Promoting partnership working in the NHS

Reasonable Adjustments Passport - Derbyshire Community Health Services NHS Foundation Trust

The organisation

Derbyshire Community Health Services NHS Foundation Trust cares for patients across a wide range of services delivered from 140 sites, including 12 community hospitals and 28 health centres across Derbyshire and in parts of Leicestershire. The trust is one of the largest providers of specialist community health services in the country, serving a patient population of more than one million and employing approximately 4500 staff.

The trust has worked in partnership with trade unions and professional bodies to develop a clear process to support employees with long-term conditions and disabilities.

The challenge

As part of a review of the attendance management policy, it was identified that it would be beneficial to management and employees if a clear process was in place to capture the support required by employees with a disability or long term condition. At the trust, the biggest cause of disability is a long-term chronic health condition; where a person’s health has deteriorated significantly, resulting in them having to take time off from work. This means that managers usually only become aware of the employee’s health needs once they have reached the sickness absence management stage.

When the idea of a Reasonable Adjustments Passport (RAP) was proposed, management were concerned about the long term impact of reasonable adjustments on employees’ ability to carry out their duties, while staff side were concerned employees may not participate in the scheme as they might be uncomfortable discussing details of their health condition with their line manager.

The aim

The aim of the initiative was to help create awareness of disability, remove physical barriers and provide extra support for employees before they reached the sickness absence management procedure. To allow managers the opportunity to understand their staff and implement their support needs, leading to increased team morale and consistent and high quality patient care.

The process

A working group was formed: HR, occupational health, equalities group and staff partnership teams (trade unions/professional organisations) worked together to draft a RAP template. All stakeholders were encouraged to challenge ideas and provide honest feedback, in order to ensure the process was as thorough as possible and the document fit for purpose. A manager’s guide was created to guide line managers through each stage of the process to ensure a consistent approach, and both managers and HR staff received training in order to instil confidence in the process.

It was agreed that the RAP would be voluntary and always completed in agreement with the employee, who could be accompanied by a trade union representative to complete the RAP if they wished. The RAP captures relevant information that the employee is willing to disclose relating to their health condition, including details of medication and any possible impact of the medication on the employee’s ability to carry out their duties.

Managers would be required to consider reasonable adjustments based on each individual and the information they had provided. This may include developing a return to work plan, considering additional training needs, arranging a workplace assessment, or making reasonable changes to their duties.

The outcome

The RAP has enabled a proactive approach to managing long term conditions and disabilities in the workplace, rather than waiting for the sickness process to be triggered. This approach has promoted confidence between staff and management, as employees feel their health needs are being fairly assessed and supported. There has also been an increase in employees declaring conditions and a reduction in sickness absence, which has reduced pressure on colleagues. Long term planning has also been established, allowing managers to prepare for the challenges of winter months, reducing pressure on staff and increasing levels of patient care. The concept has already been shared with a local hospital, showing adaptability and transferability of project to other sites.

Both staff and management feel like they are working more in line with trust values, and feel they have benefited from collaborative working between the trust and trade unions.

Top tips

  • Perseverance and promotion have helped a successful launch, even after a slow start.
  • The passport must be completed with agreement of employee, and each party must take ownership of agreed actions.
  • When communicating a new process or resolving unforeseen issues, it is important to remember the aim of partnership working and consider all parties.

The initiative won the trust a finalist place in the 2017 SPF sponsored HPMA Partnership Award. You can hear the team along with the other finalists talking about their winning projects and the challenges they faced and resolved by listening to their interviews in our podcast below.


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Further information:

Amanda Wildgust, Head of People Services

Lynn Booth, Partnership Lead – Job Share and Unison Representative