh translations;
 Appendix B, presenting a summary table of statistics
provided by organisations responding to the CfE.
Each chapter concludes with a summary of key findings, with the
exception of Chapter 5 that includes summaries of key findings in
relation to main sub-headings of discussions interspersed
throughout the chapter.
18
Chapter 2 – Opinions about regulatory
frameworks (Section A)
Of the 40 organisations that responded, 3 did not provide any
written response to question 12. There was no indication that this
question was perceived as ‘not applicable’. 32 organisations
provided some written information in relation to the question on
perceived impact on specific groups of disabled people3. 304
provided some form of response to the question of whether
regulatory frameworks are compatible with the DDA.
2.1 Perceptions of regulatory frameworks
Not all of the 37 organisations that provided some form of written
information to the question on perceived impact of regulatory
frameworks actually answered it by describing opinions about
perceived impact (or lack of) on disabled people. 33 organisations5
provided some kind of narrative6 but the majority of these
discussions (from 21 organisations7) tend to revolve around
2
CoD, GTCE and RCR.
3
The 8 organisations that did not provide a response to question 2
of Section A were CoD, GTCE, GTCW, NMC, RCR, Skill, Scope,
SEED.
4
BATD, GMC, GTCE, RCR, BASW, CoD, NHSSPABGOHS and
Skill did not answer this question.
5
ALAMA, BMA, BATD, BGUC, BAAT, BDA, CCW, OCNO, GDC,
DfES, ECU, GSCC, GTCW, GTCS, GMC, GOSH, HPC, ICP, IoE,
NASUWT, NMC, NHSSPABGOHS, NUT, RCP, RCN, SSSC,
SEED, SEHD, UoK, UoBrad, UoN, UoBright, UoD.
6
For the remaining 4 organisations (BASW, LTHT, Scope, Skill),
one mentioned that they did not want to give any comment; one
only referred us to the letter they sent to John Hutton, the other
two mentioned what their organisations did, but did not answer the
questions directly.
7
BMA, CCW, OCNO, GDC, DfES, ECU, GSCC, GTCW, GOSH,
ICP, NASUWT, NMC, NHSSPABGOHS, NUT, RCP, RCN, SSSC,
SEED, SEHD, UoBright, UoD.
19
regulations generically with little or no effort at linking these to
perceived impact.
Some did not name any specific regulation. 19 organisations8,
however, were able to name at least one specific regulation.
2.1.1 Types of regulations mentioned
For the 19 organisations that named specific regulations, these
related largely to teaching. Seven organisations named 10
regulations or guidance in teaching perceived to have an impact
on disabled people. These are:
 Fitness to Teach9 (DfEE, 2000)
 Able to Teach 2004 TDA10
 Physical and Mental Fitness to Teach of Teachers and of
Entrants to Initial Teacher Training11 (DfES Circular 4-99)
(May 1999)
 Education (Teachers) Regulations 199312
 Statutory Instrument 2003 No. 3139 The Education (Health
Standards) (England) Regulations 200313
 Statutory Instrument 2003 No. 1663 The Education
(Specified Work and Registration) (England Regulations)14
8
BMA, BGUC, BAAT, CCW, GDC, DfES, ECU, IoE, NASUWT,
NMC, NHSSPABGOHS, NUT, RCP, RCN, SSSC, SEED, SEHD,
UoBright, UoD.
9
BGUC, ECU, IoE
10
ECU
11
ECU, NASUWT, NUT
12
NASUWT
13
NASUWT, DfES
14
ECU
20
 The Teachers (Medical Requirement of Admission to
Training and Registration) (Scotland) Amendment Regulation
200415
 Qualifying to Teach, 200516
 Framework for the Inspection of Initial Teacher Training for
the Award of Qualified Teacher Status 2005-1117
 Professional Standards for Qualified Teacher Status and
Requirements for Initial Teacher Training18
 In nursing, four organisations named two specific items:
 Nursing and Midwifery Order 200119
 Nursing and Midwifery Council’s guidance on registration
under Standards of Proficiency NMC 200420.
Only two regulations were mentioned in relation to social work: one
by a Wales-based organisation and the other by an organisation in
Scotland:
 Care Standards Act 200021
 Regulation of Care (Scotland) Act 200122
15
SEED
16
ECU
17
ECU
18
ECU
19
NMC, RCN
20
UoBright, UoD
21
CCW
22
SSSC
21
Four organisations from other regulated health professions named
6 items relating to fitness to practise in medical professions:
 Tomorrow’s Doctors23 (GMC, 2003)
 The New Doctor24 (GMC, 2005)
 Medical Act 198325
 Generic Standards for Training26 (PMETB, 2006)
 Dentists Act 198427
 Managing Fitness to Practice28 (HPC, no date)
2.1.2 Regulations perceived to be unclear
Of the 33 organisations that provided some form of response, 9 of
them29 commented that the regulations governing their professions
were unclear in terms of how disability issues were addressed
within the framework, and how concerns relating to disabled
people were handled. 5 out of these 9 organisations framed their
discussion in terms of specific regulations:
“the way that Circular 4/99 is drafted does not make it clear
enough that the regulatory framework set out in Circular 4/99
is subject to Disability Discrimination Act 1995…This is not a
clear explanation of the law and ignores the clear statutory
duty on employers to make reasonable adjustments in order
to facilitate access for disabled teachers to continuing
23
BMA
24
BMA
25
RCP
26
BMA
27
GDC
28
BAAT
29
BMA, OCNO, UoN, UoBright, UoBrad, UoD, ECU, ALAMA, NUT
22
employment.”30 (Teaching)
“NMC does not specify particular proficiencies but states that
the person is ‘to be capable of safe and effective practice
without supervision’…the NMC does not as yet state which
core and essential skills are required to be achieved in order
to be registered.”31 (Nursing)
“NMC has arbitrary guidance on professional accountability
which is subject to varied interpretation.”32 (Nursing)
“no guidance is given on what is reasonable adjustment
within the context of nursing and midwifery practice.”33
(Nursing)
“The GMC requires individual medical schools to ‘put in
place valid, open, objective and fair selection procedures’ in
admitting students…to study medicine. The interpretation
and implementation of the regulatory standards is therefore
left to individual medical schools, leading to inconsistent
admissions policies and conflict with anti-discrimination
legislation. This is particularly significant in the interpretation
of reasonable adjustment.”34 (Other Regulated Health
Profession)
Organisations that did not discuss this in terms of specific
regulations generally expressed a feeling of frustration that the
regulations governing their professions were unclear. In summary,
two particular issues emerge: (a) confusion about how particular
concepts are to be interpreted; and (b) lack of clear guidance for
practice.
30
NUT
31
UoD
32
ECU
33
UoBright
34
BMA
23
2.1.3 Concepts / terminology perceived to be vague (in
relation to some groups and not others)
There was specific commentary on how certain concepts and
terminology were vague in relation to regulations, in particular,
governing the nursing sector. The requirement for those who want
to register as nurses to be in “good health and good character”
was found to be unhelpful as it was unclear what “good health and
good character” meant in practice.
Five nursing-related organisations35 commented that the NMC did
not provide much-needed specific advice or guidance in terms of
the interpretation of the concepts “good health and good
character”:
“We feel that the regulatory frameworks are vague and await
revised guidance…The DLOs sent a response to the NMC
on the draft guidance on good health and good
character…We do acknowledge that our concerns may have
been addressed in the final guidance on good health and
good character. At the time we were disappointed that the
NMC had not taken this opportunity to demonstrate that they
were embracing the Disability Equality Duty.”36
“The NMC guidance – good health and good character
makes reference to ensuring that the person ‘to be capable
of safe and effective practice without supervision and able to
meet the requirements for registration’ [Standards of
Proficiency NMC 2004]…The impact this has on disabled
people or people with long-term health conditions are
thereby difficult to quantify, as individual judgments about
accepting an individual onto a pre registration course, within
different universities proving education may not reflect
objective assessment or the use of defined criteria, but
subjective opinion. No guidance is given on what is
reasonable adjustment within the context of nursing and
midwifery practice.”37
35
OCNO, UoBright, UoD, UoN, ECU
36
UoN
37
UoBright
24
“The Nursing and Midwifery Council do have the power to
strike a person off the register if their health means that they
cannot function. However, we feel that this is vague and
potentially contributes to the lack of willingness of some
nurses to disclose disabilities or long-term health
conditions.”38
One respondent from an organisation identified as other regulated
health profession and one from a nursing-related organisation
additionally observed that there was some confusion between
‘fitness to practise’ and ‘fitness for purpose’, reflecting the wider
concerns relating to assessment of competency. This ambiguity
was perceived to have implications for disabled people who want
to study, work and register in nursing and other regulated health
professions:
“We are concerned about the differentiation between ‘fitness
to practise’ and ‘fitness for purpose’….However, the NMC
used the concepts of ‘fitness to practise’ and ‘fitness for
purpose’ interchangeably…In the absence of specific
guidance from the NMC, local policies and processes will
almost certainly be used to assess an individual’s ‘fitness for
purpose’ rather than their ‘fitness to practise’...”39
There is the perception that assessments of “good health and
good character” and ‘fitness’ in general are intrinsically subjective.
The variability of such judgement is compounded by the perceived
lack of clarity in definitions of what such terminology mean.
However, it is important to point out that some respondents have
very clear and fixed ideas about how ‘fitness’ and ‘competency’
should be assessed in relation to disability. The perceived
vagueness of concepts and terminology do not seem to apply to
certain types of impairments which individuals from responding
organisations seem to interpret as more clear-cut cases whereby
individuals with those impairments will be judged to be ‘unfit’ or not
to meet ‘competency’ standards. Thus the purported ‘vagueness’
of the range of ‘fitness’ requirements and standards is not
consistently felt to be ‘vague’ across all groups of disabled people.
38
UoN
39
UoN
25
This is found to be particularly true for mental health conditions
and certain types of physical impairments. The issue of mental
health was raised across the organisations within teaching, nursing
and social work. A respondent from one organisation commented
outright that mental health conditions are incompatible with good
clinical practice40.
Respondents from 9 other organisations41 discussed the perceived
incompatibility of mental health conditions with professional
practice in terms of competency. For instance, the ability to cope
with stressful situations is perceived to be an essential
competence requirement. People with mental health issues, in this
context, are often perceived or assumed to find it difficult to cope
with stressful situations in the three professions:
“[The regulations are perceived to impact on] Individuals with
psychological or mental health problems which would
prevent them from coping in the often stressful context of
modern healthcare systems or who are incapable of
developing therapeutic relationships with the clients/patients
in their care. Communication skills and the ability to develop
and maintain interpersonal relationships are essential
nursing skills.”42
“It is felt some mental health conditions, where they affect
student’s ability to meet deadlines, ability to work under
pressure, build relationships can be very difficult to
accommodate with the work they are expected to do. It can
be very stressful for all parties concerned. We have had
experience with students with ME and other conditions
affected by stress that have failed to complete or hand in
work or are unable to work full days on placement, failed to
attend lectures, being signed off by GPs as sick, which all
An organisation categorised as from ‘other regulated health
professions’
40
41
One Government department (Nursing), one ORHP
organisation, two regulatory bodies (Social Work), four HEIs
(Social Work, Teaching, Nursing), and one employee’s
organisation (Social Work)
42
Government department (Nursing)
26
add to our and their difficulties in trying to ensure our training
is inclusive.”43
Physical impairments were regarded by some to conflict with
competency requirements particularly in nursing, and secondarily
in social work44. Two responses from nursing-related organisations
are extracted below:
“Individuals with physical impairments which would prohibit
them in achieving the clinical competencies stipulated in the
NMC Standards of Proficiency.”45
“A student with mobility problems is likely not to be fit for
practice. Students need to be able to move freely and should
be able to respond quickly to the children in their care.”46
The issue of why certain impairments such as mental health issues
and physical impairments are thought to conflict with competence
requirements is often couched in terms of a potential health and
safety risk or some other unspecified risk:
“Disabilities which would be difficult to accommodate within
the Regulatory Framework are likely to be those where
mental alertness/awareness is affected, or any condition
which could put at risk the health, safety or welfare of pupils
in a way which cannot be managed either through
medication or reasonable adjustments.” 47
“Students with medical conditions that are uncontrolled, long
term medical conditions that affect tiredness and mental
health difficulties are likely to have particular problems with
the current regulatory framework…because their conditions
are such that others may be at risk if in their care and it is
43
HEI (Social Work)
Government department (Nursing), employer’s organisation
(Nursing), and HEI (Social Work, Teaching, Nursing)
44
45
Government department (Nursing)
46
Employer’s organisation (Nursing)
47
HEI(Social work, Nursing, Teaching)
27
more difficult to implement reasonable adjustments to
counter such risks.”48
“People with severe physical or cognitive impairment would
be precluded from pre-registration nurse education on the
grounds that the limitations imposed by their condition would
make them unsafe to practice as a nurse.”49
Health and safety issues were clearly responsible for how certain
types of health conditions were felt to be clearly incompatible with
professional practice in health settings:
“There are Scottish Executive guidance documents which
are mandatory in some limited areas of nurse employment.
The most obvious example is in relation to EPP restrictions
for those with blood borne viruses.”50
“There are many groups of staff who have significant
difficulties applying to become, training as and working as
registered nurses. Those we are most concerned about
include staff with experience of mental ill health, those with
blood borne infections (HIV and Hep A & B as examples),
people who have illness such as ME and Fybromyalgia and
those with dyslexia.51”
2.1.4 Implications for practice unclear
Implications from the practice point of view in operationalising
regulations were raised:
“These studying, qualifying, registering and working
guidelines and frameworks, fail to provide the social work
team here at the university with any clear guidance on how
to support the students in light of any disability related
disclosures, nor does it offer any practical guidance to our
placement process or providers in the area of work
48
HEI (Teaching)
49
HEI(Social work, Nursing, Teaching)
50
ORHP organisation
51
Employee’s organisation (Nursing)
28
placements. In fact, the outcome of the registration process
is not filtered through effectively to the relevant people at the
university.”52
The lack of clarity for practice can lead to confusion over who
makes decisions around ‘fitness’:
“In the absence of specific guidance from the NMC, local
policies and processes will almost certainly be used to
assess an individual’s ‘fitness for purpose’ rather than their
‘fitness to practice’. Whilst local decision making in relation to
‘purpose’ is inevitable and appropriate, the NMC should
identify that this – and only this – is within the remit of locally
designed policies.”53
This points to an important issue identified in the background
review to inform the FI (Sin et al 2006, p. 14). While ‘fitness for
practice’ is often a requirement, the exact interpretation of this “has
been devolved to the local level” (Morris and Turnbull 2006, p.
243). The lack of national standards may lead to confusion over
what is required in assessing new applicants as being ‘fit for
practice’ (Wright and Eathorne 2003). Clear guidance is thus
called for to minimise the need for self-initiated management
strategies.
When encountering issues concerning a disabled person,
organisations have a tendency to rely on particular individuals to
interpret what the regulations say or mean. Examples were given
of admission staff or occupational health professionals54
performing such a role:
“Admissions staff in HEIs are required to make judgements
about how or whether it were possible to make ‘reasonable
adjustments’ for individuals in both the theoretical and clinical
components of the course. Feedback from admissions staff
52
UoBrad
53
UoN
54
8 organisations (ALAMA, BMA, ECU, NUT, NHSSPABGOHS,
RCN, SEHD, UoBright) mentioned that they would seek advice or
refer cases of concern to OH.
29
suggested that this guidance was inadequate in helping them
to make appropriate selection decisions.”55
“…many employers and colleges delegate the decisions
about ‘fitness’ to train in the profession and to do the job to
occupational health professionals who have very little
knowledge of exactly what the Regulatory Frameworks are
for each profession...OH professionals are often put under
considerable pressure over the question as to whether or not
a person has a disability and often feel there is an
unreasonable expectation by HR and management that they
(OH) alone should make the decisions regarding ‘fitness’ for
the job. There is a considerable tendency to ‘medicalise’ the
problem and push the problem to OH for decisions absolving
management of their responsibilities.”56
The role of occupational health professionals in decision-making
around ‘fitness’ is explored as part of separate research projects
commissioned for this FI (Fong et al 2007, Wray et al 2007) which
reported that occupational health professionals often played an
important role in decisions around fitness. One responding
organisation to the CfE raised concern about this:
“Occupational health professionals at times make
recommendations that fit too easily with employers’
prejudged conclusions about the fitness of teachers for
continued employment…decision on an employees’
employability [is difficult to challenge] once an occupational
health report has been made. In light of this barrier, it is
clearly vital that occupational health fulfill a role which is
consistent with the spirit of the DDA.”57
Organisations in general felt that they struggled to assess ‘fitness
to practice’, particularly in situations where core competencies
have not been stated58. Many respondents felt caught in between
55
OCNO
56
ALAMA
57
NUT
58
UoD
30
care and support for the student/employee and potential health
and safety issues that may present to vulnerable service users.
This situation is perceived to be particularly difficult to manage with
very little guidance. Where available, guidance was often
perceived to be unclear. The full responsibility of decision-making
was felt to fall squarely on the organisation itself with little support
from regulatory bodies.
In comparison, responses from the regulatory bodies59 to the CfE
tended to revolve around descriptions of their functions and the
relevant regulations. There was very little commentary around the
adequacy of guidance issued. The following quote illustrates this
type of response:
“The provision set out in CSA 2000, 58(1) (b) has been the
subject of some controversy since it was first proposed but it
is the duty of the GSCC to implement it in a way that is
consistent with the DDA and we believe that we have found
a way to do so.”60
2.1.5 Task-specific assessment of competence, and
reasonable adjustments
In contrast to the above, the CfE also uncovered more nuanced
approaches to assessing individual cases in terms of competence
and suitability for role. This can help disabled individuals meet
specified competence standards:
“The Medical Act governs what the GMC can do about
registering doctors who are unable to carry out all the duties
of the pre-registration year in the usual way, and has made
special provision for doctors with a lasting physical disability,
ensuring that they can obtain alternative and relevant
experience. There are numerous examples of doctors who
have successfully studied medicine and gone on to practise
it, despite disabilities.”61
59
GSCC, GTCE, GTCW, GTCS, ICP, NMC, SSSC, GDC, GMC.
60
GSCC
61
RCP
31
“The full range of requirements impact on the ability of
disabled people to meet the competencies. Hearing and
visual impairments may impact depending on the severity,
we are aware of individual nurses who are severely hearing
impaired but with specialist equipment have qualified and
practise to the appropriate standard.”62
“We have had students with profound hearing problems and
have successfully supported them in practice.”63
A Scotland-based organisation commented that the relationship
between disability and competence should be assessed on a caseby-case basis. A blanket approach, such as generalised fitness,
was felt to be inappropriate:
“Where regulatory bodies do have health as a criterion for
registration, people suffering from conditions where it is not
possible to predict the impact of the disability at any one
time, may face particular difficulties. It is important that each
case is treated on its own merits. It is the impact of a
condition that needs to be judged in relation to the
requirements of a particular post.”64
It is important to note that this comment was made by a social
work organisation in Scotland where there are no fitness standards
in operation.
Reasonable adjustment is also mentioned by the same
organisation in this context:
“It is for the employer to check the impact of an individual’s
physical or mental condition on his/her suitability for a
particular post and to make reasonable adjustments under
the Disability Discrimination Act.”65
62
ECU
63
GOSH
64
SSSC
65
SSSC
32
The individualised and often localised context of assessment and
decision-making pose significant challenges when there is a
perceived lack of clear guidance on the procedures that should be
followed. How reasonable adjustments can or should be offered
and implemented is commonly discussed by respondents,
revealing a distinct sense of anxiety and concern:
“An impaired ability to deal with the stresses of the job may
lead to negative assessments, and impede progress, rather
than stimulating enquiry as to why the individual is struggling
and the provision of support and reasonable adjustments to
working conditions. A practical example is the requirement in
many specialty curricula to undertake on call duties at night.
On the one hand, patients get sick throughout the 24 hours.
On the other hand, for doctors with mental health problems
or chronic illness this requirement may prove an
insurmountable obstacle.”66
“There is conflict and personal anxiety about how a student
with a complex physical disability that affects dexterity can
achieve the requirements of our course to demonstrate
proficiency and competence within clinical skills. There are
also concerns that the physical environment of many of the
clinical settings that disadvantages the student either due to
poor access, poor lighting, poor publication of materials and
organisation.”67
“With regards to dyslexia, the University, through the
Disability Unit, offer students numerous opportunities at all
stages of their study to disclose any difficulties they may be
experiencing with their academic work…The difficulty the
social work team are facing with students with dyslexia is
how to implement the support they require, are entitled to
and receive whilst at university with academic work and
balancing this out with the demands of the job and trying to
assess students ability to independently carry out the duties
and expectations of their social work role to agency
standards. An added complication also lies with the issue of
66
RCP
67
SSSC
33
confidentiality, whereby work related records are bound by
agency rules of confidentiality which can cause students
problems if they are identified to have in place a reasonable
adjustment such as a proof reader.”68
2.2 Perceptions of the impact of regulations
Only 17 organisations69 provided specific and direct responses to
perceptions of impact of regulations on disabled people. Most did
so without any reference to specific regulations.
In several cases, organisations provided information that indicated
views on perceived impact under responses to the question about
compatibility of regulations with the DDA. Where relevant, these
responses are presented here.
2.2.1 No perceived impact, or unclear
Respondents from two organisations from other regulated health
profession70 felt that the regulations governing their profession
have no impact on disabled people
“We have no information to demonstrate there is any impact.
The [name of organisation] has no means to discriminate
disabled people from applying for membership, either as
students, qualified or working within the…profession.”71
Another mentioned that they perceived there to be an impact but
did not then specify what the impact was and whether it was
positive, negative or mixed.
“Regulatory frameworks may impact on a disabled person:
directly; for example, when they make an application to be
registered, when they renew their registration, if a complaint
68
UoBrad
69
BMA, BATD, BAAT, BGUC, GTCS, GOSH, HPC, IoE,
NASUWT, NHSSPABGOHS, NUT, RCN, UoBrad, UoBright, UoD,
UoK, UoN
70
GMC and BDA.
71
BDA
34
is made about them to the regulator…or indirectly, for
example, when they apply for a place on an approved
course, when they express an interest in a regulated
profession, when a manager is deciding whether to refer a
problem to the regulator, or if they develop a disability whilst
registered, or if an existing disability changes over time.”72
These two organisations indicated that they perceived the
regulatory frameworks governing their respective professions to be
compatible with the DDA.
2.2.2 Perceived positive impact
Respondents from 6 organisations73 commented explicitly that the
regulatory frameworks in their professions have positive impact on
disabled people. One of these is a teaching organisation based in
Scotland where there are no fitness standards stipulated in the
relevant regulatory framework74.
Only two organisations could name specific regulations: Nursing
and Midwifery Council’s Guidance on Registration under
Standards of Proficiency NMC 2004 and Managing Fitness to
Practice. In common, they all felt that the frameworks (whatever
they may be) can help ensure equality of treatment. Therefore
disabled people will not be disqualified automatically from
studying, registering, qualifying or working in the professions
simply because of their disability, as the frameworks provide a set
of criteria for assessment and support. This view is exemplified by
the following quotes:
“On the whole, regulatory frameworks have had a positive
impact on these issues as they have helped to ensure
equality of access at all stages specifically for studying,
qualifying, and registering. As a State Registered Profession
with the Health Professions Council, these issues are
usefully addressed in the ‘Fitness to Practice’ guidelines and
72
HPC
73
BATD, BAAT, GOSH, UoBright, GTCS, UoK
74
GTCS.
35
regulation.”75
“Now that the ability to literally hear in the classroom has
been removed as a requirement for fitness to teach we feel
that a significant barrier has been removed which used to
affect deaf people wishing to enter the profession”76
“We believe that the regulatory frameworks in Scotland
regarding teaching are appropriate and serve their purpose.
There is a clear recognition that organisations must fulfill
their requirements under the relevant legislation and that
disability issues be treated appropriately.”77 (Note: there are
no fitness standards stipulated in the regulatory framework in
the context of teaching in Scotland)
“The NMC’s recent guidance on evidence of good health and
good character provides a very clear set of guidelines to
assess good health, not ruling out any person with a
disability but providing crucial support to the individual.
Within the guidance, the NMC state that ‘A person’s good
health is such that they are capable of safe and effective
practice as a nurse and midwife’.”78
“The General Social Care Council (GSCC) is the regulatory
body for social work. General statements of values within
their regulatory frameworks allow for disabled people or
people with long-term health conditions to study, qualify,
register and work in social work. This is positive.”79
The above quotes reveal that a main reason for perceived positive
impact is the acknowledgement and accommodation of at least
some of the provisions within disability legislation. The
overwhelming majority of respondents felt that the regulatory
frameworks relevant to their professions were compatible with the
75
BAAT
76
BATD
77
GTCS
78
GOSH
79
UoK
36
DDA80. Unfortunately not all explained why this was so. Four
respondents81 merely answered ‘yes’ to the question in the
questionnaire.
Respondents from 13 organisations were clear about regulatory
frameworks being perceived to be compatible with the DDA and
the implications this may have for disabled people:
“We believe that the regulatory framework set out in CSA
2000 and in our Rules is compatible with the provisions of
the DDA. The regulatory process highlights the provisions of
the DDA. It draws the attention of the registrant to their rights
and recognises registrants’ responsibilities to discuss
relevant issues with their employer. This supports registrants
in working with employers to ensure reasonable adjustments
are made in the workplace and in working practices.” 82
(Note: this quote is from a social work organisation in
Scotland for which the relevant regulatory framework has no
fitness standard requirement)
“There is already a statutory requirement within the Care
Standards Act 2000 for the Council to review/maintain its
standards, which meets the subsequent DDA requirement for
regular reviewing of standards. The Council’s approval and
monitoring of social work training ensures that training and
the awards conferred by the bodies it approves do not
discriminate against disabled people. In maintaining a
register of social care workers the Council ensures that
decisions and competence standards made about
application, renewal, refusal or removal do not discriminate
against disabled people.”83
80
26 organisations (BGU, BAAT, BDA, CCW, GSCC, CTCS,
GTCW, ICP, LTHT, NASUWT, RCP, Scope, SEED, SEHD, SSSC,
UoD, UoK, BMA, OCNO, DfES, GOSH, HPC, RCN, UoBrad,
UoBright, ALAMA).
81
ICP, LTHC, UoK and SEED only mentioned ‘yes’ without any explanation.
82
GSCC
83
CCW
37
“Yes, our contention is that there is compatibility. The
requirements of the DDA and the DED are widely known
within the sector and educational organisations in Scotland
are supportive of them.”84 (Note: this quote comes from a
teaching organisation in Scotland where fitness standards
are not a requirement in the relevant regulatory framework)
2.2.3 Perceived mixed impact
Four responding organisations85 articulated explicitly that the
regulatory frameworks in their respective professions have both
positive and negative impact on disabled people.
“The framework does attempt to go some way to enable
students with disabilities to feel assured that they are offered
some level of protection but also serves to make them aware
that registration is about assessing their fitness to practice,
particularly trying to ascertain, any conditions that may affect
their ability to carry out any role in social care
safely…However, at times these, studying, qualifying,
registering and working guidelines and frameworks, fail to
provide the social work team here at the university with any
clear guidance on how to support the students in light of any
disability related disclosures, nor does it offer any practical
guidance to our placement process or providers in the area
of work placements. In fact, the outcome of the registration
process is not filtered through effectively to the relevant
people at the university.”86
“We are pleased therefore, to see in NMC guidance that they
recognise the benefit of having a nursing workforce that
mirrors patient community that has empathy with clients and
patient groups borne from experience that positively informs
clinical work…The RCN also supports nursing students and
our advisers and officers tell us that the requirement to be of
‘good health’ can be problematic for many students and
84
GTCS
85
UoBrad, UoD, NASUWT, and RCN.
86
UoBrad
38
potential students.”87
“The number of hours required for students to complete
before being eligible for registration may mitigate against
student with disability. Students work a full time, 45 week
year and the theoretical and practice curricula may be
difficult for students to sustain. The framework allows for a 5
year period in which to complete the pre-registration
programmes. The NMC does not as yet state which core and
essential skills are required to be achieved in order to be
registered. This may preclude candidates with disability
applying for nursing or midwifery. Some physical disabilities
may not be compatible with the professional practice
required of nurses and midwives.”88
“…DfES Circular 4-99 serves disabled student members’
interests well in making clear that, where there is a difference
of opinion between the student teacher’s own doctor or other
medical adviser and that of the training provider, with regard
to the member’s fitness to teach, an independent medical
assessment should be carried out. [This is positive.]
However, …where there is a difference of opinion between a
teacher’s own doctor or other medical adviser, and that of
the employer with regard to the teacher’s fitness to teach, an
independent medical assessment is not automatically carried
out. It is also a matter of concern that the DfES Medical
Adviser or a qualified independent medical adviser cannot
adjudicate on questions about the physical and mental
fitness of individual teachers or candidates for teacher
training.”89
There is some indication that while regulations may be perceived
by some organisations to be benign in relation to impact on
disabled people, the promise or potential of inclusiveness may not
necessarily be realised in practice due to a variety of reasons.
87
RCN.
88
UoD
89
NASUWT
39
The above is backed up by the fact that respondents from 9
organisations observed that, in principle, regulatory frameworks
in their respective professions are not incompatible with the DDA.
Several organisations expressed the view that variations in
interpretation90 and implementation can lead to regulatory
frameworks having outcomes that are not compatible with the
DDA. This is particularly so where a high degree of subjective
judgement is involved, for instance in the interpretation of ‘good
health and good character’ and of the relationship between health
and safety issues and the DDA (as discussed previously):
“The regulatory framework for the medical profession is
largely compatible with the DDA, however, there are some
potential areas of conflict including: 1) the requirement for all
medical students to be able to demonstrate all the skills and
competencies set out in Tomorrow’s Doctors (GMC, 2003)
upon graduation irrespective of the skills and competencies
required for their chosen career path. 2) the variation in how
the framework is interpreted and implemented, particularly
with respect to the requirement to make reasonable
adjustments whilst at the same time protecting patient
safety.”91
“We support the NMC’s statement that health conditions and
disabilities are not automatically incompatible with
registration and are encouraged by their commitment to treat
all issues on an individual basis. This is of especial concern
where the framework allows people other than the registrant
to report concerns or complaints. Our members tell us that
line management often threaten to ‘report to the NMC’ over
matters relating to ill health and disability, where the nurse is,
perhaps not complying with management action for other
reasons…As stated above our concern here relates to the
subjectivity of the test for ‘good health and good character’
and that this opens up possibilities for direct and indirect
90
Six organisations mentioned concerns over interpretation, ie
ALAMA, UoBright, UoBrad, HPC, BMA, OCNO
91
BMA
40
discrimination.”92
“The regulatory frameworks are compatible with the DDA.
But there are some students who are covered by the DDA for
who we can’t make the adjustments required, when this has
been the case it is patient safety that takes priority and if the
patient’s safety can’t be assured then the student will not be
fit for practice at the end of the course and will therefore not
be able to register as a nurse.”93
The “possibilities for direct and indirection discrimination” as a
result of subjectivity pointed out by one respondent above find
some resonance in other responses proffered. Several
organisations indicated that subjective assessments without
adequate and clear guidance can indeed lead to disabled people
being treated less favourably:
“Teachers and trainee teachers with impairments and longterm health conditions are often treated unfavourably and in
some cases discriminated against by schools and within
initial teacher training.”94
“We wholeheartedly endorse the NMC’s statement that the
regulatory framework is a ‘license to practise’ and is not a
guarantee of fitness for specific employment. For many of
our members the problem lies not within the regulatory
framework but within the discriminatory workplace – either as
an applicant, student or as a member of staff.”95
“Incidents reported to us by art therapists very often concern
discrimination by employers if they develop long term
physical or emotional problems, specially when these were
not present when initially appointed.”96
92
RCN
93
GOSH and DfES also mentioned the concerns of health and
safety issues.
94
NASUWT
95
RCN
96
BAAT
41
“The problem of discrimination is a cause for concern within
the context of employment in schools and colleges. There
are comparatively few disabled teachers employed in
schools and colleges (National Disabled Teacher Taskforce
2005). Furthermore, many schools and colleges do from time
to time appear less willing to employ disabled teachers on
the grounds that such employment might impact negatively
on the educational standards attained by pupils and
students. Such mistaken beliefs have a very real negative
impact on the careers and employment opportunities of
disabled teachers.”97
“Notwithstanding the legislative framework in Scotland, an
individual’s mental or physical fitness may be an issue in so
far as the condition may have an impact on the conduct or
competence of a worker. The [name of organisation] has on
occasion asked an individual to undergo medical (including
psychiatric) assessment.”98
2.2.4 Perceived negative impact
Respondents from 4 organisations99 mentioned that regulatory
frameworks have a negative impact on disabled people. There are
several related issues that were perceived to explain why this was
felt to be the case. First, disabled people may perceive fitness
standards or the wider regulatory framework as barriers to entering
the profession. Some may therefore make the decision not to even
attempt entry:
“Students can perceive the fitness to teach requirements as
a barrier to entering initial teacher training. We have received
a number of enquiries to the effect of, ‘I have a disability, can
I apply to the course?’ The requirements to assess fitness to
teach can, in some instances, lead to students putting off
disclosure of a disability until they are on the course…The
fact that the regulatory framework exists appears to foster
perceptions that it is there to prevent disabled people from
97
NASUWT
98
SSSC
99
BMA, UoN, BGUC, IoE
42
applying.”100
“Deaf/partial hearing students: have a desire to teach but
expect that their disability will mean they will not be ‘fit’.”101
Similarly, the existence of the ‘good health’ requirement in the
nursing profession was identified by some respondents as having
the potential to put off potential disabled candidates:
“The requirement to be of ‘good health’ can be problematic
for many students and potential students. We believe that
some potential nurses could be put off training by an image
that nurses have to be ‘super human’.”102
Second, some disabled people may be put in a position where
they are compelled (or feel compelled) to consider whether to
disclose their disability (see Chapter 3, and also Stanley et al
2007). Quite often, disclosure can come too late. This was felt to
be particularly pertinent in the cases of ‘hidden’ or ‘unseen’
disabilities:
“[Those with] mental health difficulties often choose not to
disclose their disability until they are in crisis, and explain
they didn’t make anyone aware as they thought they would
not be allowed on the programme – some remain unwilling to
make a ‘full’ disclosure to the institution.”103
“The challenge we still currently face is that of the disclosure
of hidden disabilities – dyslexia in particular. As the students
are university students and attend the Trust on an honorary
contract, there remains a reluctance to share this information
due to students’ confidentiality. Whilst dyslexia is apparent in
academic work, nurses are expected to document their
patient’s care and there appears to be more challenges
through the NMC of fitness to practice cases around staff
100
BGUC
101
BGUC
102
RCN
103
BGUC, ECU, LTHT
43
with dyslexia.”104
While most responding organisations agreed that disabled people
may not want to disclose their disability or long-term condition
because of the fear of being stigmatised, one organisation
suggested that, by not disclosing, these individuals were then least
likely to receive benefits that may be available105.
The above views find resonance in discussions from a minority of
respondents about the perceived incompatibility between
regulation in their profession and the DDA. Two respondents106,
both in teaching, clearly indicated that the current regulatory
frameworks in their profession are not compatible with the DDA.
One reason why this was felt to be so was attributed to perceived
contradictions and tensions between the DDA and health and
safety requirements:
“The regulatory frameworks are not always compatible with
the DDA. For instance in Fitness to Teach DfEE (2000) there
is a tension between health and safety legislation and the
DDA. It is recommended that health and safety legislation
takes precedence over the DDA as it is important to ensure
the safety of those who are vulnerable. However, this is only
the case if it is impossible to implement reasonable
adjustments for the disabled person or if the reasonable
adjustments provided are not sufficient to ensure health and
safety.”107
“The conflict that seems to arise for Nursing and Midwifery is
the need to take heed of Health and Safety legislation, our
professional requirement to protect the public whilst
simultaneously ensuring that individuals have not been
discriminated against.”108
104
GOSH
105
LTHT
106
IoE and NUT
107
IoE
108
UoBright
44
The management of ‘sickness absence’ was felt by another
responding organisation to be incompatible with the provisions of
the DDA:
“Section E.3 of Section E.3 of Circular 4/99 gives clear
evidence that the regulatory framework for Fitness to Teach
is incompatible with the Disability Discrimination Act at
present. The section of advice to schools on how to monitor
staff sickness absence shows no understanding of the
specific needs of disabled staff. One of the continuing
difficulties faced by the NUT in representing disabled
teachers has been the unclear distinction between ‘sickness’
and ‘disability’ and this lack of clarity is compounded by
Section E.3.”109
In one particular case, a respondent had indicated that regulations
were perceived to have a negative impact on disabled people.
However, this response was made despite the fact that the
respondent was unsure whether the regulatory framework was
compatible with the DDA:
“we cannot be sure in the absence of clear and unambiguous
guidance from the NMC.”110
2.2.5 Impact on disabled people in relation to stages
of career
Although 29 responding organisations mentioned issues relating to
registering (particularly in nursing and other regulated health
professions), and 20 organisations mentioned issues relating to
employment, responding organisations overwhelmingly did not
discuss the perceived impact of regulatory frameworks on disabled
people in relation to specific career stages (ie studying, qualifying,
registering, working, etc.). There is only one instance in which a
respondent articulated concerns about fitness requirements in
relation to the sequence of career stages, and that logically the
impact should be manifested as early on as possible:
109
NUT
110
UoN
45
“This clearly flags up that a person’s health status is
important both on entry to the profession and beyond. That is
the student must be ‘registerable and employable’. It is
ethically unacceptable to accept a student for training – who
even if they manage to get through the student stage –
would then find themselves unable to get a job at the end of
it. Therefore a potential student with any severe physical or
cognitive impairment would not be acceptable. Prior to entry
on a pre-registration nursing programme the student must
obtain clearance from the Occupational Health
Department.”111
2.3 Conclusion
In general, the majority of responses to Section A of the CfE did
not answer specifically our questions on perceived impact of
regulatory frameworks or their compatibility with the DDA.
Respondents found it difficult to be specific and to articulate
reasons for particular views. Responses overwhelmingly revolved
around generic discussions about regulatory frameworks and what
they included (or not) with little attempt at spelling out clearly the
implications of these on disabled people. This is not entirely
surprising as other information provided for Section C of the CfE
indicated that few organisations have conducted or commissioned
any research on the experiences of disabled people (see Chapter
4).
It is likely that some respondents found it difficult to be clear about
perceived impact when they found particular terminology and
concepts in the regulations hard to interpret, and the practical
implications of regulations difficult to ascertain. There is a widely
articulated concern that there is a lack of adequate and clear
guidance that can help them translate abstract regulations into
procedures implementable in practice. This seems to be
particularly so for nursing, perhaps reflecting significant challenges
in the ability to reconcile different regulatory and legislation
requirements.
There is, however, some evidence that a segment of respondents
had very clear ideas that certain types of impairments were simply
111
ECU
46
not compatible with professional practice. Decisions were therefore
influenced by blanket assumptions about the capabilities and
competencies of people that fall under those categories: namely
those with mental health issues and those with certain physical
impairments. Assessments were underpinned by negative
assumptions around competence and risk.
In cases where respondents felt that regulatory frameworks have
positive impact on disabled people, this was predominantly due to
the perception that the frameworks acknowledged or
accommodated various provisions of the DDA or, in the case of
some respondents, that generalised fitness standards do not exist
within the jurisdiction within which they operate (eg for the teaching
and social work professions in Scotland). Therefore there are
perceived to be safeguards for disabled people against
discrimination (such as automatic exclusion simply due to
disability.)
A larger group of respondents, however, felt that regulatory
frameworks had a mixed impact on disabled people. This
perception seems to be rooted in an awareness that while
regulations in and of themselves may not necessarily discriminate
against disabled people, the extent of subjective assessment and
interpretation around key concepts and requirements can lead to
discriminatory outcomes for disabled people particularly in the
context of localised and devolved decision-making in lieu of clear
procedural guidance.
A smaller group of respondents felt that regulatory frameworks
have a negative impact on disabled people. In their views, the
existence of certain fitness requirements has a symbolic effect
leading disabled people to perceive that these are barriers to
entering the profession. They may also be compelled, or feel
compelled to disclose their disability or long-term condition;
thereby risking either being stigmatised (where they disclose) or
not receiving necessary support (where they do not, or disclose
too late).
Responses to Section A overwhelmingly do not anchor
discussions to specific regulations, specific groups of disabled
people, and specific career stages.
47
Summary of findings
Most responding organisations discuss issues with regulations,
often unspecified, rather than their perceived impact on disabled
people.
In relation to ‘fitness’, regulations are felt to be imprecise in the
definitions of some terminology and concepts. This is particularly
so in relation to the requirement for ‘good health and good
character’ in nursing.
While there is some confusion around the interpretation of ‘fitness’,
there is less uncertainty in relation to some groups of disabled
people. Mental health conditions tend to be perceived as being
incompatible with professional practice across the three
professions, while people with certain types of physical
impairments can be perceived as ‘unfit’ in nursing and social work.
Perceived incompatibility is often explained as a result of health
and safety considerations or as unacceptable risk.
Regulations are also perceived as offering little concrete guidance
for implementation. How decisions are to be made and who are to
make those decisions are often thought to be unclear. This poses
problems especially when core competencies are not spelt out
clearly.
There are a few examples of more nuanced approaches to
assessing individual cases in terms of competence and suitability
for role. This can help disabled individuals meet specified
competence standards and to provide relevant and adequate
reasonable adjustments.
The main reason for perceived positive impact is the
acknowledgement and accommodation of at least some of the
provisions within disability legislation.
Perceptions that regulations have a mixed impact on disabled
people are often underlain by the feeling that while regulations
may be benign in principle or compatible with the DDA, variations
in interpretation and implementation can lead to possibilities of
direct and indirect discrimination. This is particularly so where a
high degree of subjective judgement is involved.
48
Perceptions that regulations have a negative impact on disabled
people are explained in terms of the symbolic effect of fitness
requirements being perceived as barriers to entry. Disabled people
may also be compelled, or feel compelled to disclose their
disability or long-term condition; thereby risking either being
stigmatised or not receiving necessary support.
49
Chapter 3 – Statistics and
disability/impairment questions (Section B)
Of the 40 organisations that responded to the CfE, 12 were not
asked this set of questions (ie these were organisations from other
regulated health professions).
3.1 ‘Not applicable’
Of the remaining 28 organisations112, 3 answered that Section B
was ‘not applicable’113. Two of these provided the following
explanations:
“The NMC does not currently collect data on disability but is
likely to do so in the future as part of its action plan under the
DDA”114.
“N/A as NHS Education for Scotland collects statistical
information on nursing and midwifery students. They will
have replied independently. Student information is also
available from HESA who will have replied independently.
NHS National Service Scotland collects workforce data”115.
The first quote points to the potential of the Disability Equality Duty
(DED) in getting public bodies to collect information on disability
although it is still too early to say whether information has been or
will be collected systematically and appropriately, and whether it
will be used to inform actions.
The last quote indicates that the responding organisation had not
thought about the potential need to collect disability statistics on
students and/or employees within their organisation but had
112
SCOPE, BATD, GTCE, BASW, UoN, BGUC, DfES, GOSH, IoE,
UoBright, SSSC, CCW, GTCS, LTHT, SEED, SEHD, UoBrad,
UoD, NASUWT, RCN, CoD, GSCC, GTCW, NMC, NUT, Skill, UoK
and ECU.
113
NMC, SEHD, and DfES
114
NMC
115
SEHD
50
interpreted the CfE to be solely from the perspective of a
profession-wide monitoring.
3.2 No response
Another 4 organisations did not provide any answer but neither did
they indicate that the Section was not applicable116. None had
provided any written-in information.
3.3 No statistics collected
4 organisations stated that they did not collect any statistics of the
type requested for by the CfE117. Only one provided reasons for
why statistics were not collected. This is an interesting case as the
organisation indicated that it asks a ‘disability and/or impairment’
question but does not collect statistics on disability118. This
apparent paradox is explained as follows. The organisation asks
new members at the point of joining whether they identify
themselves as disabled. It does not require members to identify
types of impairment or conditions. Hence, it:
“…has no such available data. [It] monitors its membership
by disability but does not at present have reliable figures due
to under-reporting and under-disclosure by members. [It] is
seeking to redress this by explaining the purpose of
monitoring and the meaning of the definition to members”.
This reflects one of the findings from the background review
conducted to inform the FI where the limitations of monitoring data
based on self-declaration was highlighted and where it was felt
that “it is the case that disabled people do not always declare their
disability…in case they are subsequently discriminated against.
This presents challenges in accurately describing the degree of
discrimination that occurs…and therefore in setting targets or
instigating other policy interventions” (Hurstfield et al 2004,
116
BASW, NASUWT, CoD, Skill
117
BATD, SEED, RCN, NUT
118
This is the NUT.
51
p.44)119.
3.4 Organisations that collect statistics
3.4.1 Description of statistics
17 organisations indicated that they collect statistics on disabled
people120. Closer scrutiny of the types of statistics collected by
these organisations reveals that 9 collected statistics that were
specific to their organisation121 (ie on disabled people as
employees, registrants and/or students in their organisation).
However, it is not always clear whether the statistics provided were
for disabled people studying, qualifying, registering or working in
the three professions or whether they included other disabled
people.
6 other organisations collected statistics that were not specific to
their respective organisations but were instead profession-generic.
These are all, unsurprisingly, regulatory bodies although not all
regulatory bodies collected such statistics.
One organisation did not provide the requested statistics122. In its
written submission, it stated that:
“Unfortunately this data cannot be given as it is of a
confidential nature”.
Of the organisations that collect disability statistics and provided
them in the CfE, most provided some kind of information but
commonly missed out some of the full range of requested
information. For instance, some provided information on the
119
Interestingly, this view was also expressed by a teaching
organisation. It was articulated during a seminar on disabled
people and ITT hosted by the GTCE in October 2002.
120
SCOPE, GTCE, GTCS, GTCW, UoN, BGUC, GOSH, IoE,
UoBright, SSSC, CCW, LTHT, UoBrad, UoD, GSCC, UoK, ECU
121
UoN, BGUC, IoE, UoBright, LTHT, UoBrad, GOSH, SCOPE,
UoK
122
Institution 1
52
numbers of disabled people in their organisations but did not
provide any information on the proportion. Some provided
information on the numbers and proportion of disabled people but
no information on the time period these figures related to.
13 organisations provided statistics that are linked to year(s). 4 of
these started collecting statistics from 2003, one from 2001, one
from 1996. The remaining 7 only started collecting disability
statistics from 2006 (see Appendix B).
Regulatory bodies
In relation to nursing, the NMC “does not currently collect data on
disability but is likely to do so in the future as part of its action plan
under the DDA”. The remaining regulatory bodies provided
statistics relating to different groups and sub-groups of disabled
people.
According to figures provided by the GTCE, there were 815
disabled newly qualified teachers in 2006 making up 0.15 per cent
of all newly qualified teachers. Figures provided by GTCW showed
that they have 77 disabled registered teachers in 2006 accounting
for 0.2 per cent of all registered teachers. GTCS provided figures
that showed they have 31 disabled applicants to the Teacher
Induction Scheme in 2006, accounting for 1.1 per cent of total
applications to the Teacher Induction Scheme. The GTC (England
and Wales) only collected statistics on disabled teachers from
2006.
The SSSC’s figures showed that there were 160 disabled
registered social workers comprising 2.4 per cent of all registered
social workers in Scotland in 2005. The CCW’s figures showed
that there were 94 disabled registered social work students
comprising 2.15 per cent of all registered social work students in
Wales in 2006. The CCW had started collecting statistics on
disabled social work students since 2001/02. The GSCC’s figures
demonstrated that there were 1,489 disabled qualified social
workers comprising 1.95 per cent of all qualified social workers in
2006.
53
Other organisations
For the 9 other organisations, 2 provided the numbers of disabled
people in their organisations but did not indicate the proportions123.
As the relevant responding organisation are very diverse (eg in
terms of size, location, etc.), the range and characteristics of
information provided varied considerably (see Appendix B).
3.4.2 Collecting information by impairment categories
8 organisations collected information on impairment categories124.
Only one of these is a regulatory body125. These are illustrated
below.
Types of impairment categories used
Organisation 1126
“The wording is used from UCAS.”
UCAS:
 None
 Specific learning difficulty (eg dyslexia)
 Blind or partially sighted
 Deaf
 Wheelchair or mobility difficulties
 Autistic spectrum disorder or Asperger Syndrome
 Mental health difficulties
123
Institution 2 and Institution 6
124
Institution 2, Institution 3, Institution 4, CCW, Institution 6,
Institution 8, Institution 9, ECU
125
CCW
126
Institution 9
54
 Unseen disability (eg diabetes, epilepsy, heart condition)
 Two or more of the above
 Disability, special need or medical condition not listed above
Organisation 2127
“The wording used to invite applicants to disclose on application is
as per the NMAS application form.”
NMAS:
 You have a specific learning difficulty
 You are blind or partially sighted
 You are Deaf or hard of hearing
 You use a wheelchair or have mobility difficulties
 You have mental health difficulties
 You have a disability that cannot be seen
 You have two or more of the above
 Other disability not listed above
 Autistic spectrum disorder or Asperger Syndrome
Organisation 3128
 Dyslexia
 Blind or Partially Sighted
 Deaf or Hearing Impaired
 Wheelchair User / Mobility Difficulties
127
Institution 2
128
Institution 6
55
 Personal Care Support
 Mental Health Difficulties
 Unseen Disability, eg diabetes, epilepsy, asthma
 Multiple Disabilities
 Other Disability
Organisation 4129
 Dyslexia
 Mental health
 Wheelchair
 Multiple
 Unseen Disability
Organisation 5130
 Blind / Vis. Imp.
 Deaf / Hear Imp.
 Dyslexic / Dyslexia
 Need Pers. Care
 M. Health / M. Health Diff.
 Multiple / Complex Dis.
 No Disability
 No Info Required
 No Info Supplied / Not Stated
129
Institution 8
130
CCW.
56
 Other
 Unseen
 Wheelchair
 Physical Impairment
It is apparent from the above that there is a significant amount of
overlap in the categories that organisations have used.
3.4.3 Collecting disability information that can be
cross-referenced with other demographic variables
Only two organisations that collect statistics on disabled people
also cross-reference the disability variable with other variables.
Both of these collected organisation-specific information in a way
that allows disability to be cross-referenced with gender, age and
ethnicity131. None of these are regulatory bodies. Both
organisations additionally collected information by impairment
categories.
3.5 How ‘disability’ statistics are collected
Different definitions of disability and how these are operationalised
in terms of questions can lead to wildly divergent estimates of
disability and the disabled population. The DDA (1995) defines a
disabled person as someone with “a physical or mental impairment
which has a substantial and long-term adverse effect on a person's
ability to carry out normal day-to-day activities.” The DRC itself
uses statistics based on disability questions that are broadly
modelled around the DDA definition (eg the DRC’s Disability
Briefings are based on the Labour Force Survey and the Family
Resources Survey).
An understanding of how organisations collect disability statistics
(ie whether they use a DDA definition of disability in their
question(s)) is important in helping us interpret the statistics that
are provided. It has already been highlighted previously (under the
131
Institution 6 and Institution 8
57
section ‘No statistics collected’) that one organisation had
concerns about publishing statistics on disabled people due to
perceived unreliability of the information collected132.
3.5.1 Asking DDA-type disability questions
Of the 16 organisations that ask either a ‘disability’ and/or
‘impairment’ question133, 7 of these asked ‘disability’ questions that
can broadly be considered DDA-type questions134. Some of these
organisations describe the DDA definition of disability and ask
individuals to tick a box if they feel that this definition applies to
them135.
Examples of the DDA definition of disability being used in
questions
“Please tick the box if you have a physical or mental impairment
which has a substantial and long-term adverse effect on your
ability to carry out normal day-to-day activities, (Section 1(1) of the
Disability Discrimination Act 1995)”.136
“For the purpose of this questionnaire, disability is defined as a
physical or mental impairment that has a substantial and long-term
adverse effect on a person’s ability to carry out normal day to day
activities. This includes people with visual and hearing
impairments, severe disfigurement, dyslexia and diabetes. Do you
consider yourself as a disabled person?”137
132
NUT
133
Scope, GTCE, GTCS, GTCW, Institution 2, Institution 3,
Institution 5, SSSC, CCW, Institution 7, Institution 8, GSCC,
Institution 9, ECU, Institution 1 and NUT
134
GTCE, GTCS, GTCW, SSSC, Institution 7, Institution 8 and
NUT
135
5 organisations including Institution 8, Institution 7, SSSC,
GTCS and GTCW
136
GTCS, GTCW
137
Institution 8
58
“Do you consider yourself to be disabled? No, Yes
For the purposes of this form, disabled means that you have a
physical or mental impairment that has a substantial and longterm, adverse effect on your ability to carry out normal day-to-day
activities.”138
3.5.2 Asking health-type questions
Two organisations ask ‘disability’ questions that are broadly
considered ‘health’-type questions139. The questions were used to
assess an individual’s medical fitness in relation to professional
responsibilities. Both of these organisations relate to social work.
These are listed below.
Organisation 1140:
“The [name of organisation] identifies its Rules and Requirements
for Social Work Training in The Approval and Visiting of Degree
Courses in Social Work (Wales) Rules 2004. The criteria for
Programme Approval include the following requirement:
Before admitting a student to a Degree Programme, the Institution:
(a) must satisfy itself as to the student’s medical fitness and
character in terms of their suitability to work in social work.
Section 10, about your health: (a) Do you have a physical or
mental health condition that may affect your ability to undertake
your work in social care?, (b) please give a brief description of your
health condition and read the information below about your
consent for a health report, (c) your consent to a health report. We
may need to ask for a health report about you from your general
practitioner or any other health professional who knows about your
health condition, (d) you do not have to give your consent but
without it we will not be able to get a report. This means we may
138
SSSC
139
The two are CCW and the GSCC
140
CCW
59
not be able to register you. Do you wish to give consent to a health
report?”
Organisation 2141:
“Do you have a physical or mental health condition that may affect
your ability to undertake your work in social care?
If ‘yes’
Please give a brief description of your health condition and read
the information below about your consent for a health report”.
It is common for ‘disability’ questions to conflate ‘health’, ‘illness’
and ‘disability’. The DRC’s guidance for evidence-gathering for the
purposes of the DED noted that “a person who is ill may not be
disabled, and conversely a disabled person may not have an
‘illness’, therefore care is recommended in formulating disability
questions”142.
3.5.3 Using more than one type of ‘disability’ question
It is interesting to note that the same organisation may use a DDAtype question in one instance and a non DDA-type question in
another. For instance, one organisation used a DDA question at
the recruitment stage for management records but uses a non
DDA question for its staff survey. The form of the latter question is
similar to the ‘work limiting disabled’ question used in the Labour
Force Survey.
Different operationalisations of the ‘disability’ question within
the same organisation143
Question asked at recruitment stage:
141
GSCC
142
DRC (2006b) The Disability Equality Duty. Guidance on
Gathering and Analysing Evidence to Inform Actions, London:
DRC, (p. 8).
143
Institution 7
60
“Disability Discrimination Act (1995). Under the terms of the Act a
disability is defined as a ‘physical or mental impairment which has
a substantial and long term effect on a person’s ability to carry out
normal day to day activities’. Do you consider yourself to have a
disability? (Yes/No/Do not wish to disclose)”.
Question asked for staff survey:
“Do you have any long term illness, health problem or disability
which substantially limits your daily activities or the work you can
do?”
Asking ‘disability’ questions inconsistently can mean that
individuals may interpret a question as being relevant to them in
one instance but not in another. This means that organisations
may not be capturing the views of those whom they are actually
intending to target (eg through a staff survey). It also makes it
problematic for information to be extrapolated from one context to
another.
3.5.4 Asking ‘impairment’ questions
Of the organisations that collect disability statistics, 6 organisations
did not ask a ‘disability’ question but only asked an ‘impairment’
question144. Most commonly, this involves asking individuals to
choose from a list of impairment categories.
Organisation 1145
“Do you consider that you have one or more impairments or
conditions such as those listed below? This list is not exhaustive.
Physical impairment: deaf or hard of hearing; blind or visual
impairment (not fully correctable by glasses); speech impairment;
learning difficulties; mental health condition current or previous
144
Scope, Institution 3, Institution 5, Institution 2, Institution 9,
Institution 1
145
Scope
61
(eg. depression); long-term medical condition or illness (including
anything for which you take regular prescribed medication or need
regular medical treatment eg diabetes, cancer, epilepsy, asthma,
etc; cerebral palsy; autism, dyslexic/dyspraxia; wheelchair-user.
Yes/No/Do not wish to declare”
Organisation 2146
“The [name or organisation] receives its information regarding a
PGCE applicants’ disclosure from the following sources, GTTR,
PGCE full time post compulsory form, occupational health
questionnaire and self referral. Please find below the actual
wording for each used to identify disabled individuals and types of
impairment / conditions.
GTTR:
 You have a specific learning difficulty (for example dyslexia)
 You are blind, Blind or partially sighted
 You are Deaf or hard of hearing
 You are a wheelchair user or have mobility difficulties
 You have Autistic Spectrum Disorder or Asperger Syndrome
 You have mental health difficulties
 You have an unseen disability, eg diabetes, epilepsy, heart
condition
 You have two or more of the above
 You have a disability, special need or medical condition not
 listed above
 None”
146
Institution 3
62
There is no direct ‘read-over’ between disability and impairment
statistics as people who indicate that they have an impairment may
not think of themselves as ‘disabled’ (National Centre for Social
Research 2007, Grewal et al 2002). There are thus implications for
organisations using ‘impairment’ statistics as a read-over for
‘disability’.
It may not always be relevant to ask an ‘impairment’ question and
asking for information relating to impairments can also be regarded
as contentious. The DRC guidance on evidence gathering for the
DED noted that “The justification for using monitoring by
impairment type will be the extent to which it is relevant to
promoting equality for disabled people. If an authority is not ready
and able to make use of the information it gathers on impairment
type, this may dissipate the energy that the public authority should
be directing at promoting disability equality and may not be
appropriate. Asking for information on type of impairment may also
decrease response rates, unless its rationale is clearly justified to
respondents”147.
3.5.5 Asking both ‘disability’ and ‘impairment’
questions
One organisation asks both a disability (which is a DDA-type
question) and an impairment question148. These are presented
below.
The ‘disability’ question
“(For guidance, please refer to the list in section three for a range
of conditions covered by disability legislation).
I have a disability I wish to disclose:
(Please tick if applicable, and give more details in section
147
DRC (2006b) The Disability Equality Duty. Guidance on
Gathering and Analysing Evidence to Inform Actions, London:
DRC, (p. 43).
148
Institution 5
63
three)
I do not have a disability:
(Please tick if applicable, and go to section four)
I do not wish to disclose information:
(Please tick if applicable, and go to section four)”
The ‘impairment’ question
“Please tick the category most applicable to you:
 Specific learning difficulty (including dyslexia)
 Blind/partially sighted
 Deaf/partial hearing
 Wheelchair user/mobility difficulties
 Autistic disorder
 Mental health
 Unseen disability (including epilepsy, asthma, diabetes)
 Multiple disabilities
 A disability not listed
3.6 Perceived utility of asking ‘disability’
questions
As the background review for the FI revealed, there is some
acknowledgement from some organisations relating to the three
professions that disability statistics (where they exist) are based on
individuals who self-declare and may therefore understate the
incidence of disability (Hurstfield et al 2004). It has already been
noted above that one organisation asks a disability question but
does not present statistics on disabled people as perceived
“under-reporting and under-disclosure by members” render these
64
figures unreliable149.
Another organisation that collects (organisation-specific) statistics
on disabled people offered the following cautionary remark in
interpreting the statistics it provided:
“Although every effort is made to encourage prospective and
current students to disclose a disability, we are aware that there
will always be an element of under reporting as many students do
not wish to disclose a disability and others are not aware that they
are considered to be disabled under the DDA”.150
In addition to the issue of potential ‘under-reporting’, there is also
concern with data completeness where answering a disability
question is optional. This is exemplified by the following quote:
“Teachers are not required to provide this information. The way in
which disability data are collected during the application process
affects the measure of completeness. Historically, teachers were
asked to indicate ‘yes’ or ‘no’ in response to the disability question.
Where neither option was selected, the description of “unknown”
was used during processing to indicate that the teacher had been
given the opportunity to provide the data. Currently the application
process simply asks the teacher to indicate if they have a disability
and this does not lend itself to enabling assessment of the relative
proportion of disability and data completeness. This will be an
important consideration to take forward to any large-scale
collection of disability data that the organisation embarks upon to
ensure usefulness of data in statistical analysis”151.
The above quote discusses how the handling of ‘non-response’
can crucially affect the interpretation of disability statistics. Where
there is no recorded answer, it is important to distinguish whether
this is because an individual has been given the opportunity to
respond but chose not to (for whatever reason), or whether an
individual was not asked. This has implications for the assessment
of coverage, and hence on establishing with any confidence the
149
NUT
150
Institution 3
151
GTCE
65
likely number/proportion of disabled people.
The above issues can be compounded by the fact that disclosure
is not a one-off event and can be re-negotiated under different
circumstances, therefore leading to further challenges in
interpreting different sets of statistics collected by the same
organisation under different circumstances:
“Some students disclose a disability to the Disabilities Support
Office in order to obtain support, but request that this information is
not included in their student record, despite assurances that this
information will be remain confidential”152.
Another response to the written evidence submitted for Section B
additionally highlighted that the wording of the disability question
can have a concrete impact on potential response, and hence the
utility of information collected. This bears quoting at length:
“The applicant for a post as teacher or social worker often does not
realise that they have a disability as defined by the DDA 1995.
Quite often on a pre-employment health questionnaire when there
is a specific question on “do you think you have a disability” the
applicant says no when manifestly from other declared history on
the form there is a high probability that they do have a disability.
This is not a deliberate deception but a genuine lack of
understanding that the condition may fall into the category of
disability. Typical examples of cases where the OH may feel the
individual has a disability but the person themselves does not are:
psychiatric conditions such as bipolar affective disorder in
remission with medication, epilepsy controlled completely with
medication, insulin dependant (Type I) diabetes, the early
stages of chronic progressive diseases which may be intermittent
such as multiple sclerosis or rheumatoid arthritis. Cancer in
remission”.153(original emphasis)
152
Institution 3
153
ALAMA
66
3.7 Purposes of asking disability questions
The issue of disclosing disability and/or long term health conditions
emerged as being of great significance across the three
professions from the perspectives of both practitioners/students
(eg Morris and Turnbull 2006) and employers/educational
providers (Hurstfield et al 2003, Wray et al 2005). As the
background paper to the FI concluded, “There are a range of
concerns expressed by disabled people around the real and
perceived discriminations against them as a result of disclosure.
The implications of non-disclosure, however, are that support may
not be rendered or that discrimination cannot be tackled
effectively. Interventions may therefore not be timely” (Sin et al
2006, p. 19).
Responses to Section B of the CfE indicate that for those
organisations that ask a disability and/or impairment question,
seven154 of these do not state clearly the reasons for asking such a
question or describe what the information will be used for.
Most of the organisations, however, do give some indication of
why they are asking such a question. These can be categorised
into (a) estimates of disabled population(s); (b) appropriate support
provision; (c) legal and/or regulatory requirement in relation to
‘fitness’ decisions; and (d) equal opportunities or other forms of
monitoring. These are not mutually exclusive.
With the exception of questions for equal opportunities monitoring
which are located in a separate dedicated section, explanations of
the purpose of information gathering are usually found immediately
after the ‘disability and/or impairment’ question. Examples of exact
wordings are provided below.
154
GSCC, Scope GTCE, Institution 3, SSSC, Institution 9 and NUT
67
Estimates of disabled population
“This information will be used to estimate the number of registered
teachers with disabilities, as defined by the Disability
Discrimination Act 1995155.”
Appropriate support provision
“If you have a disability can you indicate the support you may need
attending for interview (eg parking permit, loop facility, signer etc)
This information will help us to provide any additional support you
may need as a student at the university. Moreover, if you have a
disability and need any reasonable adjustments for the interview
please indicate below156”.
“If yes, do you need special arrangements to enable you to attend
for interview? If yes, please give details below157”.
“Students who disclose on their application form will be recorded
on our database and sent information about the support that will be
available to them during the programme158”.
Legal and/or regulatory requirement
“The [name or organisation] identifies its Rules and Requirements
for Social Work Training in The Approval and Visiting of Degree
Courses in Social Work (Wales) Rules 2004. The criteria for
Programme Approval include the following requirement:
Before admitting a student to a Degree Programme, the Institution:
(a) must satisfy itself as to the student’s medical fitness and
character in terms of their suitability to work in social work.”159
155
GTCS and GTCW
156
Institution 8
157
Institution 7
158
Institution 9
159
CCW
68
“Under Section 134 of the Education Act 2002 and Regulation 7 of
the Education (Specified Work and Registration) (Wales)
Regulations, every qualified teacher who carries out the ‘specified
work’ of a teacher in a maintained school must be registered with
the General Teaching Council for Wales”.160
“For all candidates offered a place on a programme of initial
teacher training we must receive a satisfactory Declaration of
Health form. It is also our policy to obtain the same from
candidates for some of our other programmes which involve
placements in school”.161
Monitoring purposes
“If you have a disability which might effect where you can work
during your teacher induction placement year please tick this box.
If you have ticked the above box the Council will contact you.
Please refer to the notes section of the application pack.
The above question is asked so that the local authorities can be
informed of any disability when allocating students to a placement
within the Teacher Induction Scheme.”162
The DRC guidance on evidence gathering for the purposes of the
DED noted that “Any questions which are going to be used to
monitor the numbers and experiences of disabled people who are
employees or service users should be carefully introduced to
explain why you are collecting this information, the use it will be
put to and assurances about confidentiality. It is also important to
emphasise the commitment of your organisation to promote
equality of opportunity and to explain how you will publish the
anonymised information you have gathered. Experience shows
that setting the context for questions in this way significantly
160
GTCW
161
Institution 5
162
GTCS
69
increases response rates”163.
3.8 Whether disclosure is optional
In the case of 7 organisations164, it was stated clearly that
disclosure is optional. (eg following on from the disability question,
options are provided which allow respondents to select
“Yes/No/Do not wish to disclose or declare”165, or the disability
question explicitly informs respondents that disclosure is
optional166).
However, in one of these cases, the potential consequences of
non-disclosure were highlighted against the context of a
legal/regulatory requirement167.
3.9 Conclusion
Historically there is a paucity of robust and comparable information
on disability with no one satisfactory data source even at the
national level. Estimates of prevalence alone at the national level
are not always sufficiently informative. At both a national and an
institutional level many organisations do not disaggregate their
existing data sources to reflect the particular experiences of
disabled people.
While gathering information on disabled people is important, this is
not an end in itself. The DRC contends that gathering disability
information should be placed in the broader context of promoting
disability equality by using the information to help decide where
action is most needed, take such action, review its effectiveness
163
DRC (2006b) The Disability Equality Duty. Guidance on
Gathering and Analysing Evidence to Inform Actions, London:
DRC. (p. 44)
164
GTCE, Institution 7, Institution 5, Scope, CCW, GSCC,
Institution 9
165
Institution 7, Institution 5, Scope
166
GTCE: “Teachers are not required to provide this information”.
167
CCW
70
and decide what further work needs to be done.
There are real challenges in collecting information on disability and
real concerns over the reliability of information. Disclosure of
disability can be low due to fear as to the consequences of
disclosure and failure to understand the broader potential benefits
of disclosure in terms of improvements for disabled people.
Additionally many people with impairments or long term health
conditions would not describe themselves as ‘disabled’.
Through guidance issued for the DED, the DRC has put forward a
number of key principles to underpin information collection on
disability. Information gathering should be:
 Voluntary – participants should know that their
participation is entirely voluntary.
 Confidential – participants should be assured that
personal information about them will not be disclosed to
others without their permission.
 Transparent – participants should understand what is
meant by ‘disabled’, why information is requested, and
how it will be used.
 Positive – the organisation should make it clear that it will
use the evidence gathered to develop good practice and
bring about improvements.
 Accessible – adjustments should be made to allow the
widest possible range of disabled people to speak for
themselves.
 Based on self-disclosure – disabled people themselves
should be asked whether they are disabled; managers
should not guess whether their employees are disabled,
and people working in the frontline should not be asked to
guess whether customers are disabled.
 Involving disabled people in the design of the
measurement or research.
 Supported by trained staff.
Ultimately, organisations need to convince disabled people that the
71
information collected will be analysed and used to promote
disability equality and bring about real and positive changes.
Information gathering and use should thus be informed by the
social model of disability whereby organisations should focus on
the barriers that disabled people face and not explain ‘problems’ in
relation to a person being disabled or having an impairment.
The social model should inform not only how the research or
information gathering process is designed and analysed but the
method of its production. This can be achieved by involving
disabled people in designing mechanisms for gathering information
and ensuring that the information produced is transparent and
easily accessible for disabled people.
Summary of findings
Most organisations do not have any statistics on disabled people
as employees and/or students in their organisations. Only two
collect information in a way that allows disability statistics to be
cross-referenced with a range of other demographic variables and
to be disaggregated by impairment categories.
Where available, statistics are not collected and/or presented in a
consistent or comparable way. Information relating to disability is
overwhelmingly collected only in recent years.
There is concern over the reliability (and hence usefulness) of
disability statistics due to (a) under-disclosure and the complexity
around the process of and context around disclosure; (b)
incompleteness of coverage; and (c) inappropriate or inconsistent
disability and/or impairment question(s).
In some cases, the purpose of asking about disability and/or
impairment is unclear. Where stated, organisations tend to collect
such information for four main reasons: (a) estimates of disabled
population(s); (b) appropriate support provision; (c) legal and/or
regulatory requirement in relation to ‘fitness’ decisions; and (d)
equal opportunities or other forms of monitoring.
Disclosure of disability and/or impairment is not always optional.
72
Chapter 4 – Research on the experiences
of disabled people (Section C)
Of the 40 organisations that responded to the CfE, 12 were not
asked this set of questions (ie these were organisations from other
regulated health professions).
4.1 ‘Not applicable’
8 organisations indicated that Section C was ‘not applicable’ to
them168. 7 did not provide any explanation for why this was so and
the one organisation that did provide some kind of reason stated
that they did not need to commission or conduct research because
“we have robust and full feedback mechanisms, as well as equality
focus groups but they do not follow the above format [ie
research]”169. This indicates the possibility that some organisations
do not necessarily feel that research is relevant or required when a
range of other channels may exist that allows them to tap into the
experiences of disabled people. There is no evidence on the
perceived effectiveness of such alternative mechanisms.
4.2 No existing research
Two organisations indicated that they have not commissioned or
conducted any research on disabled people but that they intended
to do so “in the future”170. In one case, the responding organisation
indicated that the intended research is envisaged to be conducted
in 2007/08 and will explore and capture “experiences as a way of
improving our provision” and to gain a “greater understanding of
their needs and the views of practitioners”171. The other
organisation did not provide any information on the nature and
objectives of their intended future research on disabled people.
A third organisation reflected the impact of country-specific
168
Scope, SEED, SEHD, UoBrad, UoD, UoN, GTCS, and IoE
169
This organisation is the IoE
170
ECU (institution K) and the UoBright
171
UoBright
73
contexts in relation to the conduct of research. In its submission, it
indicated that does not, currently, commission or conduct any
research but that “prior to the removal of the medical requirements
for teaching in Scotland (2004) there was a disability working
group which consulted widely before the changes were made”172.
While this does not necessarily mean that research was
conducted/commissioned prior to 2004, it does indicate that there
were structures in place that enabled the involvement and input of
disabled people. It is unclear whether the disability working group
is still in place and functioning effectively since 2004.
4.3 Relevant research commissioned or
conducted
7 organisations173 have commissioned or conducted some form of
research that they deem to be relevant for the purpose of Section
C. Most of these relate to teaching. Detailed analysis of the types
of research indicated by these organisations reveals three main
clusters of research: (a) research that is specifically on disabled
people in the organisation; (b) research on disabled people that is
profession-generic; and (c) profession-generic research not
specifically on disabled people.
4.3.1 Profession-generic research not specifically on
disabled people
4 of the 7 organisations indicated that they have commissioned or
conducted research that is generic to a profession and not
specifically on disabled individuals within the profession, although
findings are perceived to be generally applicable across groups.
Unsurprisingly, all 4 organisations that commissioned or conducted
such research are regulatory bodies174.
172
This is the GTCS
173
The 7 organisations are ECU/BGUC, DfES, SSSC, GTCW,
NASUWT, NUT and RCN. ECU and BGUC both indicated that
research was conducted/commissioned, but ECU’s return for this
section actually referred to BGUC. To avoid double-counting,
ECU/BGUC are counted as one organisation here
174
RCN, SSSC, NUT and GTCW
74
Research, in these cases, was not motivated by a desire to find
out about the experiences of disabled people (either as employees
or as students) but was instead due to the imperative of exploring
certain issues across a wider group of professionals. The
objectives and uses of research were not always indicated175.
In some cases, the research identified or produced information that
related to disabled people in these organisations176.
4.3.2 Profession-generic research specifically on
disabled people
One organisation indicated that it had commissioned research that
is specific to disabled people in a profession-generic manner (ie
not specific to the organisation itself as an employer and/or
educational provider)177. This is presented in Figure 4.1.
The “RCN surveyed its members to look specifically at nurses
wellbeing and working lives”. This resulted in a document
containing a number of recommendations for employers. The NUT
indicated that it has conducted a poll of teachers. The objective of
the research was not stated. We are still awaiting the research to
be sent to us. The SSSC is conducting research on the views of
service users and carers “regarding the skills requirements” for
social services staff. The objective of this research was not stated
in the questionnaire and the SSSC indicated that the research was
ongoing. The GTCW reported conducting a qualitative survey of
teachers, review of recruitment and retention information and
information provided by other sources such as Higher Education
Funding Council for Wales and the Wales Assembly Government,
and seeking participants’ views at a multi-agency conference. The
GTCW had conducted all these over the period of two years with
the aim of producing an action plan on recruitment and retention of
teachers in Wales
175
The RCN’s research, for instance, reported a finding relating
specifically to disabled nurses, where four out of ten had
experienced bullying
176
177
DfES commissioned research by University of Glasgow on the
impact of disability on teachers’ careers
75
Figure 4.1
Objective of research
To assess the impact of disability on teachers’ careers.
Sample
Disabled teachers and school governors. (No information on
impairment types covered).
Method
 Postal survey of 2,158 teachers (including 104 disabled
teachers) from a sample of 62 local authorities in England.
 Interviews with 109 teachers and 14 governors in 18 case
study schools. (No information on whether all or how many of
the 109 were disabled).
 Workshops with the NUT.
 Top-up survey of disabled teachers facilitated by the British
Association of Teachers of the Deaf and the Association of
Blind and Partially Sighted Teachers, with 14 teachers with
either visual or hearing impairments responding.
Findings
 Proportionately more disabled teachers than non-disabled
teachers work part-time.
 ‘White’ teachers report having warmer relationships with
colleagues than minority ethnic or disabled teachers.
 Disabled teachers more likely than other groups to think
about leaving the profession.
 Disabled teachers (together with older teachers and teachers
who work part-time or job share) most likely to indicate that
they would struggle with increased responsibilities.
 Disabled teachers find their needs often ignored by INSET
providers.
76
 There are few disabled headteachers.
 43 per cent of teachers surveyed believed that disability
would negatively influence a teacher’s promotion prospects.
Uses of research
No indication.
4.3.3 Organisation-specific research on disabled
people
Only three organisations178 have conducted or commissioned
research specifically on the experiences of disabled people in their
respective organisations. Information was provided by one of these
in relation to the objective, method, findings and uses of the
research179. This is presented in Figure 4.2.
Figure 4.2
Objective of research
To assess the needs of disabled students and to ensure
adequate support is provided by the university and by
placement providers.
Sample
Disabled students across all departments. No information
provided on which impairment categories were included or
the size of the sample.
Method
 Benchmarking exercise with staff in all departments.
178
NASUWT, ECU/BGUC and ECU(Institution F)
179
ECU/BGUC
77
 Students contacted by phone, email and letter, and asked
questions about the College’s provision of support across
departments.
 Focus group session with students.
Findings
 Further improvements needed in terms of liaison between
the university and placement providers to ensure that the
latter are aware of the needs of disabled students where
consent has been provided to disclose information on
disability.
 Detailed information required in advance of placement and
field trip activities in order that adjustments can be discussed
and put in place where required.
 Need for more consistent approaches to disseminating
information about required adjustments amongst programme
teams.
 More consistent response to providing accessible materials
in advance of lectures and seminars.
 Establish consistent practices for institutional responses to
student emails and voicemail messages.
Uses of research
 Responses being made to more immediate issues
highlighted by disabled students.
 Issues of a longer term nature have been incorporated into
the Disability Equality Scheme action plan.
 Senior managers throughout the institution are given
responsibility to respond to the issues at an operational level.
 Issues have also been fed into the strategic framework of the
university via its committee structure.
78
The second organisation180 stated that they have “undertaken
detailed research and consultation with disabled members
throughout the UK” and “has an annual programme of consultation
conferences for disabled teachers in addition to its research work”.
There was no information provided on what the research involved.
The organisation went on to state that its “research and
consultation confirm that many teachers in schools and colleges
are either unaware of the provisions of the DDA or find it difficult to
gain the support of their employer in making reasonable
adjustments. [The organisation’s] research confirms the need for
disability awareness training for all staff”. The organisation
additional stated that they have “detailed knowledge of the
experiences of disabled teachers through its ongoing casework.
Teachers and trainee teachers with impairments and long-term
health conditions are often treated unfavourably and in some
cases discriminated against by schools and within initial teacher
training”.
The third organisation stated that its research is currently
underway and explores “the experiences of disabled ITT trainees
but results will not be available until next year”181.
180
NASUWT
181
ECU (Institution F)
79
4.4 Research that is not commissioned or
conducted by responding organisations
3 organisations referred to research done elsewhere182. Another
organisation referred to research conducted by a second
organisation (that also responded to this CfE). The second
organisation, however, responded that “We have not carried out or
commissioned any research about the experience of disabled
people…”183.
182
OCNO indicated that a nursing officer was undertaking Ph.D
research on dyslexic pre-registration nurses looking at how they
develop clinical competencies. The GSCC indicated that it was
“aware of research carried out by a team linked to Hull University
which led to a good practice guide about practice learning
placements for disabled social work students - Wray et al (2005)
PEdDS Best Practice Guide: disabled social work students and
placements, Hull: University of Hull”. The ECU (institution J)
provided a link to “Primary information for the Deaf Peoples
Access to Nurse Education project” which brings up a number of
case studies. It indicated that it offers nurse education
programmes to Deaf students. It indicated three projects on Deaf
students in the school of nursing including (a) a professional
doctorate project entitled “Empowerment through access. A study
of Deaf people’s access to nursing”, (b) an ongoing widening
participation project looking at support in clinical practice for
dyslexic nursing students, and (c) on ongoing widening
participation project looking at disability in the nursing preregistration curriculum. ECU (institution J) stated that these
projects “have supported the development of posts specific to the
support of Deaf students within the school of nursing”.
CCW stated that they are aware that the “GSCC is undertaking
research into ‘Diversity and Progression in Social Work Education’
– This work has been commissioned by GSCC working with SCIE
to investigate differential progression routes in social work
education qualifying courses and to begin to establish reasons for
this”. The CCW stated that “The research is being undertaken by
the Social Care Workforce Research Unit at Kings College
London”. The GSCC, however, indicated in its submission that it
did not conduct or commission any research.
183
80
For two of the organisations that referred to research conducted
elsewhere, one cited “research carried out by a team linked to Hull
University which led to a good practice guide about practice
learning placements for disabled social work students – Wray et al
(2005) PEdDs Best Practice Guide: disabled social work students
and placements, Hull: University of Hull”184. The other organisation
indicated that one of its nursing officers is currently undertaking
research for a Ph.D, looking at how dyslexic pre-registration
nurses develop clinical competencies185. This is summarised in
Figure 4.3.
Figure 4.3
Objective
To explore how dyslexic pre-registration nurses develop
clinical competencies.
Sample
Stage 1:
 8 admissions lecturers (two from each branch of nursing).
 3 school and university specific learning needs support
officers.
 7 pre-registration dyslexic nursing students studying in years
2 and 3 of the programme.
 9 clinical mentors who had supported dyslexic students.
Stage 2:
 4 pre-registration dyslexic nurses.
 7 of the students’ clinical mentors.
184
This was the GSCC
185
This was OCNO
81
Method
Stage 1:
 Qualitative methodology utilising a case study approach.
 Semi structured interviews lecturers, learning needs support
officers, and nursing students.
 Postal questionnaire responses from clinical mentors.
 University and School written policies in respect of disabled
students were reviewed, in particular guidance standards for
selection and support.
Stage 2:
 Longitudinal study of four dyslexic nursing students studying
the two years branch element of the course.
 Interviews with clinical mentors of dyslexic students.
Findings
 All students in the study had difficulty in clinical practice
attributable to the nature and severity of their dyslexia.
 Difficulties involved dealing with verbal and written
information, comprehension of information, constructing
reports, remembering things, and being able to prioritise and
organise their work within specific timeframes.
 Diagnosis of dyslexia impacted negatively on self-image,
particularly affecting those diagnosed as adults, which in turn
impinged on feelings of self worth and performance in
practice.
 Disclosure decisions influenced by past disclosure
experiences.
 Admission lecturers’ selection decisions related directly to
how they reconciled the tension they felt about upholding the
rights of the individual student to be offered the opportunity
to become a registered nurse against the potential risk they
thought the student posed to patients/ clients because of
82
their specific learning need.
 The Nursing and Midwifery (92202; 2004e) standards for
clinical mentor preparation do not include outcomes for
working with students with disabilities. Mentors in this study
had therefore not received instruction on supporting the
learning and assessment of students with specific learning
needs.
 Timing and type (nature of work) of clinical placement either
assisted or further challenged dyslexic students as they
worked to develop clinical competence.
 Students and mentors recognised that dyslexic students had
a responsibility to develop a range of coping strategies to
function as a registered nurse, particularly as support was
likely to diminish once they were qualified.
 Students identified a range of coping strategies they
developed in practice including the use of informal support
networks such as family and friends, which they depend on
their own circumstances and the environment in which they
worked.
 Students expressed a desire for the formation of peer
support group. This had not been put in place by the schools
in this study due to the perceived need to preserve student
confidentiality.
Uses of research
 A paper from this research was submitted to the Nursing
Standard for publication in September 2006.
 A conference presentation was made at the 8 RCN Joint
Education Forum’s Conference – Partners in Practice, on 22
– 24 February 2006.
 Results from both pieces of work have been shared with the
NMC and the Health Professions Council, and with key
stakeholders in Wales such as the schools of nursing.
83
4.5 Uses of research
Figures 4.1 to 4.3 illustrate three particular cases where research
led to different outcomes. Fundamentally, they illustrate three
different models of research usage: (a) where research was
specifically commissioned/conducted, but not used (or no
indication was given of its use); (b) where research was
specifically commissioned/conducted and used to inform policy
and practice; and (c) where research was
commissioned/conducted and findings were disseminated. These
broadly exemplify three broad models of the impact of research on
policy and/or practice: (a) non usage; (b) direct or instrumental use
(ie to bring about changes in practice); and (c) conceptual use (ie
to raise awareness, knowledge, etc) (Nutley 2003, p. 8).
In addition, it was also clear that there are cases where professiongeneric research (ie research not targeted specifically at disabled
people within responding organisations) was
conducted/commissioned and, in the process, identified or
revealed information relating to disabled people. There was no
indication in the responses received from these organisations that
such research was used to inform policy and practice in relation to
disabled people although plans may be formulated to target
members of the profession in general.
4.6 Conclusion
This part of the CfE confirms the finding from the background
literature review for the FI that there is a dearth of research on
disabled people studying, qualifying, registering and working in the
three professions.
This is true even of organisations relevant to the three professions.
A significant number do not see researching disabled students
and/or employees in their organisations as being relevant to them.
Although there are suggestions of alternative modes of gaining
information in some cases, the nature and effectiveness of these
alternatives were not indicated.
Where research was conducted/commissioned, this was
overwhelmingly not due to a specific interest in disabled people
but was rather profession-generic. In due course, some of this
research uncovered or identified information that is pertinent to
disabled people studying or working in the professions. However,
84
there is no indication that this information, where available, has
been used to influence policy and practice relating to disabled
people.
Apart from profession-generic research that does not focus on
disabled people, one organisation conducted/commissioned
profession-generic research looking specifically at disabled people,
while two conducted/commissioned research on disabled people
specific to their organisations.
Regardless of the nature or origin of research, there is only one
instance of research being used to inform policy and practice. This
can be characterised as an ‘active’ and ‘instrumental’ use of
research. One other organisation had disseminated research
findings to other stakeholders. This can be characterised as a
‘passive’ use of research.
There is early indication, picked up by the CfE, of the potential of
the DED in encouraging organisations to gather evidence on
disabled people through research and other means. It is too early
to assess the impact of the DED at this stage.
Summary of findings
Researching the experiences and needs of disabled people often
not seen to be necessary, important or relevant.
Profession-generic research, particularly those commissioned or
conducted by regulatory bodies, may identify or gather useful
information on disabled people. However, there is no indication
that this information is used.
In general where research is conducted or commissioned, there is
scant evidence of it being used to influence policy or practice.
85
Chapter 5 – Non-statutory guidances
(Section D)
5.1 Overview of response
19 organisations provided some form of response with regards to
the call for information in relation to Section D. 11 organisations
submitted information in both written-in responses to the
questionnaire as well as additional documents186. 3 organisations
only submitted additional documents187. 5188 organisations only
submitted written-in responses to the questionnaire.
However, several of these organisations produced and/or
discussed a number of statutory guidance which is not the focus of
Section D.
5 organisations189 did not respond to Section D, only one provided
some form of explanation as to why this was so. The organisation:
“…does not have any non-statutory guidance specifically for
disabled people employed as nurses, teachers and social
workers. However, we do have guidance on how to support
disabled staff in all roles across [the organisation]”190
3 organisations191 indicated that Section D was ‘not applicable’.
One of these indicated that “Higher Education Institutions have
their own guidance”.192
Section D requested information specifically in relation to five main
186
BGUC, DfES, UoN, CCW, LTHT, SSSC, UoBrad, IoE,
NASUWT, NMC, GSCC
187
UoBright, UoK, Skill
188
OCNO, BASW, GTCS, RCN, ECU
189
Scope, UoD, CoD, GTCE, BATD
190
Scope
191
SEHD, SEED, GTCW
192
SEHD
86
themes: (a) disability discrimination; (b) reasonable adjustments;
(c) equal opportunities; (d) health/fitness criteria; and (e)
disclosure. Responding organisations overwhelmingly did not
indicate which response (or additional document) related to which
specific theme. Documents and questionnaire responses therefore
had to be read in their entirety to ascertain relevance.
5.2 Disability discrimination
Quite often, organisations produced documents that mentioned
discrimination in some general manner but not specifically in
relation to disability.
Two organisations have distinct non-statutory policies and
procedures specifically on disability and mentioning disability
discrimination193, while the remaining organisations include
mentions of disability discrimination in other policy documents (eg
equal opportunities policy).
5.2.1 Organisations with distinct disability policy
mentioning disability discrimination
Both organisations with distinct disability policies are higher
educational institutions. Both discuss disability discrimination
differently.
Organisation 1194:
Document name:
Disability Statement for Students
Content:
 Student support: accessibility services
 Physical access and health and safety issues
 Accommodation
193
BGUC and UoK
194
BGUC
87
 Admissions arrangements
 Educational facilities and support
 Teaching and learning
 Examinations and assessments
 Placements
 Arrangements for handling complaints and appeals
 Requirements of professional bodies
Discussion on disability discrimination:
Disability discrimination is discussed in relation to the section on
‘Requirements of professional bodies’: “The College cannot
discriminate against a disabled people either during the
admissions procedure, or once a student is enrolled on a
programme of study”.
Organisation 2195:
Document name:
Student Disability Policy
Content:
 Introduction
 Policy
 Purpose
 Scope
 The legislation
 Discrimination
195
UoK
88
 Duty
 Student services
 Responsibilities
 Disclosure and confidentiality
 Recruitment and selection facilities
 Policy implementation
 Complaints and feedback
 Monitoring and evaluation
 Other information available
 Further help and guidance
Discussion on discrimination
Section on ‘Discrimination’:
“Discrimination may occur in two ways:
 When a responsible body treats a disabled person less
favourably for a reason relating to the persons disability, than
it treats or would treat a person to whom that reason did not
apply
 It also occurs where a responsible body has failed to make a
reasonable adjustment, which has meant that a disabled
person has been placed at a substantial disadvantage in
comparison with a student who is not disabled.”
The section on ‘The legislation’ also includes mention of disability
discrimination as above.
89
5.2.2 Organisations mentioning disability
discrimination in other policies and procedures
Disability discrimination is also mentioned in the context of other
policies and procedures, in particular, those relating to equal
opportunities
Disability discrimination is mentioned in the equal opportunities
policies of three other organisations196 (see also section on Equal
Opportunities below). All three explain the meaning of disability
discrimination and the ways in which it can occur. One of the
organisations described ‘direct’ and ‘indirect’ discrimination197.
Two of the organisations198 set out procedures for proactively
preventing discrimination from taking place and explain ways of
seeking recourse. The third organisation only discusses the
latter199.
Another organisation200 mentioned the challenges around
implementing non-discriminatory practice:
196
CCW, SSSC and IoE
The concept of ‘indirect discrimination’ is not relevant to
disability discrimination.
197
198
SSSC states that they support the principle of diversity and will
not tolerate discrimination against any individual either directly or
indirectly. They also state that they would take positive action to
promote a culture where all employees can contribute fully towards
the work of the organisation. IoE explains steps to be taken to
prevent direct and indirect discrimination during admission and
course of study. There is detailed discussion of reasonable
adjustments to support students, and that the institute is committed
to fully implement the requirements of the DDA (1995) and (2005),
and SENDA (2001).
199
CCW
OCNO’s ‘Health Professions Wales, Position Paper- Making
Reasonable Adjustments in Clinical Practice for Disabled Health
Students’.
200
90
“The challenge for clinical mentors/supervisors is to act in a
non-discriminatory way to provide support for students with
specific needs in practice so that they are able to develop the
proficiencies/competencies required for the course they are
taking. Evidence suggests that the majority of clinical staff
that act as mentors/supervisors are not receiving specific
training or support for working with students with specific
needs.”
Only one organisation defined, explicitly, what direct discrimination
is in the context of disability. This was in the context of an Equality
and Diversity Policy, and reads:
“Direct Discrimination is where an individual is treated less
favourably than another in similar circumstances because of
their race, ethnic or national origin, religion, age, gender,
sexual or marital status or disability”.201
No responding organisation provided any non-statutory
guidance/policy and procedures that addresses disability-related
discrimination. Two organisations referred to statutory guidance202
that contains statements that can be interpreted as potentially
leading to disability-related discrimination:
“An individual who is infected with, for example, HIV,
Hepatitis B or Hepatitis A might be precluded from being able
to practise in some posts. However, such an infection would
not preclude them from being registered. It is essential,
therefore, that registrants applying for posts or registering
with an agency are aware of and comply with good health
requirements for employment as well as for registration. See
for example, draft Department of Health guidance on serious
communicable diseases published in December 2003.”203
“Under the criteria for Initial Teacher Training, all entrants to
courses must be able to communicate clearly and
201
SSSC’s Equality and Diversity Policy
202
NMC Guidance 06/04 Requirements for Evidence of Good
Health and Good Character
203
NMC
91
grammatically in spoken and written English, and where
appropriate, Welsh.”204
In relation to the sentiments expressed in the first quote, there may
be legitimate concerns about people with blood-borne viruses
carrying out certain types of jobs, particularly ‘exposure prone
procedures’. Where somebody with a blood-borne virus is not
allowed to carry out a particular job involving exposure prone
procedures, this may amount to disability-related discrimination
that has a legitimate justification. However, if the job in question
only rarely involved exposure prone procedures and there were
reasonable adjustments that could be made then the disabilityrelated discrimination could not be justified. So it is important that
the good health requirements operated by the employers are
specific to the needs of the particular job, and that the guidance
explains this.
The second quote relates to English language standards. The
review of statutory and regulatory frameworks conducted as part of
this FI identified “some academic standards that may adversely
impact on disabled people, particularly those that relate to English
language” (Ruebain et al 2006, p. 8). It concluded that “The
imprecise wording used in some documents is more likely to
amount to, or give rise to, disability discrimination (particularly
disability related discrimination). …[While acknowledging that]
Requirements for specific standards of English language or
communication skills may be legitimate competence standards,…
the wording of these standards may unnecessarily exclude groups
of disabled people, such as some deaf people who may have a
good knowledge of English but are not able to speak clearly”
(Ruebain et al 2006, p. 8).
204
DfES questionnaire response, referring to guidance Physical
and Mental Fitness to Teach of Teachers and of Entrants to Initial
Teacher Training, Circular No. 4/99
92
An example of how statements can lead to the potential for
direct and disability-related discrimination205
The extract:
“On completion of the occupational health screening process, you
will be allocated to one of three categories:
A. Those who are in good health and free from physical defects or
who have conditions which are not likely to interfere with efficiency
in teaching.
B. Those who are in good health but suffer from conditions which
are likely to interfere to some extent with their efficiency in
teaching either all subjects or certain specified subjects, though
these conditions are not serious enough to make the candidate
unfit for the teaching profession.
C. Those whose condition is such as to make them unfit for the
teaching profession. Candidates should not normally be included
in this category unless they suffer from a psychiatric or physical
disorder likely to interfere seriously with regular and efficient
teaching.”
Potential for discrimination to arise:
Statements A, B and C come from the DfES circular 4/99. As
argued in the review of legislation and regulation commissioned as
part of this FI (Ruebain et al 2006), this statement could give rise
to direct discrimination. This is because it could lead to those who
are implementing this guidance making assumptions that people
with particular diagnoses (eg a diagnosis of bipolar disorder or
schizophrenia) would be unfit for teaching (see DRC 2004b). The
DDA Code of Practice – Employment and Occupation, says:
“Less favourable treatment which is disability-specific, or which
arises out of prejudice about disability (or about a particular type of
disability), is also likely to amount to direct discrimination” (DRC
2004b, para 4.9).
The above guidance could also give rise to disability related
205
BGUC questionnaire response, relating to their Admissions
Policy, based on DfES circular 4/99
93
discrimination, if a disabled student is judged to be teaching less
efficiently than other students, but the reason for this difference in
performance is related to the student’s disability. The organisation
would need to consider whether any reasonable adjustments could
be made to the training or to the assessment process.
Statements A, B, and C make no reference to reasonable
adjustments so, for example, someone who indeed have “physical
defects” (in the language of this document) may work less
efficiently and therefore be classified under B or C, when in fact
with reasonable adjustments would be able to perform the role as
teacher safely and competently.
The statement “If a full medical examination or specialist
consultation and report are required, the candidate is responsible
for meeting any costs incurred” may also lead to direct
discrimination or disability related discrimination. For example, if a
candidate indicated that s/he had a particular diagnosis (say,
epilepsy or depression) and on the basis of this was asked to pay
for a full medical examination or specialist consultation – even if
the condition was well managed, this may amount to less
favourable treatment on the grounds of disability ie direct
discrimination. It could alternatively be disability related
discrimination.
5.2.3 Victimisation and harassment
Apart from direct mentions of disability discrimination,
organisations sometimes produce examples of non-statutory
guidance relating to or mentioning particular aspects relevant to
disability discrimination. Most commonly these relate to
victimisation and harassment.
One organisation produced non-statutory guidance that included
mentions of victimisation in the context of disability206. Victimisation
was only mentioned for the purpose of defining it in relation to a
wider discussion on disability discrimination in the case of one
206
IoE referred to their Equal Opportunities Policy
94
organisation207.
A second organisation had an Equal Opportunities Policy that
included victimisation but this was discussed in the context of sex
discrimination and general discussions around direct and indirect
discrimination (not specific to disability)208.
Four organisations produced non-statutory guidance/policies and
procedures mentioning harassment209. All mentioned harassment
in relation, but not restricted, to disability discrimination and in the
context of equal opportunities. All discussed harassment in terms
of procedures for dealing with it although the clarity and
comprehensiveness of such stated procedures varies:
“Staff who feel they are being harassed, discriminated
against or bullied, or who have witnessed it happening to
someone else, have the right to complain without fear of
victimisation using the formal grievance process detailed in
the Grievance Policy. Members of the public who feel they
are being harassed, discriminated against or bullied have the
right of redress through the Care Council’s External
Complaints Procedure.”210
“Harassment Contacts: there is a network of contacts who
are trained to support students and staff who feel that they
are receiving sexual or racial harassment, or behaviour that
otherwise contravenes the law or our EO policy (for example
religious intolerance, homophobia, bullying, or detrimental
treatment because of an impairment). Their names are found
at [link provided].
Supporters for students who have suffered serious sexual assault
or rape on campus. This rota, organised by the EO Office,
comprises students and staff who have been trained to assist out
of hours with people who suffered in this way. They are contacted
207
IoE’s Equal Opportunities Policy
208
CCW
209
CCW, SSSC, IoE and UoK
210
CCW’s Equal Opportunity Policy
95
phone via the Sick Bay or Security Staff.”211
“Paragraph 4 ‘As a social service employer you must put into
place and implement written policies and procedures to deal
with dangerous, discriminatory or exploitative behaviour and
practice.’
Paragraph 4.2 ‘This includes establishing and promoting
procedures for social service workers to report dangerous,
discriminatory, abusive or exploitative behaviour and practice and
dealing with these reports promptly, effectively and openly’.”212
“Breaches of equal opportunities policies. We recognise that
discriminatory behaviour and personal harassment can
seriously harm working and social conditions for students
and staff at the Institute. Any such incidents will be regarded
extremely seriously and will be dealt with in accordance with
the appropriate Institute procedures.”213
5.2.4 Mentioning the DDA
7 organisations214 provided non-statutory guidances/policies and
procedures that include mentions of the DDA. 2 organisations215
mentioned the DDA in their questionnaire response to Section D
and it was not clear whether these were from any non-statutory
guidance/policies and procedures. Most include descriptions of the
DDA and its implications in specific contexts. Others merely
mention the DDA in passing. There is little evidence that the
implications of the DDA are thought through across a range of
211
UoK’s Equal Opportunities
SSSC’s questionnaire response that cited their Equality and
Diversity Policy
212
213
IoE Equal Opportunities Policy. The IoE also submitted a
documented entitled ‘Primary PGCE, Open Learning Part Time
Route, Partnerships Schools Booklet’ that included discussion
around response to allegations of racism and other forms of
harassment (not in specific relation to disability).
214
BGUC, UoK, UoBright, CCW, OCNO, Skill and IoE
215
LTHT and GTCS
96
policies and procedures. There is a tendency for the DDA to be
mentioned solely in the context of policies and procedures relating
to disability, equality and diversity, and equal opportunities.
Different ways in which the DDA is mentioned include: (a)
description of DDA (or parts of the DDA); (b) description of how
DDA has changed; (c) implications of the DDA on particular
policies/procedures; (d) implementation of the DDA in the specific
context of the organisation. These are not mutually exclusive and
examples of the first three are provided in Figure 5.1.
Figure 5.1
Description of DDA (or parts of the DDA): Example
“The DDA defines disability as a physical or mental impairment
which has a substantial and long-term adverse effect on a person’s
ability to carry out normal day-to-day activities. It is intended to
counter discrimination against disabled people. It covers all people
with a substantial disability which is long term or recurring. Those
who have a history of disability are also covered. The Act gives
disabled people new rights not to be discriminated against in
employment. This includes: recruitment, selection, training,
promotion, development, dismissal, general treatment at work.” 216
Description of how DDA has changed: Example
“The DDA has gone through a series of amendments, the latest of
which came into force on 5 December 2005. This amends the
definition of ‘disability’ to cover certain conditions from the point of
diagnosis and eases the definition of mental health impairment. It
also includes a Disability Equality Duty on public bodies, which
comes into force in December 2006. This general duty indicates a
shift in the legal framework from one that relies on disabled people
complaining about discrimination to one in which the public sector
becomes a proactive agent of change, actively promoting disability
equality.”217
216
CCW’s Equal Opportunities Policy
OCNO’s ‘Disability’ (section in online document on Health and
Safety)
217
97
Implications of DDA on particular policies and procedures:
Example
“The Disability Discrimination Act (DDA) (IV) (or SENDA) requires
Higher Education Institutions to ensure that students are not
discriminated against for reasons relating to their disability, whilst
on a placement arranged by the University…DDA (II) obliges
placement providers who pay the student not to discriminate on
disability grounds, as the student is an employee and therefore
covered by employment provisions of the Act...The Disability Act
extends employers’ responsibilities under the DDA as of October
2004. It means that unpaid work placements are also covered by
the provisions of part II of the Act.”218
It is more common for the DDA to be mentioned in terms of its
implication for a particular practice (not systematically throughout),
as well as for it to be described. It is far less common to see
descriptions of plans or actions taken to implement the DDA within
a responding organisation. Only one organisation provided such
information in a non-statutory policy document219 (see Figure 5.2).
Figure 5.2
Implementation of DDA in the responding organisation:
Example
“The disabilities sub-committee is responsible for ensuring that the
Institute fully implements the requirements of the original Disability
Discrimination Act (1995) and the Special Educational Needs and
Disability Act (2001). With the introduction of the requirement to
actively promote disability equality under the new Disability
Discrimination Act (2005), the sub-committee is working on a
Disability Equality Scheme, which will be published by December
2006 in order to ensure compliance with the new legislation. The
sub-committee will continue to work closely with relevant
departments to ensure that we provide effective support for
218
UoBright’s ‘Policy on Disabled Students and Placements’
IoE’s ‘Primary PGCE, Open Learning Part Time Route,
Partnerships Schools Booklet, January 2007’
219
98
disabled students and staff. More information about this subcommittee can be found at [link to website provided]…Disabilities
Sub-Committee, which are responsible for ensuring that the
Institute complies with the requirements of the Disability
Discrimination Act (1995) and the Special Educational Needs and
Disability Act (2001). Information about both these sub-committees
is set out below.”
Two organisations made specific mention of the DED, and
produced their respective DES220.
5.2.5 Summary
While Section D called for non-statutory guidance/policies and
procedures, a few responding organisations produced or referred
to statutory guidance. In other relevant documentation,
discrimination is often mentioned in some form but not always in
relation to disability.
Few have policies and procedures addressing disability
discrimination specifically. Disability discrimination, in several
instances, is discussed in relation to policies and procedures
relating to equal opportunities, or to equality and diversity.
Disability discrimination, where discussed, tends to be generic with
little attempt at distinguishing between direct and disability-related
discrimination although there are a few examples of material (from
statutory guidance) containing wording that may be interpreted in a
way that gives rise to disability-related discrimination.
A minority of responding organisations produced non-statutory
guidance/policies and procedures that addressed the DDA. Where
mentioned, it is usually for the purpose of describing it (or parts of
it); describing how it has changed; and its implications for
particular policies and/or procedures. There is only one example of
clear description of plans around implementing the DDA.
There is little evidence that the implications of the DDA are thought
through across a range of policies and procedures. There is a
220
SSSC and IoE
99
tendency for the DDA to be mentioned solely in the context of
policies and procedures relating to disability, equality and diversity,
and equal opportunities.
Summary of findings on disability discrimination
Few organisations have policies and procedures or guidance
dealing specifically with disability.
Few generic policies and procedures discuss disability in any
sustained or systematic way.
There is little evidence that organisations appreciate the different
aspects of disability discrimination, such as direct discrimination,
disability-related discrimination, victimisation and harassment.
There are examples of statutory documents containing wording
that may be interpreted in ways that can lead to disability-related
discrimination.
Few organisations have policies and procedures or guidance that
discuss the DDA, and none work through the implications of the
DDA across the full range of policies and procedures.
The DDA tends only to be mentioned in the context of policies and
procedures relating specifically to disability or to equal
opportunities, equality and diversity.
5.3 Equal opportunities
Only 8 of the 19 organisations that responded to Section D
provided an equal opportunities policy or statement221. One of
these provided a statement. This is quoted below:
“[Name of organisation] is committed to developing an
environment that is inclusive, fair, open and welcoming of
individuals from diverse groups. Diversity and equality are
recognised, encouraged, promoted and valued at all levels of the
[name of organisation] and in all its functions. [Name of
221
BGUC, CCW, SSSC, ECU, GTCS, IoE, UoBrad, and UoK
100
organisation] values people and promotes equal opportunities.222”
Two organisations did not provide their equal opportunities policy
and neither was it clear that they had one. In one case, the
organisation provided an extract from “January 2006 Policy
Statement on the Accreditation of Programmes of Initial Teacher
Education. Within it, paragraph 1.2.5 says: ‘Equal
Opportunities/Disability Discrimination. The [name of organisation]
requires that courses and programmes will embrace diversity and
promote the equal opportunity requirements laid down by
statute”223.
The second organisation did not mention any equal opportunities
policy but provided the following statement instead: “The
regulatory frameworks seek to strike a balance between promoting
equal opportunities in the workforce and in protecting the
public…the regulatory frameworks are a balancing act, unlike the
DDA which seeks to remove barriers and promote equality and
inclusivity. There is an inherence tension between these two
positions which will require ongoing dialogue and potential
challenge in the courts”224.
Three organisations submitted policies specifically on equal
opportunities225. The main provisions in the respective policies are
illustrated in Figure 5.3.
Figure 5.3
Organisation 1226
Statement:
“It is therefore committed to a Policy of promoting equality and
diversity and the elimination of discrimination in all aspects of
222
BGUC
223
GTCS
224
ECU
225
UoK, CCW and IoE
226
CCW
101
employment, on the grounds of, including, gender, marital status,
social class, race, colour, ethnic origin, preferred language,
religious belief, sexual orientation, age, disability, HIV status,
family/domestic responsibilities, offending background or part-time
working.”
Includes:
 Discrete section on disability discrimination, including
description and explanation of the DDA.
 Sections on direct discrimination, indirect discrimination,
harassment and victimisation across six equality strands.
 Mentions provisions for equality training.
 Section on grievance and complaints procedures.
 Section on recording, monitoring and evaluation.
 Consideration of setting equality targets on the back of
these.
Organisation 2227
Statement:
“The policy aims to reach beyond legislative boundaries to provide
equality of opportunity regardless of gender, ethnicity, colour,
disability, religion, family responsibility, age, occupation, marital
status, sexual orientation or trade union affiliation.”
Includes:
 Section on Equal Opportunities Committee (with a
Disabilities Sub-Committee to ensure compliance to DDA
and SENDA.
 Has named policy owner.
 Section on preventing disability discrimination in relation to
227
IoE
102
admissions and selection process.
Organisation 3228
Statement:
“The [name of organisation] is committed to the creation and
support of a balanced, inclusive and diverse community which is
free from bias and is open and accessible to all students, staff and
visitors and members of the public:
 where individuals are integrated within the Institution, where
the diversity of individuals is valued and there is flexibility to
support their differing aspirations and goals.
 where disadvantaged groups are empowered to contribute
fully.
 where good relations are promoted between members of all
groups
 where minority groups are appropriately represented in staff
and student profiles and their voice is heard in consultation
processes.
 where there is the right to work and study with dignity and
respect.
Includes:
 Named Equal Opportunities officer and role
 Types of institutional support available
 Principles
 Scope
 Procedures
228
UoK. The Equal Opportunities Policy is linked to the Equality
and Diversity Policy
103
Several others either extracted relevant information for the CfE
questionnaire or provided other policy documents that included
statements on equal opportunities. The discussions around equal
opportunities are illustrated in Figure 5.4.
Figure 5.4
Organisation 4229 - (Equality and Diversity Policy)
Statement:
“The [name of organisation], its Employees and members
recognise and support the principle of valuing diversity in carrying
out the [name of organisation]’s functions. The [name of
organisation] will not tolerate discrimination against any individual,
either directly or indirectly, unlawfully or unjustifiable because of
their personal status in relation to race, ethnic or national origin,
religion, age, gender, sexual or marital status or disability. The
[name of organisation] will take positive action to promote a culture
where all employees can fully contribute to the work of the [name
of organisation].”
Includes:
 Section on direct and indirect discrimination in relation to six
strands.
 Section on implementation of policy through codes of
practice.
 Section on monitoring and reporting.
 Section on recruitment procedures.
 Section on complaints and grievance procedures.
229
SSSC
104
Organisation 5230 - (Information for Disabled Students)
Statement:
“The University is committed to promoting equality, diversity and
an inclusive and supportive environment for students, staff and
others closely associated with the University in conformity with the
provisions of its Charter. IN PARTICULAR, THE UNIVERSITY
WILL: seek to ensure that people are treated equitably regardless
of their gender, race, colour, ethnic or national origins, age,
disability, socio-economic background, religious or political beliefs
and affiliations, marital status, family responsibilities, sexual
orientation or other inappropriate distinction;…”
Includes:
 Mention of acting against any direct and indirect
discriminatory behaviour, including harassment, bullying etc.
5.3.1 Summary
A minority of organisations that responded to the CfE produced a
specific equal opportunities policy. It is more common for equal
opportunities to be mentioned within a range of other policies and
procedures, although the extent of coverage varies.
Summary of findings equal opportunities
Not all responding organisations have an explicit and specific
equal opportunities policy or statement.
Treatment of equal opportunities issues varied significantly in
coverage and detail.
230
UoBrad
105
5.4 Reasonable adjustments
Most of the responses are general comments on reasonable
adjustments (as written-in commentary in the questionnaire not
referring specifically to any non-statutory guidance/policies and
procedures) with few instances of named and/or produced nonstatutory guidance/policies and procedures.
The first type of response falls under the headings of:
 general comments about the need to provide reasonable
adjustments in compliance with the DDA:
Eg: “Under the DDA, employers have a duty to consider making
‘reasonable adjustments’ to make sure employees are not put at a
substantial disadvantage by employment policies, practices and
procedures or any physical feature of the workplace.”231
 discussions around providing reasonable adjustments in
practice:
Eg: “This includes while ensuring that the care and safety of
service users is your priority, providing appropriate assistance to
social service workers whose work is affected by ill health or
dependency on drugs and alcohol and giving clear guidance about
any limits on their work while they are receiving treatment”232
 problems with providing reasonable adjustments:
Eg: “Too often we hear from our members that they are not being
supported in employment due to their health status, even where
adjustments and adaptations have been made…”233
A few organisations referred to a range of statutory guidance
including:
 DfEE Circular 3/97
231
DfES
232
SSSC
233
RCN
106
 NMC Guidance 06/04
 The Nursing and Midwifery Standards for Conduct,
Performance and Ethics
 Tomorrows Doctors (GMC, 2003)
 Professional Standards for Qualified Teacher Status and
Requirements for Initial Teacher Training: TDA
 DfES Circular 4/99, Physical and Mental Fitness to Teach of
Teachers and Entrants to Initial Teacher Training, May 1999’
Fitness to Teach 2000 Dept of Health/DFEE/HMSO
 Able to Teach 2004 TDA
5.4.1 Specific guidance on making reasonable
adjustments
Only two organisations have specific guidance on making
reasonable adjustments234. Both include discussions on
 types of reasonable adjustments; and
 supporting and implementing reasonable adjustments
Organisation 1235
Name of document:
Making Reasonable Adjustments in Clinical Practice for Disabled
Health Students
Content
(a) Reasonable adjustments in relation to:
 changing practices
OCNO has a guidance entitled ‘Making reasonable adjustments
in clinical practice for disabled health students’ and the University
of Brighton has guidance on ‘Supporting students with a disability’
234
235
OCNO
107
 changing policies and procedures
 providing auxiliary aids and services
 overcoming a physical feature by removing it, altering it,
avoiding it, or providing services by alternative methods.
(b) Principles underpinning the consideration and provision of
reasonable adjustments, in relation to:
 approach and assumptions
 identifying and agreeing
 reviewing and revising
 identifying alternatives
 supporting those making decisions
 establishing and accessing specialist disability advisory
services
Organisation 2236
Name of document:
Supporting Students with a Disability
Content
(a) Reasonable adjustments in relation to:
 course
 academic support
 clinical practice support
 - during clinical allocation
236
UoBright
108
Organisation 1 included additional discussion on the context for
thinking about reasonable adjustments, revealing some of the
underpinnings of the social model of disability:
“Students with specific needs should not be seen as ‘a
problem’, the emphasis should be on considering ways to
adjust the environment to accommodate their needs while
ensuring standards of patient/client care remain unaffected.”
“Assumptions about impairments and what adjustments
should be made should be avoided. It should not be
assumed that what worked for one person with a specific
type of difficulty would work for someone else with the same
type of difficulty.
“Staff need to be open and non-judgemental and be
prepared to learn with progress”
5.4.2 Other discussions of reasonable adjustments
Reasonable adjustments, however, are more commonly discussed
as part of policies relating to disability and equality/diversity. The
extent and nature of discussion varies considerably with a few
documents going into some length about reasonable adjustments
while most others only mention reasonable adjustments briefly.
The latter are predominantly in the style typified by the following
extracts:
“As part of this commitment whatever steps are practical and
reasonable will be taken to discharge the duty under the
employment provisions of the Disability Discrimination Act
1995 (DDA) as amended.”237
“The costs of making adjustments for employees with a
disability are often very small and there is considerable
financial and practical help available to help improve access
and facilities for people with a disability.”238
“Facilities to interpret information…will be made available
237
CCW’s Disability and Employment Policy
238
LTHT’s Disability Advice for Employees and Managers
109
wherever a need is identified…”239
“may have to make ‘reasonable adjustments’ to premises or
working practices to ensure that an employee is not
disadvantaged because of their disability…‘Reasonableness’
would be determined by weighing up potential benefits
against the difficulty and cost of making adjustments.”240
“The Act makes it a statutory duty for a responsible body to
make reasonable adjustments…The Code states that
responsible bodies should not wait until a disabled person
applies to a course or tries to use a Service before thinking
about what reasonable adjustments they could make.
Instead they should continually be anticipating the
requirements of disabled people or students and the
adjustments they could be making for them, such as (i)
regular staff development and (ii) reviews of practice. Failure
to anticipate the need for an adjustment may mean it is too
late to comply with the duty to make the adjustment when it
is required”.241
On the other hand, there are guidance documents that go into
some depth on the issue242 even though these are not identified as
specific guidance on reasonable adjustments. In common, these
have detailed discussion of the types of reasonable adjustments
that are relevant to the organisational contexts and how
assessments are to be made.
239
SSSC’s Equality and Diversity Policy
NASUWT’s ‘Disability’ (section in online Health and Safety
document)
240
241
UoK’s Student Disability Policy
BGUC’s Disability Statement, University of Bradford’s
Information for Disabled Students, IoE’s Assessment Policy, and
UoK’s SENDA Guidance
242
110
5.4.3 Summary
Most responding organisations did not send the DRC any nonstatutory guidance/policies and procedures addressing reasonable
adjustments, choosing instead to respond in writing within the
questionnaire. These types of responses can be broadly grouped
into those that are general comments about the need to provide
reasonable adjustments in compliance with the DDA; discussions
around providing reasonable adjustments in practice; and
problems with providing reasonable adjustments.
A few organisations referred to a wide range of statutory guidance,
which are not relevant to Section D.
Two organisations have specific guidance on making reasonable
adjustments. These documents include descriptions of different
types of reasonable adjustments; as well as methods of supporting
and implementing reasonable adjustments.
Several organisations preferred to deal with reasonable
adjustments as part of their policies relating to disability and
equality/diversity, although the extent and nature of discussion
varied considerably.
Summary of findings on reasonable adjustments
Only two organisations produced specific guidance on reasonable
adjustments, describing the various types and how they should be
implemented, although there can be significant discussions around
reasonable adjustments in guidance on other disability related
issues.
More commonly, reasonable adjustments are discussed to varying
degrees in policies relating to disability and equality/diversity.
111
5.5 Health and fitness criteria and their
implementation
14 organisations provided some form of response in relation to
non-statutory guidance addressing health and fitness criteria
and/or their implementation243. However, on closer scrutiny, most
did so, especially regulatory bodies, by making reference to
statutory guidance244 such as DfEE circular 4/99245 and NMC
Guidance 06/04246.
Health and fitness criteria tended to be discussed in non-statutory
guidance/policies and procedures in relation to the following:
 Mention of the need to meet health and fitness / fitness to
practice criteria set by relevant regulatory bodies
 Discussion of how assessment of health and fitness sits with
reasonable adjustments
 Issues around health and safety, and risk
 Procedures in relation to health and fitness
These are not mutually exclusive and particular documents can
contain one or more of the above.
5.5.1 Needing to meet health and fitness / fitness to
practice criteria set by relevant regulatory bodies
Commonly, responding organisations would mention health and
fitness or fitness to practise in the context of needing to fulfil such
criteria as set by the relevant regulatory body. These are clearly
discussed as requirements set externally over which the
responding organisation has no control over. Some examples of
243
BGUC, BASW, CCW, OCNO, ECU, GSCC, GTCS, IoE,
NASUWT, NMC, RCN, SSSC, Skill and UoBrad
244
GSCC, SSSC, NMC, NASUWT, GTCS
245
NASUWT
246
NMC
112
responses are provided, as follows:
“The NMC requires that entrants provide evidence of good
health and good character at initial registration and on reregistration, which is required at regular intervals. Although
not all disabilities have a health dimension, individuals are
required to make declarations about their specific difficulties
under the good health and good character requirements.”247
“The Teacher Training Agency (TTA) requires the College to
assess the physical and mental fitness of entrants to courses
of initial teacher training.”248
“The DOH and GSCC require academic institutions to ensure
the fitness and suitability of those people wishing to train as
qualified social workers during and at the point of entry to the
profession.”249
“In the case of the Primary, Secondary and Post-Compulsory
PGCE programmes, applicants need to consult the
Department for Education and Skills’ Able to Teach
document (April 2004). Applicants for these PGCE courses
(who will often apply through the Graduate Teacher Training
Registry) will have to pass an Occupational Health screening
before embarking on any PGCE course. This is a statutory
requirement for all courses leading to Qualified Teacher
Status and the Institute adopts the same procedures in
relation to the Post-Compulsory PGCE.”250
In one case, however, there is an acknowledgement of the
different requirements for registration and for employment, and a
reminder to employers to assess a person’s ability to meet
247
OCNO (written-in response to questionnaire, referring to the
NMC Guidance 06/04, Requirements of Evidence of Good Health
and Good Character).
BGUC’s “Disability Statement”. They also submitted a
‘Declaration of Health’ questionnaire
248
249
UoBrad’s (statement on health report)
250
IoE (written-in response to questionnaire)
113
competencies for employment in the context of reasonable
adjustments:
“Registration confirms that an individual has met threshold
standards to be considered ‘Fit to Practise’. This is not a
guarantee of employment…but is required for employment.
By comparison employment is determined by whether the
individual meets the job specific person specification, in other
words are they ‘Fit for Purpose’. Employers have
responsibilities under legislation to make reasonable
adjustments to enable a disabled person to work. It is often
(wrongly) assumed that registration automatically means that
an individual could be employed in any or all areas related to
their profession practice.”251 (original emphasis)
5.5.2 Discussion of how assessment of health and
fitness sits with reasonable adjustment
The need for decisions around health and fitness to factor in
reasonable adjustments is mentioned in the non-statutory
guidance produced by two organisations:
“In making such an assessment [on health and fitness], and
in accordance with the Disability Discrimination Act (DDA),
the College cannot discriminate against disabled people
either during the admissions procedure, or once a student is
enrolled on a programme of study. The College is also
required to make reasonable adjustments for disabled
students and must not, without justification, treat a
disabled candidate/student less favourably for a reason
relating to their disability.”252 (original emphasis)
“There is a clear requirement for all students to meet the
specified standards for physical and mental fitness but these
can and should be enabled by reasonable adjustment where
OCNO (‘Health Professions Wales, Position Paper – Making
Reasonable Adjustments in Clinical Practice for Disabled Health
Students’.)
251
252
BGUC’s “Disability Statement”
114
appropriate.”253
The second quote comes from an organisation that additionally
expressed the view that the definition of ‘reasonableness’ can
vary, thereby making decision-making around fitness challenging:
“There was an understanding that fitness to practice should
be assessed on the basis that reasonable adjustments will
be made in employment, but it was pointed out that
reasonableness in the context of contemporary health care is
increasingly driven by cost effectiveness and fear of
litigation. If reasonableness is assessed on the resources of
individual organisations then reasonableness in an HEI will
not necessarily be the same in employment.” 254
A third organisation255 goes into some detail in explaining how
assessment against the fit to teach requirement may lead to one of
three potential outcomes, in accordance with statutory guidance
for teaching:
“We apply the fitness to teach requirement to Primary,
Secondary and Post-Compulsory candidates, all of whom
must complete a health questionnaire for scrutiny by our
occupational health provider. We will send you the relevant
questionnaire to complete if you are offered a place. On
completion of the occupational health screening process, you
will be allocated to one of three categories: A – Fit to teach:
Those who are in good health and free from conditions which
might be likely to interfere with efficiency in teaching. B – Fit
to teach with reasonable adjustments: Those who are in
generally good health, but who have conditions which are
likely to interfere to some extent with their efficiency in
teaching either all subjects or certain specified subjects, but
not necessarily serious enough to make the candidate unfit
253
ECU written-in response
254
ECU written-in response
255
IoE (written-in response, referring to the need to apply
requirements stated in ‘Physical and Mental Fitness to Teach of
Teachers and of Entrants to Initial Teacher Training, Circular No.
4/99’)
115
for the teaching profession. This includes candidates whose
disability could require employers to make a reasonable
adjustment to enable them to provide effective and efficient
teaching. C – Unfit to teach: Those whose condition is such
as to make them unfit for the teaching profession. You will
not normally be included in this category unless you have a
psychiatric or physical disorder likely to interfere seriously
with regular and efficient teaching of either general subjects
or the subject, such as PE or science subjects, in which you
intend to specialise, or if you have an illness that may carry a
risk to the safety and welfare of your pupils.”
See previous section for wider discussions around reasonable
adjustments.
5.5.3 Issues around health and safety, and risks
One organisation256 submitted additional documents that included
discussions around health and safety issues in the context of
considerations around health and fitness criteria. However, the
submitted documents are all statutory guidance257.
256
NMC
NMC referred to the NMC code of professional conduct:
Standards for conduct, performance and ethics in which health and
safety is discussed in relation to both practitioners and patients:
“As a registered nurse or midwife, you must act to identify and
minimise the risk to patients and clients you must act quickly to
protect patients and clients from risk if you have good reason to
believe that you or a colleague, from your own or another
profession, may not be fit to practise for reasons of conduct, health
or competence. You should be aware of the terms of legislation
that offer protection for people who raise concerns about health
and safety issues.” (Clause 8.2). “Ill health, which affects a
registrant’s ability to practise safely and effectively, can arise at
any time. Normally, in these circumstances, registrants will cease
practising until they are well enough to return to practice.
Sometimes, however, practitioners are not aware of the problem or
are not aware that their ability to practise is compromised by ill
health; in continuing to practise, they are putting patients/clients,
colleagues and themselves at risk of harm. Such individuals
257
116
7 organisations258 provided material that included discussions of
risk in the context of health and fitness criteria. However, 3 of
these provided statutory guidance documents259. Most commonly,
discussion revolved around the purpose of regulation and criteria
around health and fitness as being to protect the public, patients or
service users. This is particularly so in the statutory
guidance/policies and procedures submitted by some
organisations260. Other organisations submitted non-statutory
guidance/policies and procedures that reflected on this perceived
bias and its potential implications:
“Driving force behind the GSCC is protection for service
users, their carers and the general public and raising
standards of service provision. The role of the GSCC will be
to act as a backstop, to ensure that those who are not safe
and competent to practice are not registered. Registration
will be seen as a stamp of approval and the registration
criteria must have public confidence. We feel that a health
check is an essential contribution to the safety of the public
but we will expect the GSCC to apply the test sensitively and
workers will able to appeal to the tribunal.”261
“The primary purpose of professional regulation is to protect
the public. There is a degree of subjectivity in selection
decisions as staff consider firstly the suitability of the
individual to take the course and secondly the potential of
should be referred to the Council alleging their unfitness to practise
due to ill health.”
258
DfES, NASUWT, Skill, NMC, SSSW, OCNO and BASW
259
NMC, DfES and SSSC
260
For example, NMC referred to NMC Guidance 06/04
Requirements for Evidence of Good Health and Good Character
which stated that: “Parliament introduced the requirement for
evidence of good health and good character into the Order, to
enhance protection of the public, following a number of high-profile
cases involving the health and character of doctors and nurses.”
BASW’s ‘Letter from John Hutton (June 2000 ) Department for
Health CARE STANDARDS BILL CLAUSE 54’
261
117
each applicant to be able to practise on completion of
training against any potential risk this individual may pose to
patients/clients.”262
In one rare instance, there is discussion of risks to disabled people
as professionals.
“The ‘Management…Regulations’ require employers to take
account of vulnerable workers such as those who are
disabled when assessing workplace risks.”263
5.5.4 Procedures in relation to health and fitness
issues
9 organisations264 submitted some information in relation to
procedures around health and fitness issues. However, a number
of these referred to statutory guidance/policies and procedures.
3 organisations, all referring to statutory guidance/policies and
procedures, indicated that decisions around a disabled candidate’s
suitability for employment or study depend on the assessment
report of medical advisers265. A fourth organisation required
Occupational Health clearance before confirmation of employment:
“All employees of the Trust must receive Occupational
Health (OH) clearance prior to commencing employment.
OCNO’s ‘Health Professions Wales, Position Paper- Making
Reasonable Adjustments in Clinical Practice for Disabled Health
Students’
262
NASUWT (‘Disability’ within an online Health and Safety
document)
263
264
BGUC, DfES, UoBright, LTHT, NMC, OCNO, GSCC, BASW
and SSSC
265
DfES, GSCC and SSSC (although the SSSC noted that health
is not a criterion for registration, the legislative context
notwithstanding, it has asked candidates to undergo medial
(including psychiatric) assessment on occasion, but pointed out
that it does not have the power to require such assessments,
which have to be undertaken voluntarily).
118
This ensures that they are fit to undertake the role applied for
and safeguards the health of other employees and
patients.”266
In a submitted additional document, one organisation stated that it
did not support the reliance on medical advice as a basis of
informing decisions around the suitability of disabled candidates as
this has, in the past, been shown to be unreliable on occasion:
“The decisions made by the GSCC have on occasion failed
to take account of disability…The medical adviser in one
case gave opinion that had no relation to medical advice - it
was about the legal meaning of medical ill-health retirement,
which is in fact legal advice.”267
5.5.5 Summary
Non-statutory guidance/policies and procedures dealing with
health and fitness criteria tend to discuss this in relation to the
need to fulfill such requirements as set by relevant regulatory
bodies; how the assessment of health and fitness sits with
considerations around reasonable adjustments (albeit only
addressed in two examples), health and safety, and risks. There is
little evidence identified in the CfE of guidance produced detailing
procedures around dealing with health and fitness assessments.
Most responding organisations referred, unsurprisingly, to statutory
guidance produced by various regulatory bodies in relation to
health and fitness criteria, although there is some awareness that
these may not be adequate.
Summary of findings on health and fitness criteria, and their
implementation
Most responding organisations referred to statutory guidance
produced by regulatory bodies. Few produced or provided their
own non-statutory guidance around implementing health and
fitness criteria.
LTHT’s ‘Recruitment and selection policy, procedure and
guidance, Leeds Teaching Hospitals NHS Trust’
266
267
‘BASW response to the Disability Survey’
119
Health and fitness criteria are mostly discussed in terms of the
need to fulfil set requirements, and their perceived utility in
safeguarding against different risks.
There is little evidence of organisations producing non-statutory
guidance detailing procedures for implementing and assessing
health and fitness criteria. There is also little evidence of
organisations attempt to explain or clarify within guidance how
health and fitness criteria can be met in the context of the DDA.
5.6 Disclosure of disability and/or health
8 organisations provided some information relating to disclosure268,
although none produced a specific policy on disclosure. One
organisation269 provided information in the form of additional
documents submitted to the CfE, two organisations270 provided
only written-in responses in the CfE questionnaire, while the
remainder submitted evidence using a combination of methods.
The information provided varied in terms of which aspect of
disclosure it related to and the detail provided. An overview of all
the relevant information submitted yields the following types of
sub-categories that emerge:
 What individuals are being asked to disclose
 Whether disclosure is optional
 Whether purpose of disclosure is made clear
 Format of disclosure
 Stage at which disclosure relates
268
BGUC, UoBright, UoBrad, UoN, NMC, OCNO, DfES, BASW
269
UoBright
270
OCNO, BASW (BASW submitted additional documents but
these were not relevant to the purposes of Section D in this
context)
120
 Procedures for dealing with disclosure
No organisation provided information for all the above.
5.6.1 What are individuals being asked to disclose?
There are three broad categories of information that individuals are
asked to disclose: (a) disability; (b) health and/or fitness; and (c)
‘good character’. The last is in relation, primarily, to nursing where
there is a requirement to fulfil a ‘good health and good character’
stipulation. One organisation referred to statutory guidance in
social work discussing the requirement for assessment of
‘character’271, while another referred to statutory guidance in
nursing in relation to ‘good health and good character’272.
4 organisations stated that disclosure relates to disability273. In 3 of
the cases274, existing pro-formas from UCAS, GTTR and NMAS
are used to solicit disclosure of disability (see Section B for details
of these) These are all higher educational institutions.
There was particular concern and attention over ‘hidden’ and
‘unseen’ disabilities (with dyslexia being mentioned in all relevant
instances) expressed by 2 organisations275.
It is equally common for organisations to solicit disclosure on
health and/or fitness276. Most of these are in the health and social
care setting.
One organisation stated that it solicits the disclosure of different
types of information as a result of different procedures277 (see
271
GSCC
272
NMC
273
BGUC, UoN, UoBrad, UoBright
274
All except UoBright did not state how they solicit disclosure
275
UoN, OCNO
276
NMC, DfES, UoBrad
277
UoBrad
121
section below on ‘stage disclosure relates to’).
An organisation can solicit the disclosure of one or more of the
above types of information.
5.6.2 Is it optional?
Most of the information provided does not make it explicit whether
disclosure is optional. Instead, it is quite common to find that
candidates “have the opportunity”278 to declare; are “personally
and professionally accountable”279, are “encouraged” or “strongly
encouraged”280, or are “invited”281.
There are a few specific instances where the organisation’s
documentation indicated clearly a positive and supportive
approach towards disclosure. These are exemplified below:
“Placement coordinators should be aware of personal (for
the student) and legal (for the university) issues surrounding
disclosure of information about a student’s disability to a
placement provider. The student may need support in
deciding whether or how to disclose a disability…”282
“Mentors should establish relationships with the students that
are open, non-judgemental, friendly, relaxed and where the
students feel able to disclose that they are dyslexic and
discuss their learning needs…Education and service
providers should strive to establish an environment which
enables students to feel confident that disclosure of their
specific needs would not lead to discrimination.
Mentors/supervisors need to be fully informed about a
student’s specific needs, which can only be achieved with
278
BGUC
279
NMC
280
UoBrad
281
UoN
282
UoBright
122
the student’s permission.”283
“Regards to the SW training course procedures, we have
tried to create a culture which encourages students to
disclose their disability.”284
“In the first week of the programme, there is a dedicated
session on Academic Support. Within this session, students
are invited to disclose to either the Centre DLO or their
personal tutor if they have dyslexia, a disability or long-term
health condition.”285
On the other hand, there are also clear examples of compulsion
with threats of punitive approaches being adopted. Examples
include:
“I understand that failure to disclose information or giving
false information may result in termination of my offer and
subsequently of my course.”286 [statement to be
countersigned on form]
“It is improper for candidates to declare a specific learning
disability on a confidential medical questionnaire but not to
declare it in their application.”287
“Finally they are asked to give consent to a health report
provided by their GP or other health professional. If they do
not give consent, it clearly states, that they may not be able
to register.”288
283
OCNO
284
UoBrad
285
UoN
286
HEI (Teaching)
287
Government department (Education)
288
HEI (Social Work)
123
5.6.3 Is purpose made clear?
All responding organisations that provided relevant information on
disclosure are clear about the purposes behind such solicitation.
These can be categorised broadly into the following: (a) supporting
assessment and provision; (b) meeting legal requirements; (c)
enabling further checks; and (d) determining competence, ability,
or suitability.
Disclosure for the purpose of ascertaining and providing support
was stated by 5 organisations289:
“Once the College receives information that a student has a
disability, a timely response will follow and the student will
receive information about the available support. The student
will be invited to identify their support needs…The Student
Associate Scheme also offers similar support…once they are
aware of the student’s needs, staff responsible for running
the scheme will liaise with placement providers (and Student
Support, where appropriate) to ensure individual needs are
taken into consideration when arranging a placement.”290
“If [the candidate] meets entry requirements, [the] potential
student [will be] asked to attend meeting with Disability
Liaison Tutor to discuss course and reasonable
adjustment.”291
“Dyslexic students should be collaborative partners in
determining how their learning needs should be met. They
must be encouraged to develop appropriate coping
strategies in order to safely function as a registered nurse,
where levels of support may be diminished. Students should
take responsibility for their own learning needs.”292
“…to encourage them [the students] to seek the support they
289
BGUC, OCNO, UoBright, UoBrad, UoN
290
BGUC
291
UoBright
292
OCNO
124
may need.”293
“Students who disclose on their application form will be
recorded on our database and sent information about the
support that will be available to them during the
programme.”294
The above quotes all display an element of collaboration between
organisations and disabled students and/or employees.
In the case of 2 organisations295, the purpose of seeking
information on disability and/or health is explicitly framed in relation
to the need to meet legal and/or regulatory requirements:
“Placement coordinators should be aware of …legal (for the
university) issues surrounding disclosure of information
about a student’s disability to a placement provider…and the
university may have a legal obligation to pass on (or not to
pass on) this information.”296
“Every practitioner …will be required to make a selfdeclaration to the effect that their health and character are
sufficiently good to enable them to practise safely and
effectively…Self-declaration is not new as registrants are
already required to make a declaration about complying with
the continuing professional development (CPD) and practice
standards for maintaining their registration.” 297
In 2 cases298, the purpose of soliciting information on disability
and/or health is to enable further checks to be carried out, such as
by Occupational Health.
293
UoBrad
294
UoN
295
UoBright, NMC
296
UoBright
297
NMC
298
UoBright, DfES
125
There are also clear indications that disclosure is required in order
to facilitate assessments of competence, ability or suitability for a
job or course. In one case, disabled candidates called for interview
are required to sit for a “literacy and numeracy test”299. (see also
section above on ‘disability-related discrimination’)
5.6.4 Format of disclosure
The majority of organisations that provided information on this
indicated that disclosure is via the filling in of a form or a proforma300 (see also Wray et al 2007 and Stanley et al 2007).
In one case301, apart from disclosure at the application stage
(which is done on an NMAS form), “Invitations to disclose would
tend to be verbal after the application process”. Opportunities for
verbal disclosure can be found within a dedicated session on
Academic Support as well as at the commencement of new
modules302.
There is a rare example of an organisation enabling students to
decide “how to disclose a disability”303.
5.6.5 Stage disclosure relates to
It is quite common that disclosure relates specifically to application
to start a course or at the registration stage. It is also common for
a further requirement to disclose before final acceptance on a
course. In one particular instance, disclosure is called for at each
stage of a process:
299
UoBright
300
BGUC (UCAS or GTTR application form), NMC (selfdeclaration form), DfES (medical questionnaire), UoBrad (UCAS
application form, monitoring form and health disclosure form), UoN
(NMAS application form)
301
UoN
302
UoN
303
UoBright
126
“We have a clear admission procedures which starts with the
University application (UCAS) procedure form, asking
students to disclose whether they have a disability…This is
then followed by a student health disclosure form at interview
stage which asks them to disclose any condition, as defined
under the DDA, which may affect their ability to carry out
their studies…Alongside this process, the GSCC also
requires student social workers to be registered with them.
Again they are asked to provide information about any
physical or mental health condition that may affect their
ability to undertake work in social care. They are asked to
disclose this together with a description of their health
condition. Finally they are asked to give consent to a health
report provided by their GP or other health professional.”304
It is interesting to note that different types of information are
solicited at different stage of the process. Disclosures on disability
as well as on health are required at various stages.
Only one organisation indicated an appreciation of ongoing
opportunities for disclosure. It provides ongoing opportunities for
verbal disclosure via the Centre Disability Liaison Officer or the
student’s personal tutor throughout a course, particularly when
students start new modules305.
5.6.6 Procedures for dealing with disclosure
It is not always clear what procedures organisations have for
dealing with information received as a result of disclosure. As
noted previously, disclosure can lead to information relating to
support being provided as well as to further assessments and
checks being performed (including the need to attend a university
screening, in one case306).
Issues relating to confidentiality and data protection were noted by
only two organisations. However, as the quotes below illustrate, it
is not clear the extent to which these considerations are to protect
304
UoBrad
305
UoBright
306
UoBrad
127
the disabled person:
“I consent to the College and University processing and
disclosing this information to other relevant parties having
due regard to the Data Protection Act.”307[to be
countersigned on form]
For the second organisation308, it states that:
“…the university may have a legal obligation to pass on (or
not to pass on) this information. Advice on this issue can be
sought from the relevant professional body, and/or the
University’s Data Protection Officer.”
It additionally states that:
“Acceptance of offer [of a place on a course], to include
permission for information about the disability to be shared
on a ‘need to know’ basis in order that the level of support
required, to meet the requirements of the course, can be
identified.”
There is some appreciation that disclosed information must be
treated appropriately. There is awareness of bad practice
elsewhere and how that had led to discriminatory treatment:
“In May 2005, a case was reported to the Royal College of
Nursing Association of Nursing Students Executive about a
student with dyslexia who had been forced to wear a badge
during their placement which said, ‘I am a disabled student’
(News Section, Nursing Standard 2005a, p7).”309
5.6.7 Summary
No responding organisation indicated that they have a specific
policy around disclosure. None produced any such document.
Several referred to statutory guidance that included mentions of
307
BGUC
308
UoBright
309
Reported by OCNO as written-in response to questionnaire,
and not referring to any specific non-statutory guidance
128
disclosure.
Broadly speaking, organisations require or request disclosure of
disability; health and/or fitness; and ‘good character’. The last is in
relation, primarily, to nursing where there is a requirement to fulfil a
‘good health and good character’ stipulation. Different types of
information may be solicited by the same organisation at different
stages and for different purposes.
More often than not, disclosure is solicited via the filling in of a
form, for instance those by UCAS, GTTR and NMAS.
It is not always clear whether disclosure is optional, although there
are clear examples of supportive approaches as well as
approaches underlined by strong messages of compulsion and
potential punitive action.
Organisations require or request disclosure for four main
purposes, including the facilitation of assessing and providing
appropriate support; the need to meet legal requirements; enabling
further checks to be performed; and to determine competence,
ability, or suitability.
Disclosure commonly relates specifically to application to start a
course or at the registration stage. It is also common for a further
requirement to disclose before final acceptance on a course.
Summary of findings on disclosure
No responding organisation has a specific policy on disclosure.
Where required/requested, disclosure relates to disability, health
and/or fitness, and character.
Disclosure may be compulsory, with punitive actions threatened, or
it may be voluntary and supported. It is, however, not always clear
whether disclosure is optional.
Information obtained is used primarily for supporting assessment
and provision; meeting legal requirements; enabling further
checks; and determining competence, ability, or suitability.
Disclosure is overwhelmingly sought via form-filling.
Disclosure is most commonly required/requested at the stage of
applying to start a course or at registration. Different types of
129
information may be solicited at different disclosure stages. There is
only one instance of provision for the opportunity of ongoing
disclosure.
There is a lack of clear procedures for treating information
gathered as a result of disclosure. Confidentiality and data
protection issues are mentioned by only two organisations and it is
not entirely clear whether these are for the benefit of disabled
people or of the organisations.
130
References
Association of Graduate Careers Advisory Services (AGCAS)
(2005) What Happens Next? A Report on the First
Destinations of 2003 Graduates with Disabilities, Sheffield:
AGCAS, Disabilities Task Group. Available at:
http://www.natdisteam.ac.uk/documents/AGCAS_fistdestinationsdi
sgrad2003_published2004.doc. Accessed on 8 March 2006.
Bajekal M, Harries T, Breman R, Woodfield K and the National
Centre for Social Research (2004) Review of Disability
Estimates and Definitions. London: HMSO.
Disability Rights Commission (2004a) The Employment of
Disabled People in the Public Sector: A Review of Data and
Literature, London: DRC. Available at:
http://www.drc.org.uk/uploaded_files/documents/10_657_SPRU
per cent20Report per cent20FINAL.doc
Disability Rights Commission (2004b) Disability Discrimination
Act 1995. Code of Practice – Employment and Occupation,
London: The Stationery Office. Available at:
http://www.drc.org.uk/pdf/4008_323_employment_occupation_pdf.
pdf
Disability Rights Commission (2006a) Disability Briefing, March
2006, London: DRC.
Disability Rights Commission (2006b) The Disability Equality
Duty. Guidance on Gathering and Analysing Evidence to
Inform Actions, London: DRC. Available at:
http://www.drc.org.uk/docs/DRC_Evidence_Gathering_Guidance.d
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Fong J, Sin CH, with Wray J, Gibson H, Aspland J and Data
Captain Ltd. (2007) Assessments and Decisions Relating to
‘Fitness’ for Employment within Teaching, Nursing and Social
Work: A Survey of Employers, London: DRC.
Ford K, Oberski I and Higgins S (2000) Computer-aided qualitative
analysis of interview data: some recommendations for
collaborative working, The Qualitative Report, Vol. 4, Nos. 3 and
4. Available at: http://www.nova.edu/ssss/QR/QR4-3/oberski.html
Grewal I, Joy S, Lewis J, Swales K and Woodfield K (2002)
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Disabled for Life?’ Attitudes Towards, and Experiences of,
Disability in Britain. Department for Work and Pensions
Research Report No. 173, Leeds: CDS. Available at:
http://www.dwp.gov.uk/asd/asd5/173summ.asp
Hurstfield J, Aston J, Mitchell H and Ritchie H (2004)
Qualifications Bodies and the Disability Discrimination Act,
Institute for Employment Studies Report 417, Brighton: Institute for
Employment Studies
Morris D and Turnbull P (2006) Clinical experiences of students
with dyslexia, Journal of Advanced Nursing, Vol.54, No.2, pp.
238-247
National Audit Office (2002) Widening Participation in Higher
Education in England, report by the comptroller and auditor
general HC 485 Session 2001-2002: 18 January 2002, London:
The Stationary Office
National Centre for Social Research (2007) Attitudes Towards
and Perceptions of Disabled People – Findings from a Module
Included in the 2005 British Social Attitudes Survey, London:
National Centre for Social Research for the Disability Rights
Commission (forthcoming).
The National Disabled Teacher Taskforce (2005) Eliminating
Barriers and Creating Opportunities, meeting report – 15
February 2005, London: General Teaching Council for England.
Nutley S (2003) Increasing Research Impact: Early Reflections
from the ESRC Evidence Network, ESRC UK Centre for
Evidence Based Policy and Practice, Working Paper 16, University
of St. Andrews.
Priest H, Roberts P and Woods L (2002) An overview of three
different approaches to the interpretation of qualitative data. Part 1:
theoretical issues, Nurse Researcher, Vol. 10, No. 1, pp. 30-42.
Richards L (2005) Handling Qualitative Data. London: Sage.
Ruebain D, Honnigmann J, Mountfield H and Parker C (2006)
Review of legislation, regulations and statutory guidance within
professional occupations. London: DRC. Available at: www.drcgb.org/docs/Fitness_Regulatory_Review_Report.doc
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Sin CH (2007) Using software to open up the ‘black box’ of
qualitative data analysis in evaluations, Evaluation, Vol. 13, No. 1,
pp. 110-120.
Sin CH, Kreel M, Johnston C, Thomas A and Fong J (2006)
Background to the Disability Rights Commission’s Formal
Investigation into Fitness Standards in Social Work, Nursing
and Teaching Professions, London: DRC. Available at:
http://www.drc.org.uk/docs/FitnessStandardsBackgroundPaper.do
c
Stanley N, Ridley J, Manthorpe J, Harris J and Hurst A (2007)
Disclosing Disability: Disabled Students and Practitioners in
Social Work, Nursing and Teaching. A Research Study to
Inform the Disability Rights Commission’s Formal
Investigation into Fitness Standards. University of Central
Lancashire and the Social Care Workforce Research Unit, King’s
College, London for the Disability Rights Commission.
Wray J, Fell B, Stanley N, Manthorpe J and Coyne E (2005) The
PEdDS Project: Disabled Social Worker Students and
Placements, Hull: University of Hull. Available at:
http://www.hull.ac.uk/pedds/documents/MASTERRESEARCHREP
ORT15_000.doc. Accessed on 21 March 2006.
Wray J, Gibson H and Aspland J (2007) Research into
assessments and decisions relating to ‘fitness’ in training,
qualifying and working within Teaching, Nursing and Social
Work. University of Hull for the Disability Rights Commission.
Wright D and Eathorne V (2003) Supporting students with
disabilities, Nursing Standard, Vol.18, No.11, pp. 37-42.
133
Appendix A1 – Main questionnaire (English
version)
The Disability Rights Commission is conducting a formal
investigation into fitness standards in teaching, nursing and social
work. This investigation is looking at barriers that disabled people
(including people with long-term health conditions) face in
studying, qualifying, registering and working within these
professions, focussing on standards for medical and physical
fitness which operate within these sectors.
This questionnaire is to enable your organisation to formally
contribute to the evidence gathering for the DRC’s formal
investigation. Please email us your response to:
investigations@drc-gb.org by November 30th 2006.
We are looking for information about the sector your organisation
works in (eg nursing, teaching or social work). If your organisation
does not specifically work within one of these sectors we are
looking for information, from your organisation’s perspective, that
concerns disabled people studying, qualifying, registering or
working within these sectors.
There are several areas we are interested in:
a) Your organisation’s views on the regulatory frameworks
(Section A)
b) Any relevant statistical data (Section B)
c) Any relevant research that your organisation has conducted or
commissioned (Section C)
d) Key extracts from your non-statutory policy documents or
guidance that relate to disabled people studying, qualifying,
registering or being employed in teaching, nursing or social work
(Section D)
e) Organisation details (Section E)
Section A: Regulatory Framework
By the regulatory frameworks we mean all the legislation,
regulations, statutory guidance and government directives that lay
down standards for physical and mental fitness.
134
A disabled person is defined, for the purpose of this formal
investigation, according to the definitions contained in the
Disability Discrimination Act 1995 (as amended) as someone
who has ‘a physical or mental impairment which has a substantial
and long-term adverse effect on [their] ability to carry out day-today activities’. This includes people with sensory impairments,
epilepsy, cancer, schizophrenia, depression, Down’s syndrome,
diabetes, HIV and many other types of impairments and long-term
health conditions.
Questions
1. How, in your, opinion do regulatory frameworks impact on
disabled people or people with long-term health conditions
studying, qualifying, registering or working in nursing,
teaching or social work?
2. Please specify which groups of disabled people are likely to
have particular problems with the current regulatory
frameworks, and explain why you think this is the case.
3. Do you think the regulatory frameworks are compatible with
the Disability Discrimination Act (DDA)? Please provide an
explanation of your thinking. (For information about the DDA,
please visit www.drc-gb.org).
In your response, please state which regulatory frameworks you
are referring to.
Section B: Statistics
Some organisations collect administrative data on students,
employees or registrants within teaching, social work or nursing. If
you are such an organisation please respond to this section. We
are seeking anonymised statistics that have been aggregated, and
the actual wording of the question(s) used for identifying disabled
individuals.
Questions
1. Please send us annual figures eg for 2005 and/or 2006
(detailing both total numbers, percentages, and where
applicable data broken down by impairment categories
and/or cross referenced with gender, age, ethnicity). If data
is available for more than one year, please provide the data
135
on an annual basis for as far back as possible.
2. Please provide the actual wording of the question(s) used for
identifying disabled individuals and types of
impairment/conditions (where applicable).
For examples on how to present your data, please refer to
Appendix 1.
If this section is not relevant to your organisation, please state that
it is not applicable (N/A).
Section C: Research - disabled people’s experiences
Your organisation may have conducted or commissioned research
that is about your organisation and specifically relates to disabled
people’s experiences of studying, qualifying, registering or working
in nursing, teaching or social work.
Question
1. Please provide the following information about each piece of
research:
 Title, year and author of the research
 An electronic link to the research if available
 Summary of the research methodology
 Summary of key findings
 How has the research been used eg has it been used to
inform your organisation’s policies?
If this section is not relevant to your organisation, please state that
it is not applicable (N/A).
Section D: Non- Statutory Policy Guidance
Your organisation may have drafted non-statutory guidance on
practices/policies/procedures, or generic guidance which impacts
on disabled people studying, qualifying, registering or working in
nursing, teaching or social work. This may be guidance for your
own organisation to follow or guidance that you expect (or
recommend) other organisations to follow.
136
Question
1. Please name and reference the guidance that is being referred
to and extract the following relevant information on:
1. Disability discrimination
2. Reasonable adjustments
3. Equal opportunities statements
4. Health/fitness criteria, and information outlining the
procedures for implementing these criteria
5. Policies and procedures concerning disclosure of an
individual’s impairment and/or long-term health
condition
For each non-statutory guidance document please provide the
following details:
 Title, year and author
 An electronic link to the non-statutory document if available
If this section is not relevant to your organisation, please state that
it is not applicable (N/A).
Section E: Organisation’s Details
Please tick the options that apply to your organisation.
Questions
1. Which country (s) does your organisation represent/work in?
 England
 Scotland
 Wales
 England and Wales only
 Great Britain
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2. Which sector (s) does your organisation represent/work in?
 Nursing
 Teaching
 Social work
 Higher Education
 Occupational Health
 Health and Safety
 Other (please state)………………………………………………
3. Is your organisation one of the following?
Statutory body
Government department
Employers' organisation
Staff/employees’ organsation
Students' organisation
Disability organisation
Other (please
state)………………………………………………………………
Appendix 1: Statistics
An example of how to present your statistical data
Name of Organisation eg General Teaching Council for Wales
Table Title - Number of newly qualified disabled and non- disabled
teachers
Year - 200X to 2000X
Number of newly
qualified teachers
Percentage of
newly qualified
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teachers
Disabled teachers
Non- disabled
teachers
Total
Examples of Disability Questions used in Questionnaires
1. ‘The Disability Discrimination Act considers a person disabled if:
 You have a longstanding physical or mental condition or
disability that has lasted or is likely to last at least 12 months,
and
 This condition or disability has a substantial adverse effect
on your ability to carry out normal day-to-day activities.
Do you consider yourself to be disabled as set out under the
Disability Discrimination Act? Yes / No’
2. ‘Please state the type of impairment which applies to you.
People may experience more than one type of impairment, in
which case you may indicate more than one. If none of the
categories apply, please mark ‘Other’ and specify the type of
impairment
 Physical impairment, such as difficulty using your arms or
mobility issues which means using a wheelchair or crutches
 Sensory impairment, such as being blind / having a serious
visual impairment or being deaf / having a serious hearing
impairment
 Mental health condition, such as depression or schizophrenia
 Learning disability/difficulty, (such as Down’s syndrome or
dyslexia) or cognitive impairment (such as autistic spectrum
disorder)
139
 Long-standing illness or health condition such as cancer,
HIV, diabetes, chronic heart disease, or epilepsy
 Other (please specify)
140
Appendix A2 – Main questionnaire (Welsh
version)
Galw am Dystiolaeth Ysgrifenedig: Holiadur
Mae’r Comisiwn Hawliau Anabledd yn cynnal ymchwiliad ffurfiol i
safonau ffitrwydd mewn gwaith cymdeithasol, dysgu a nyrsio.
Mae’r ymchwiliad hwn yn edrych ar y rhwystrau y mae pobl anabl
(gan gynnwys pobl â chyflyrau iechyd hir dymor) yn eu hwynebu
wrth astudio, cymhwyso, cofrestru a gweithio yn y proffesiynau
hyn, gan ganolbwyntio ar safonau ffitrwydd meddygol a chorfforol
sy’n gweithredu yn y sectorau hyn.
Diben yr holiadur hwn yw galluogi eich sefydliad i gyfrannu’n
ffurfiol at gasglu tystiolaeth ar gyfer ymchwiliad ffurfiol y Comisiwn
Hawliau Anabledd. Anfonwch eich ateb atom drwy e-bost:
investigations@drc-gb.org erbyn Tachedd 30ain 2006.
Rydym yn chwilio am wybodaeth ynglŷn â’r sector y mae eich
sefydliad yn gweithio ynddo (e.e. nyrsio, dysgu neu waith
cymdeithasol). Os nad yw eich sefydliad yn gweithio’n benodol
mewn un o’r sectorau hyn, rydym yn chwilio am wybodaeth, o
safbwynt eich sefydliad, sy’n ymwneud â phobl anabl yn astudio,
cymhwyso, cofrestru neu’n gweithio yn y sectorau hyn.
Mae gennym ddiddordeb mewn sawl maes:
a) Safbwyntiau eich sefydliad ar y fframweithiau rheoleiddio (Adran
A)
b) Unrhyw ddata ystadegol perthnasol (Adran B)
c) Unrhyw ymchwil perthnasol y mae eich sefydliad wedi’i gynnal
neu wedi’i gomisiynu (Adran C)
ch) Darnau allweddol o’ch dogfennau neu ganllaw polisi anstatudol
sy’n ymwneud â phobl anabl yn astudio, cymhwyso, cofrestru
neu’n cael eu cyflogi ym maes dysgu, nyrsio neu waith
cymdeithasol (Adran Ch)
d) Manylion y sefydliad (Adran D)
Adran A: Fframwaith Rheoleiddio
Ystyr fframweithiau rheoleiddio yw’r holl ddeddfwriaeth, rheoliadau,
141
canllawiau statudol a chyfarwyddebau’r llywodraeth sy’n gosod y
safonau ar gyfer ffitrwydd corfforol a meddyliol.
Diffinnir person anabl, at ddibenion yr ymchwiliad ffurfiol hwn, yn
unol â’r diffiniad a gynhwysir yn Neddf Gwahaniaethu ar sail
Anabledd 1995 (fel y’i diwygiwyd) fel rhywun sydd â ‘nam corfforol
neu feddyliol sy’n cael effaith andwyol sylweddol a hir dymor ar
[eu] gallu i gyflawni gweithgareddau bob dydd’. Mae hyn yn
cynnwys pobl sydd â nam er eu synhwyrau, epilepsi, canser,
sgitsoffrenia, iselder, syndrom Down, clefyd siwgr, HIV a llawer o
wahanol fathau o namau a chyflyrau iechyd eraill.
Cwestiynau
4. Sut, yn eich barn chi, y mae’r fframweithiau rheoleiddio yn
effeithio ar bobl anabl neu bobl sydd â chyflyrau iechyd hir
dymor sy’n astudio, cymhwyso, cofrestru neu’n gweithio ym
maes nyrsio, dysgu neu waith cymdeithasol?
5. Nodwch pa grwpiau o bobl anabl sy’n debygol o gael
problemau penodol gyda’r fframweithiau rheoleiddio cyfredol,
ac esboniwch y rheswm dros hyn yn eich barn chi.
6. A ydych chi o’r farn fod y fframweithiau rheoleiddio yn
cydweddu â’r Ddeddf Gwahaniaethu ar sail Anabledd?
Rhowch esboniad o’ch barn. (I gael gwybodaeth am y
Ddeddf Gwahaniaethu ar sail Anabledd ewch i www.drcgb.org).
Yn eich ymateb, nodwch pa fframweithiau rheoleiddio yr ydych yn
cyfeirio atynt.
Adran B: Ystadegau
Mae rhai sefydliadau yn casglu data gweinyddol am fyfyrwyr,
gweithwyr neu’r rhai sy’n cofrestru ym maes dysgu, gwaith
cymdeithasol neu nyrsio. Os ydych chi’n sefydliad o’r fath, dylech
ymateb i’r adran hon. Rydym yn chwilio am ystadegau sydd
wedi’u casglu’n ddienw, yn ogystal ag union eiriad y
cwestiwn/cwestiynau a ddefnyddir ar gyfer canfod unigolion anabl.
Cwestiynau
3. Anfonwch ffigurau blynyddol atom e.e. ar gyfer 2005 a/neu
2006 (gan nodi cyfanswm y nifer, canran, a phan ei fod yn
142
berthnasol, y data sydd wedi’i rannu’n gategorïau yn ôl y
nam a/neu wedi ei groesgyfeirio yn ôl rhyw, oedran,
ethnigrwydd). Os yw data ar gael am fwy na blwyddyn,
dylech ddarparu’r data ar sail blynyddol mor bell yn ôl ag sy’n
bosibl.
4. Dylech ddarparu yr union eiriad a ddefnyddir ar gyfer y
cwestiwn/cwestiynau ar gyfer canfod unigolion anabl a’r
mathau o namau/cyflyrau (ble y bo’n berthnasol).
I gael enghreifftiau o sut i gyflwyno eich data, cyfeiriwch at Atodiad
1.
Os nad yw’r adran hon yn berthnasol i’ch sefydliad chi, dylech nodi
nad yw’n berthnasol (amherthnasol).
Adran C: Ymchwil – profiadau pobl anabl
Efallai bod eich sefydliad wedi cynnal neu gomisiynu ymchwil
ynglŷn â’ch sefydliad ac sy’n ymwneud yn benodol â phrofiadau
pobl anabl o astudio, cymhwyso, cofrestru neu weithio ym maes
nyrsio, dysgu neu waith cymdeithasol.
Cwestiwn
2. Dylech ddarparu’r wybodaeth ganlynol ynglŷn â phob darn o
ymchwil:
 Teitl, blwyddyn ac awdur yr ymchwil
 Cyswllt electronig i’r ymchwil os yw ar gael
 Crynodeb o fethodoleg yr ymchwil
 Crynodeb o’r canfyddiadau allweddol
 Sut y defnyddiwyd yr ymchwil e.e. a yw wedi cael ei
ddefnyddio i lunio polisïau eich sefydliad?
Os nad yw’r adran hon yn berthnasol i’ch sefydliad chi, dylech nodi
nad yw’n berthnasol (amherthnasol).
Adran Ch: Canllaw Polisi Anstatudol
Efallai bod eich sefydliad wedi drafftio canllaw anstatudol ar
arferion/polisïau/gweithdrefnau, neu ganllaw cyffredinol, sy’n
143
effeithio ar bobl anabl sy’n astudio, cymhwyso, cofrestru neu’n
gweithio ym maes nyrsio, dysgu neu waith cymdeithasol. Gallai
hwn fod yn ganllaw i’ch sefydliad chi ei ddilyn neu’n ganllaw yr
ydych yn disgwyl (neu’n argymell) i sefydliadau eraill ei ddilyn.
Cwestiwn
2. Nodwch enw a chyfeirnod y canllaw y cyfeirir ato, a dyfynnwch
y wybodaeth berthnasol ganlynol ynglŷn â:
1. Gwahaniaethu ar sail anabledd
2. Newidiadau rhesymol
3. Datganiadau cyfle cyfartal
4. Meini prawf iechyd/ffitrwydd a gwybodaeth sy’n
amlinellu’r gweithdrefnau ar gyfer gweithredu’r meini
prawf hyn
5. Polisïau a gweithdrefnau sy’n ymwneud â datgelu nam
a/neu gyflwr iechyd hir dymor unigolyn
Dylech ddarparu’r manylion canlynol ar gyfer pob canllaw
anstatudol:
 Teitl, blwyddyn ac awdur
 Cyswllt electronig i’r ddogfen anstatudol os yw ar gael
Os nad yw’r adran hon yn berthnasol i’ch sefydliad chi, dylech nodi
nad yw’n berthnasol (amherthnasol).
Adran D: Manylion y Sefydliad
Ticiwch y dewisiadau sy’n berthnasol i’ch sefydliad chi.
Cwestiynau
4. Pa wlad/wledydd y mae eich sefydliad yn eu
cynrychioli/gweithio ynddynt?
 Lloegr
 Yr Alban
 Cymru
144
 Cymru a Lloegr yn unig
 Prydain Fawr
5. Pa sector(au) y mae eich sefydliad yn ei gynrychioli/gweithio
ynddo?
 Nyrsio
 Dysgu
 Gwaith cymdeithasol
 Addysg uwch
 Iechyd galwedigaethol
 Iechyd a Diogelwch
 Arall (nodwch)………………………………………………
6. A yw eich sefydliad yn un o’r canlynol?
Corff statudol
Adran y Llywodraeth
Sefydliad cyflogwyr
Sefydliad staff/gweithwyr
Sefydliad myfyrwyr
Sefydliad pobl anabl
Arall (nodwch)……………………………………………...
Atodiad 1: Ystadegau
Enghraifft o Sut i Gyflwyno Eich Data Ystadegol
Enw’r Sefydliad e.e. Cyngor Addysgu Cyffredinol Cymru
Teitl y Tabl – Nifer yr athrawon anabl a heb fod yn anabl sydd
newydd gymhwyso
Blwyddyn - 200X i 200X
145
Nifer yr athrawon
sydd newydd
gymhwyso
Canran yr
athrawon sydd
newydd gymhwyso
Athrawon anabl
Athrawon nad
ydynt yn anabl
Cyfanswm
Enghreifftiau o Gwestiynau Anabledd a ddefnyddir mewn
Holiaduron
1. Mae’r Ddeddf Gwahaniaethu ar sail Anabledd yn ystyried bod
unigolyn yn anabl os:
 Oes gennych gyflwr corfforol neu feddyliol hir sefydlog neu
anabledd sydd wedi parhau neu’n debygol o barhau am o
leiaf 12 mis, a
 Bod y cyflwr neu’r anabledd hwn yn cael effaith andwyol
sylweddol ar eich gallu i gyflawni gweithgareddau cyffredin
bob dydd.
A ydych yn ystyried eich hun yn anabl fel yr amlinellir dan y Ddeddf
Gwahaniaethu ar sail Anabledd? Ydw / Nac ydw
2. Nodwch y math o nam sy’n berthnasol i chi. Efallai bod gan rai
pobl fwy nag un math o nam, ac os felly, cewch nodi mwy nag un.
Os nad yw’r un o’r categorïau yn berthnasol, dylech nodi ‘Arall’ a
nodi’r math o nam
 Nam corfforol, megis cael anhawster i ddefnyddio eich
breichiau neu broblemau symudedd sy’n golygu defnyddio
cadair olwyn neu faglau
 Nam ar eich synhwyrau, megis bod yn ddall / nam difrifol ar
eich golwg neu eich bod yn fyddar / nam difrifol ar eich clyw
 Cyflwr iechyd meddwl, megis iselder neu sgitsoffrenia
146
 Anabledd/anawsterau dysgu, (megis syndrom Down neu
ddyslecsia) neu nam gwybyddol (megis anhwylder sbectrwm
awtistig)
 Salwch neu gyflwr hir sefydlog megis canser, HIV, clefyd
siwgr, clefyd cronig y galon neu epilepsi
 Arall (nodwch)
147
Appendix A3 – Questionnaire for other
regulated health professions (English
version)
The Disability Rights Commission (DRC) is conducting a formal
investigation into fitness standards focussing on teaching, nursing
and social work. This investigation is looking at barriers that
disabled people, including people with long-term health conditions,
face in studying, qualifying, registering and working within these
professions and it is considering the standards for mental and
physical fitness which operate within these sectors. We are aware
that there are similar standards within a broader group of health
professions and we are therefore interested in the regulatory
frameworks that cover health professions such as medicine,
dentistry and the other professions covered by the Health
Professions Council.
This questionnaire is to enable your organisation to formally
contribute to the evidence gathering for the DRC’s formal
investigation. Please email us your response to:
investigations@drc-gb.org by November 30th 2006.
We are looking for information from key organisations that cover
health professions (eg medicine, speech and language therapy,
occupational therapy etc). We are interested in your organisation’s
views on the regulatory frameworks and how they impact on
disabled people including those with long-term health conditions,
studying, qualifying, registering and working within your profession.
Regulatory Frameworks
By the regulatory frameworks we mean all the legislation,
regulations, statutory guidance and government directives that lay
down standards for physical and mental fitness.
A disabled person is defined, for the purpose of this formal
investigation, according to the definitions contained in the
Disability Discrimination Act 1995 (as amended) as someone
who has ‘a physical or mental impairment which has a substantial
and long-term adverse effect on [their] ability to carry out day-today activities’. This includes people with sensory impairments,
epilepsy, cancer, schizophrenia, depression, Down’s syndrome,
diabetes, HIV and many other types of impairments and health
148
conditions.
Questions
7. How, in your, opinion do regulatory frameworks impact on
disabled people, including people with long-term health
conditions, studying, qualifying, registering or working within
your profession?
8. Please specify which groups of disabled people are likely to
have particular problems with the current regulatory
frameworks, and explain why you think this is the case.
9. Do you think the regulatory frameworks are compatible with
the Disability Discrimination Act (DDA)? Please provide an
explanation of your thinking. (For information about the DDA,
please visit www.drc-gb.org).
In your response, please state which regulatory frameworks you
are referring to.
Organisation’s Details
Please tick the options that apply to your organisation.
Questions
7. Which country (s) does your organisation represent/work in?
 England
 Scotland
 Wales
 England and Wales only
 Great Britain
8. Which occupational sector does your organisation
represent/work in?
 Please state………………………………………………………..
9. Is your organisation one of the following?
 Statutory body
149
 Government department
 Employers' organisation
 Staff/employees’ organisation
 Students' organisation
 Disability organisation
 Other (please state)………………………...
150
Appendix A4 – Questionnaire for other
regulated health professions (Welsh
version)
Galw am Dystiolaeth Ysgrifenedig: Holiadur
Mae’r Comisiwn Hawliau Anabledd yn cynnal ymchwiliad ffurfiol i
safonau ffitrwydd gan ganolbwyntio ar ddysgu, nyrsio a gwaith
cymdeithasol. Mae’r ymchwiliad hwn yn edrych ar y rhwystrau y
mae pobl anabl, gan gynnwys pobl â chyflyrau iechyd hir dymor,
yn eu hwynebu wrth astudio, cymhwyso, cofrestru a gweithio yn y
proffesiynau hyn, ac mae’n ystyried y safonau ar gyfer ffitrwydd
meddyliol a chorfforol sy’n gweithredu yn y sectorau hyn. Rydym
yn ymwybodol bod safonau tebyg o fewn grŵp ehangach o
alwedigaethau proffesiynol, ac felly mae gennym ddiddordeb yn y
fframweithiau rheoleiddio sy’n cwmpasu proffesiynau iechyd megis
meddygaeth, deintyddiaeth a’r proffesiynau eraill y mae’r Cyngor
Proffesiynau Iechyd yn eu cwmpasu.
Diben yr holiadur hwn yw galluogi eich sefydliad i gyfrannu’n
ffurfiol at gasglu tystiolaeth ar gyfer ymchwiliad ffurfiol y Comisiwn
Hawliau Anabledd. Anfonwch eich ymateb atom drwy e-bost:
investigations@drc-gb.org erbyn Tachedd 30ain 2006.
Rydym yn chwilio am wybodaeth gan sefydliadau allweddol sy’n
cwmpasu proffesiynau iechyd (e.e. meddygaeth, therapi lleferydd
a iaith, therapi galwedigaethol ayb). Mae gennym ddiddordeb yn
safbwyntiau eich sefydliad am y fframweithiau rheoleiddio a sut y
maent yn effeithio ar bobl anabl, gan gynnwys y rhai sydd â
chyflyrau iechyd hir dymor, sy’n astudio, cymhwyso, cofrestru a
gweithio o fewn eich proffesiwn.
Fframweithiau Rheoleiddio
Ystyr fframweithiau rheoleiddio yw’r holl ddeddfwriaeth, rheoliadau,
canllawiau statudol a chyfarwyddebau’r llywodraeth sy’n gosod y
safonau ar gyfer ffitrwydd corfforol a meddyliol.
Diffinnir person anabl, at ddibenion yr ymchwiliad ffurfiol hwn, yn
unol â’r diffiniad a gynhwysir yn Neddf Gwahaniaethu ar sail
Anabledd 1995 (fel y’i diwygiwyd) fel rhywun sydd â ‘nam corfforol
neu feddyliol sy’n cael effaith andwyol sylweddol a hir dymor ar
[eu] gallu i gyflawni gweithgareddau bob dydd’. Mae hyn yn
151
cynnwys pobl sydd â nam er eu synhwyrau, epilepsi, canser,
sgitsoffrenia, iselder, syndrom Down, clefyd siwgr, HIV a llawer o
wahanol fathau o namau a chyflyrau iechyd eraill.
Cwestiynau
10.
Sut, yn eich barn chi, y mae’r fframweithiau rheoleiddio
yn effeithio ar bobl anabl, gan gynnwys pobl â chyflyrau
iechyd hir dymor, sy’n astudio, cymhwyso, cofrestru neu’n
gweithio yn eich proffesiwn?
11.
Nodwch pa grwpiau o bobl anabl sy’n debygol o gael
problemau penodol gyda’r fframweithiau rheoleiddio cyfredol,
ac esboniwch y rheswm dros hyn yn eich barn chi.
12.
A ydych chi o’r farn fod y fframweithiau rheoleiddio yn
cydweddu â’r Ddeddf Gwahaniaethu ar sail Anabledd?
Rhowch esboniad o’ch barn. (I gael gwybodaeth am y
Ddeddf Gwahaniaethu ar sail Anabledd ewch i www.drcgb.org).
Yn eich ymateb, nodwch pa fframweithiau rheoleiddio yr ydych yn
cyfeirio atynt.
Manylion y Sefydliad
Ticiwch y dewisiadau sy’n berthnasol i’ch sefydliad.
Cwestiynau
10. Pa wlad/wledydd y mae eich sefydliad yn eu
cynrychioli/gweithio ynddynt?
 Lloegr
 Yr Alban
 Cymru
 Cymru a Lloegr yn unig
 Prydain Fawr
11. Pa sector galwedigaethol y mae eich sefydliad yn ei
gynrychioli/gweithio ynddo?
 Nodwch………………………………………………………..
152
12.
A yw eich sefydliad yn un o’r canlynol?
 Corff statudol
 Adran y Llywodraeth
 Sefydliad cyflogwyr
 Sefydliad staff/gweithwyr
 Sefydliad myfyrwyr
 Sefydliad pobl anabl
 Arall (nodwch)……………………………………………..
153
Appendix B – Summary of statistics provided
Organisation Collect
s
statistics?
Skill
No answer
NASUWT
No answer
CoD
No answer
BASW
No answer
NMC
Not
applicable
DfES
Not
applicable
SEHD
Not
applicable
BATD
Not collect
Number
Proport Coverage
ion
(years)
Most
recent
Role of
Impair Cross
disabled people cat.
ref.
154
SEED
Not collect
RCN
Not collect
NUT
Not collect
Institution 1
Yes, cannot
provide
Scope
Yes
242 (total
organisation)
15.22
GTCE
Yes
815
0.15
2006
Institution 2
Yes
177
Unstate
d
Institution 3
Yes
45
Institution 4
Yes
Institution 5
Yes
Employees
No
No
2006
Newly qualified
teachers
No
No
Unstated
2006
Nursing students Yes
12
2003/4 2006/7
2006-07 Newly qualified
teachers
(0304-0906
coh)16
4.84
Unstated
240 (total
University)
3.5
2003/4 2005/6
No
Yes
No
Unstate
d
Nursing students Yes
No
2005/6
Students
No
No
155
Institution 6
Yes
244 (total
University)
Unstate
d
2003/4 2005/6
2005-06 Students
Yes
Yes
SSSC
Yes
160
2.4
2005
2005
Social work
registrants
No
No
CCW
Yes
94
2.15
2001/22005/6
2006
Social work
registrants
Yes
No
GTCS
Yes
31
1.1
2006
2006
App. TIS (Teac
Ind Sch)
No
No
Institution 7
Yes
247 (total
organisation)
4.85
2005-06
2005-06 Employees
No
No
Institution 8
Yes
33
15.86
2003-2007
20032007
Social work
students
Yes
Yes
GSCC
Yes
1,489
1.95
Unstated
2006
Qualified social
workers
No
No
GTCW
Yes
77
0.2
2006
2006
Registered
teachers
No
No
Institution 9
Yes
610 (total
University)
6
1996/72005/6
2005-06 Students
Yes
No
156
HESA
Yes
Post grad –
9,410
5.11
Undergrad –
45,245
6.12
2005-06
2006
Students
Yes
Yes
2001-2005
2005
Students
Yes
Yes
-
2006
Students
Yes
Yes
6.38
All levels –
54,830
UCAS
Yes
Applicants –
24,517
5.51
5.47
Accepted –
19,713
NMAS
Yes
Applicants –
2,426
7.43
8.47
Accepted –
1,278
AGCAS*
Yes
Disabled
graduates
13,960
7
2001-2005
2005
Full-time
Graduate
Students
Yes
No
GTTR
Yes
Applicants –
5.6
2002-2006
2006
Students
Yes
Yes
157
23,086
5.4
Accepted –
18,814
ECU
Figures provided for different
institutions
*AGCAS draws on data from HES
158