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Reasonable adjustment flag

The reasonable adjustment flag is a national record which indicates that reasonable adjustments are required for a patient and optionally includes details of the patient’s significant impairments and key adjustments that should be considered. 

NHS England and NHS Digital have built a reasonable adjustment flag in the NHS Spine to enable health and care professionals to record, share and view patients’ reasonable adjustments across the NHS. This enables staff and services to carry out this anticipatory duty wherever the patient is treated.

Reasonable adjustments, an overview

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. 

How the reasonable adjustment flag works

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. 

How the reasonable adjustment flag can help

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

The pilots

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.

Further information

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    NHS England reasonable adjustments information for NHS staff

    How can I help make sure these adjustments are made? Including what digital flagging means for patients a short film is about how sharing information can help staff in health services know the right way to work with people with a learning disability and/or autism.

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    The confidential inquiry into premature deaths of people with learning disabilities

    The inquiry found: 1) The lack of reasonable adjustments … was a contributory factor in a number of deaths. 2) GP referrals commonly did not mention learning disabilities, and hospital ‘flagging’ systems to identify people with learning disabilities who needed reasonable adjustments were limited. 3) There is a need for clear identification of people with learning disabilities on the NHS central registration system and for this information to be made available to care professionals in healthcare record systems. Merely identifying that a person has learning disabilities is not sufficient - this information needs to be supplemented by a statement of the reasonable adjustments required.

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    Accessible Information Standard

    All organisations that provide NHS or adult social care must follow the accessible information standard by law. The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand with support so they can communicate effectively with health and social care services.

Last edited: 20 August 2019 11:15 am