Reasonable adjustment flag

Under the Equality Act 2010, organisations have a legal duty to make changes in their approach or provision to ensure that services are as accessible to people with disabilities as they are for everybody else. These changes are called reasonable adjustments.

Reasonable adjustments can mean alterations to buildings by providing lifts, wide doors, ramps and tactile signage, but may also mean changes to policies, procedures and staff training to ensure that services work equally well for people with physical or sensory disabilities, learning disabilities or long-term conditions such as dementia.

Other adjustments include longer appointments, providing easy read materials or communications via a carer. This legal duty is anticipatory which means a service should know about a patient’s need for adjustments when the patient is referred or presents for care. For this to happen, adjustments need to be recorded and shared across the NHS. 

The flag is part of the Spine and healthcare professionals and administrative staff can view, create, add or remove information from the flag. This can be done using the Summary Care Record Application (SCRa). Longer term, a software interface will be available for clinical systems to integrate with the flag.

Access is controlled via NHS smartcards and the appropriate Role Based Access Codes (RBAC), so that only authorised healthcare professionals and administrative staff with the relevant security permissions can access the information in the reasonable adjustment flag. Administrative staff who only access demographics information on the spine can clearly see the presence of the flag but not the information within it.  

Health and care organisations create the flag in conjunction with the patient and/or carer or in line with existing best interest decision processes. Along with the details of adjustments to care, the flag can optionally contain details of the disability or long term condition that is the source of the patient’s impairment(s). Some patients may prefer not to share this information and the solution developed supports this choice.

The reasonable adjustment flag has been developed to support the needs of all patients within the remit of the Equality Act 2010. This includes those with physical or sensory disability, learning disability, autism or long-term conditions such as dementia. 

The flag complements the existing recording of reasonable adjustments locally and enhances the effectiveness of initiatives such as the national accessible information standard.

The national flag contains key adjustment information promoted from local records to benefit the patient at reception, or on referral where information about adjustments or other special requirements may be incomplete or unknown.

The flag provides an immediate visible alert; providing basic context, is a prompt for key adjustments and can signpost to further information in shared clinical records or from other organisations, other healthcare professionals, the patients’ carer or the patient themselves.

The flag is designed to provide staff with information on their duties under the Equality Act 2010 and is a means of delivering on them. It offers pick lists of existing adjustments defined by clinical codes – such as communication needs defined using the accessible information standard codes - as well as the opportunity to create highly individualised bespoke adjustments for patients

NHS Digital is trialing the SCRa solution for patients with learning disabilities in Gloucester and Devon during summer 2019 to test the technology behind the flag and gather feedback from staff, patients and carers.

From autumn 2019, NHS England and NHS Digital will explore a potential expansion, including widening the geographical area, giving access to more care settings, use with other patient cohorts and trialing integration with clinical and screening systems.