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Staff should be as diverse as our patients

By Dr Suzanne Crowe - 05th Mar 2023

disability

There should be no reason why the teenage patient with a disability cannot aspire to become a doctor or nurse

Over the last year I’ve been contacted by a number of doctors who have a disability and who are struggling to work in a health service which demands so much. This coincided with a patient pointing out that none of the staff in the hospital “looked like him”. We were chatting about future jobs and he said he’d love to work in a hospital, but never could because of his physical disability. This is sad, and a terrible indictment of a health service which does not appear to reflect the many kinds of people in our country. Role modelling is one of the most powerful methods of changing behaviour and attitudes – could our healthcare system do better?

Our education system has made considerable progress, with the Disability Access Route to Education (DARE) at secondary level, and the Higher Education Authority (HEA) funded support of access programmes at third-level. One young doctor I spoke to had availed of support throughout their education, but now found themselves adrift in a clinical role where they are expected to work long hours and night shifts. The assessment process for a reduction in hours is through the lens of health and safety and places the emphasis on risk assessment and mitigation – risk to the healthcare worker asking for reasonable accommodation, and risk to patients and colleagues. This perspective operates as a barrier to staff with disabilities and limits their access to further training and achievement of competencies. The implicit threat of not being ‘signed off’ is ever present and built into the system. They see their peers surging ahead, which makes them feel even more devalued, and may contribute to a sense of regret in choosing a career in healthcare.

Recently, I was filling out an application form for a newly established State body. It was heartening to be asked questions about disability, gender, ethnicity, and caring responsibilities outside of employment. Although I have had many jobs in healthcare, I’ve never been asked those questions before. If data is not being collected on the people who work in our health service, how can we measure and adjust the level of change required to make life easier for colleagues who have a hidden or more obvious disability? It’s silent discrimination if the employment system is not actively addressing the needs of people based on the grounds of age, gender identity, ethnicity, and disability.

Our health service employs more than 120,000 people, delivering care to over five million. There are many who require support to live comfortably. It’s to be expected there will be a significant number of healthcare workers with a declared or undeclared disability or chronic illness. There are legal challenges that can be made to access rights within employment, so why not move ahead of this and address the needs of all staff in a proactive manner, rather than deal with individual claims in an adversarial way.

There should be no reason why the teenage patient with a disability cannot aspire to working and training as a doctor or nurse on the ward. They may become a kind and committed team member caring for future patients in an even better way.

The reason it is difficult for them to pursue such careers at present is that the system is too rigid to make room for their needs, creating obstacles with poor infrastructure, onerous rosters, and assessments based only on hours or placements completed. It is a system set up for a neurotypical, physically able, and well trainee.

Every time a doctor or nurse with a disability moves jobs, they must undergo an occupational assessment and petition for accommodation. If someone enters training with a chronic illness or a disability, they are likely to continue to require accommodation for many years. Repeated assessment is demeaning and acts as a barrier to career progression.

National guidance on access like that developed by the HEA would be a good place to start, combined with collection of employment data. There are already equality and employment laws and unions to support improvement. Guidance with an implementation pathway specific to the healthcare environment could be developed with disability advocacy groups, such as Inclusion Ireland, AHEAD, and the Disability Federation of Ireland, so that it meets the lived experience and is realistic. Postgraduate training bodies and regulators must change their accreditation processes to make them more flexible in the assessment of core competencies so that staff maintain standards of training – within a framework and timeframe that meets their needs.

Speaking up about access to support is one thing – but if we are to improve the experience of healthcare staff and encourage students with disabilities to choose a career in health and social care, tangible action in the workplace is needed. Changing the focus from potential risk to potential benefits for patient care is a switch in perspective that would help.

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