The Ward Round: Trusts’ ‘unknown’ disability problem revealed

Staffing is the issue keeping NHS leaders awake at night – and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, this week by HSJ employment and equalities correspondent Nick Kituno, ensures you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce.

The NHS’s latest report into discrimination against disabled staff shows signs of improvement, but there also remain signs of some big problems.

Earlier this month, NHS England published its fourth annual workforce disability equality standard report, which monitors the workplace and career experiences of disabled NHS staff.

The overall findings are familiar – “some progress, but not enough” – as four of the five core metrics were improved on the previous year.

For instance, the proportion of staff declaring their disability has risen year-on-year, while disabled staff being appointed from shortlistings is becoming more comparable with their colleagues.

However, disabled staff are now twice as likely as others to enter the formal capability process for performance – this should ring alarm bells in particular, as the trend has deteriorated since the Workforce Disablity Equality Standard was first launched.

It is when you look at the underlying figures that a key concern emerges: the data is correct as of March 2022. Given we are now in September 2023, the figures are nearly 18 months out of date.

This creates obvious challenges because trusts will have inevitably seen their performance against WDES metrics change since then, for better or worse.

Organisations will rightly point out that the data is obsolete and insist they have already taken steps to improve. Indeed, many of them do publish their WDES progress and that is a healthy sign of accountability.

However, surely an NHSE report that is published annually should contain more recent figures to inform the national picture?

This contrasts with the workforce race equality standard, its sister programme that monitors workplace experiences for staff from ethnic minority backgrounds, which has seen a more consistent timetable and has been around for twice as long.

The first WDES report was published in March 2020 and drew data from the previous year, which was correct as of the end of March 2019.

The next report was published more than 18 months later, in October 2021 – with covid offering some justification – then the third edition arrived more promptly in May 2022. But this most recent edition has seen another 18-month gap.

While not ignoring the pandemic’s impact, this yo-yoing risks making the WDES feel like an afterthought.

If the NHS is serious about eradicating discrimination against disabled staff then it must return to a more consistent format.

Non-declaration rates

The Ward Round has reviewed trust-level performance on the WDES metrics.

Despite the worsening national trend on capability processes, trust-level data for 2022 has been withheld due to “volitivity and small numbers”.

But a closer look at disability declaration rates shows incredibly that, at three trusts, more than half of staff had theirs recorded as “null” or “unknown”, with the national average standing at 18 per cent.

High rates of “unknown” make it difficult to ascertain the true picture of workplace experiences for disabled staff when it comes to discrimination. It could also highlight a problem with staff not feeling comfortable enough to disclose it, which HSJ has drawn attention to previously. It has therefore been a big focus of recent disability equality campaigns in the NHS.

The Ward Round approached the five trusts with the highest rates of overall “null” or “unknown” disability status, to ask why.

East Midlands Ambulance Service Trust, which had the highest rate at 56.4 per cent, said it had improved since 2022 and was aiming for 10 per cent who had declared a disability by the end of 2023. Head of wellbeing and inclusion Neelesh Sutaria said: “There may be a variety of personal reasons as to why staff may not automatically feel comfortable disclosing their disability.

“That’s why, since the establishment of our Disability and Carers Staff Network in 2022, we have had regular joint meetings to discuss the feedback of colleagues with disabilities from the 2022 NHS Staff Survey. This has helped us identify key aims and objectives… We know there is more we can do.”

Black Country Healthcare Foundation Trust, which was second highest at 54 per cent “unknown”, said it had reduced its non-declaration rate by a quarter and increased the proportion of staff with a declared disability to 8 per cent. Chief people officer Ashi Williams said: “We still have to work further to reduce our non-declaration rate, [which is] currently at 30 per cent.”

Dudley Integrated Health and Care Trust was third at 51.1 per cent. It said its own “not stated” rate had improved from 60 per cent to 30 per cent in March 2023, and the proportion of staff with declared disabilities had increased by more than 3 per cent.

Nottingham University Hospitals Trust was fourth highest at 49.7 per cent. Gilbert George, NUH’s director of corporate governance, said it was learning from Nottinghamshire Healthcare FT and Nottinghamshire integrated care system and had developed a WDES action plan.

Whittington Health Trust had the fifth highest at 49.6 per cent and said there were no clear reasons why declaration rates appear lower among its staff. However, there has been a “slight improvement in recent years” and it is planning a new campaign.

The WDES dataset contains comprehensive analyses of most metrics – by sector, region, and organisation – and provides interesting nuance to the overall headline figures. It is worth a look.

What the WDES programme needs is a more consistent timeline for publishing to reinforce the hard work.