NHS Scotland learning disability employment: tools and guidance

Guidance and tools to support NHS Scotland to increase the number of the people employed with learning disabilities.

2. Creating an accessible organisation

Taking steps to employ people with learning disabilities will help to create a more accessible organisation by increasing interactions. As organisations go through the process of hiring people with learning disabilities, this will provide a practical opportunity to review organisational policies and processes to make sure they are accessible for all applicants. Organisations that implement equitable hiring practices to create a more diverse workplace see the positive effects in the whole organisation.

2.1 Reasonable Adjustments

There is an expectation that where reasonable adjustments (as set out in the Equality Act 2010) are necessary they are provided efficiently. The provision of reasonable adjustments ensures that all disabled workers, including people with learning disabilities, are not disadvantaged when doing their jobs. These adjustments apply to all contract workers, trainees, apprentices, and full and part time employees. Adjustments apply throughout the recruitment process and the duration of employment at an organisation. Reasonable adjustments may include equipment and changes to the physical environment, they may also include changes to working practices and the working day (including shift changes, different methods, line management arrangements etc.)

It is very important not to make assumptions about an individual’s ability to perform a task. They will know the effect of their disability/impairment and they should be given the chance to demonstrate whether they can do the job. Everyone is different, which means that not everyone will need the same adjustments; employees need to be engaged in conversations about adjustments needed to support them in the workplace.

Adjustments should be reviewed frequently to ensure that the adjustment is effective. Several adjustments may be required to reduce an array of disadvantages that may not be obvious to an employer. There are several considerations that should be made when thinking about reasonable adjustments:

  • how effective the change will be in avoiding the disadvantage the worker would otherwise experience;
  • is it practical;
  • the cost;
  • your organisation’s resources and size;
  • the availability of financial resources.

The duty contains three requirements that apply in situations where a disabled person would be substantially disadvantaged compared to people who are not disabled.

2.1.1 Changing the way things are done

Where a disabled worker is put at a disadvantage by a provision, criterion or practice of their employer, amending the way of doing things will make it more inclusive for employees with disabilities. For example, changes to the existing induction, onboarding, and mandatory training processes could make a real difference to the experience of an employee with a learning disability. Some adjustments that NHSScotland Boards have taken include face-to-face training, or using the aid of a support worker.

2.1.2 Changes to overcome barriers created by the physical workplace

Thinking creatively about the physical environment and considering adding prompts may help people with learning disabilities complete their jobs more efficiently. Some adjustments that NHSScotland Boards have taken include restructuring working hours, such as shifting the start and end times of the working day, or working shorter days.

2.1.3 Providing extra equipment

Additional or different equipment may make it easier for some people with learning disabilities to communicate or access information within the team and wider organisation. This can take the form of providing specialist software, easy read documents, or by working with a support worker when necessary.

The Equality and Human Rights Commission provide examples of how the three requirements work in practice. Please refer to their webpage for an in-depth explanation of reasonable adjustments in practice.

2.2 External Support

There is often a perception that employers will face increased costs and challenges to employ people with a disability when reasonable adjustments will need to be made. The reality is that there is a lot of support available to employers, including funding, much of it at zero, or low cost to the employer. For example, the UK Government Access to Work scheme can help pay for reasonable adjustments which will minimise the financial burden on organisations. Further information and references to external support can be found in Annex A.

2.3 The Accessibility Information Standard

All organisations that provide NHS or adult social care have a legal duty (produced under section 250 of the Health and Social Care Act 2012 and supported by the Equality Act 2010 obligations) to make ‘reasonable adjustments’ to improve access for disabled people. The ‘Accessible Information Standard’ aims to clarify what is ‘reasonable’. The Standard is only legally enforceable to health services in England, but it is seen as best practice for the NHSScotland Boards to help implement the duties in the Equality Act.

The aim of the Accessible Information Standard is to ensure that people who have a disability or sensory loss get information that they can access and understand, and any communication support that they need. This includes providing accessible information and communication support for people with a learning disability. Further information can be sought from the Scottish Accessible information forum.

2.4 Inclusive Communication

Everyone needs to communicate effectively to take part in daily life, whether at home, school, work or going to a café. Some people face barriers in doing this due to other people's lack of:

  • awareness of how they communicate;
  • knowledge about how best to support them.

Inclusive communication refers to all forms of communication, including spoken language, written language and all forms of non-verbal communication. It can be face to face or by telephone, written information or online. Inclusive communication is vital to ensure equity of access to services, person centred care, increased participation, and social interaction.

Everyone is responsible for communicating in ways that include others and for creating supportive environments. Inclusive communication demonstrates that, as a society, we value, respect and include people with communication support needs. It promotes functional, effective and valued communication so social inclusion can be achieved and maintained.

Organisations should consider how to support staff to communicate in ways which are more accessible and inclusive to support the recruitment and retention of colleagues with learning disabilities.

Some general tips when communicating either verbally or through written means include:

  • use plain English;
  • avoid jargon, acronyms and figures of speech;
  • use clear, short sentences.

2.4.1 Face-to-face

Some ‘top tips’ for effective face-to-face communication with people with learning disabilities are as follows:

  • clearly identify or introduce yourself - if appropriate, explain who you are and what you do;
  • find a suitable place to talk, ideally away from noise and distractions;
  • speak clearly and perhaps a little slower than you would do usually, but do not shout;
  • use gestures and facial expressions to support what you are saying;
  • if necessary, repeat phrases, re-phrase the sentence or use simpler words or phrases;
  • check if the person has understood what you are saying; look for visual clues as well as asking if they have understood;
  • encourage people to ask questions or request further information; ask if they would like anything in writing as a reminder or reference;
  • try different ways of getting your point across, for example writing things down, drawing or using symbols or objects to support your point.

2.4.2 Written and Printed

Equally, it is important to ensure that written or printed communication is accessible. Some ‘top tips’ for accessible printed communication are as follows:

  • use a minimum font size of 14 point;
  • use a clear, uncluttered and sans serif font such as Arial;
  • align text to the left margin and avoid ‘justifying’ text;
  • ensure plenty of ‘white space’ on documents, especially between sections and avoid ‘squashing’ text onto a page; if possible, include a double-space between paragraphs;
  • print on matt, not gloss, paper;
  • use page numbers;
  • if printing double-sided ensure that the paper is of sufficient thickness to avoid text showing through from the other side;
  • consider making all ‘standard’ printed letters / documents ‘easier to read’ – using plain English, highlighting important information, and supporting text with diagrams, images or photographs.

Many people with a learning disability will need written information in ‘easy read’ format. ‘Easy read’ refers to information which is written using simpler words and phrases, supported by images, symbols or photographs. It is good practice to ensure that people with learning disabilities are involved in the development of easy read documents.

Organisations should take steps to ensure that their internet and intranet sites are accessible, including to people with a learning disability and to users of assistive technology. For more information on how to make your webpage recognised as accessible refer to the Web Content Accessibility Guidelines. The BBC My Web My Way website has a very useful best practice page which provides information on making your website accessible for people with learning disabilities.

Consideration should also be given to colleagues with other information or communication needs, and to the fact that some people with a learning disability may also have additional communication needs, for example sensory loss. More information about correctly formatting documents to ensure that they are accessible to users of assistive technology is included in the NHS Guide in Creating Accessible Documents.


Email: Emma Weedon

Back to top