1. Research on the experience of disabled staff within the NHS workforce Peter Ryan & Mike Edwards Findings from the NHS 2014 staff survey and the 2014 Electronic Staff Record

2. Key research questions: What is staff with disabilities’ representation at all levels of the NHS and covering different types of disability? Why is there a disparity between the proportion of staff who declare a disability on the Electronic Staff Record System and of those who declare a disability on the anonymous NHS staff survey? How well are staff supported who become disabled during the course of their employment? Is there a process for recording this on the staff survey? What are appraisal rates for staff with disabilities compared to non-disabled staff? Do staff with disabilities have similar levels of access to training and development as non-disabled staff? How well do NHS organisations make reasonable adjustments for staff with disabilities, from the recruitment process to the end of employment? What difference does the ‘two ticks’ symbol make to recruitment and employment? What are the numbers of staff with disabilities who are the subject of employment processes and procedures, for example disciplinary and capability processes? What are the turn-over, retention and stability rates for staff with disabilities within the NHS?

3. Data sources The NHS staff survey is conducted annually. The 2014 Staff Survey involved 287 NHS organisations in England. Over 624,000 NHS staff were invited to participate using a self- completion postal questionnaire survey,or electronically via email. Received responses from 255,000 NHS staff, a response rate of 42% (49% in 2013). All full-time and part- time staff who were directly employed by an NHS organisation on September 1st 2014 were eligible, unless on long term sick leave. Results weighted by staff occupation only. The ESR is primarily a system for getting employees paid. Trusts have ‘400 different ways of entering information’. ESR is ‘real time’ data that is collected on all staff.

4. Disabled staff representation at all levels of the NHS, and covering different types of disability NHS Survey definition: ‘have a long-standing (meaning that it has lasted, or will last, at least 12 months) illness, health problem or disability’. 17% overall report such a disability By Trust: Range (Trusts with over 200 respondents): 11 – 26% By Occupation: Range: 11 - 25% By Staff Characteristics of age, ethnicity, religion, sexuality: 9 - 27%

5. Disabled staff representation at all levels of the NHS, and covering different types of disability ESR definition: ‘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’. This is the Equality Act definition. 1% of 113,214 medical staff and 3% of 1,100,219 non-medical staff (approx 40% ‘Not disclosed’ or ‘Not known’)

6. Disabled staff representation at all levels of the NHS, and covering different types of disability Disability type not available in Survey or ESR. Break down by length of service not available in Survey (available by Trust only) or ESR Disabled staff are older, more often white, worked longer in same trust, admin roles, less senior, according to survey results

7. How well are staff supported who become disabled during the course of their employment? The ‘Violence, Bullying and Harassment’ survey questions (20-23) indicate that staff with disabilities record 12 percentage points difference in reported bullying by manager and colleagues, which is much greater than the disparities related to ethnicity or gender. Of all the demographic variables (age, gender, sexuality, disability, religion, ethnicity), disability is the only significant variable (B=.271; p<.001) impacting reported bullying by managers and colleagues.

8. How well are staff supported who become disabled during the course of their employment? The ‘Pressure to work when feeling unwell’ questions (15a to 15c) may give another indicator of relevance to this issue. There is an 11 percentage point difference in the proportion of staff with disabilities who feel under pressure from their manager to attend when feeling not well enough to perform their duties, compared to those without. (Perhaps confirms DRUK findings around the issue of sick leave and accommodations for disability, and around use of holiday leave for medical and other disability related appointments.) More disabled staff felt (8 points difference; Q22) unfairly treated with respect to opportunities for career progression. This perception of being disadvantaged was especially pronounced amongst BME staff who were disabled (13 points difference).

9. Appraisal rates for disabled staff compared to non-disabled staff. In the staff survey, while the range of appraisal rates between staff groups and types of Trust is great (28 – 100%), only one percentage point fewer disabled than non-disabled staff report having an appraisal, annual review, development review or KSF development review. This seems to be consistent across types of trust (although Ambulance Trusts have a disparity rate of 61% disabled vs 66% non-disabled, whereas rates in acute, ambulance, CCG, community and mental health Trusts are within one percentage point).

10. Quality of Appraisal However, disabled staff are less satisfied with the actions taken as a result of their appraisal 7 percentage points fewer staff with disabilities felt that appraisals improved their performance. 9 percentage points more disabled staff report that their appraisal left them feeling that their work is not valued by their organisation.

11. Do disabled staff have similar levels of access to training and development as non-disabled staff? There is very little disparity between disabled and non-disabled staff in the proportion not receiving training, or in their satisfaction with the training.

12. How well do NHS organisations make reasonable adjustments for disabled staff, from the recruitment process to the end of employment? Staff survey asks if ‘employer has made adequate adjustment(s) to enable you to carry on your work’. In the three groups, 40% respond ‘Yes’, 14% ‘No’ and 46% ‘No adjustment required’. There is little disparity between types of Trust (apart from a higher level in Ambulance Trusts), but within types of Trusts the extent to which people with disabilities report that their employer has made adequate adjustments varies greatly. Staff with disability find career progression less fair than other staff (56% found it fair vs 63 % of non-disabled staff).

13. What difference does the ‘two ticks’ symbol make to recruitment and employment? A comparison was made between Trusts with and without the ‘Two Ticks’ award of the extent to which staff who declare a disability report that their employer failed to make ‘adequate adjustments’ to enable them to carry out their work. 18 of 244 (7%) of Trusts were found to not have the award. Although in our study, there was a consistent finding that Trusts that have the ‘Two Ticks’ award have marginally higher average rates of ‘adequate adjustments’ reported by staff with disabilities, the difference is small, the number of ‘No award’ Trusts is small (just 1 in the case of Ambulance and Community Trusts) and the range among all Trusts is very large (from 5% to 41 %).

14. Additional question: Do staff with disabilities report lower job satisfaction? Disabled staff, in comparison with staff without disabilities, report less: Recognition for their good work undertaken (8 percentage points fewer) Support from their immediate managers (5 percentage points fewer). Support from their work colleagues (3 percentage points fewer). Satisfaction with the levels of responsibility they had been given (4 percentage points fewer). Opportunity to use their skills (5 percentage points fewer). Satisfaction with their level of remuneration (9 percentage points lower)