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.

The Reasonable Adjustment Flag was developed in the NHS Spine to enable health and care workers to record, share and view details of reasonable adjustments across the NHS, wherever the person is treated.

The capability is now available on the National Care Records Service (NCRS).

A Fast Healthcare Interoperability Resources (FHIR) software interface is available for API-based integration with local point-of-care applications.

• The Flag is immediately visible (to reception staff, as permitted by local role-based access controls) when the patient is referred or presents for care, often when no other information is available.
• It will ensure that details of impairments and other key information (such as communication requirements) are shared consistently across the NHS – with patient consent.
• Supports carers to feel less stressed by informing them of adjustments to services.
• It can help to reduce stress both for the patient and those treating them.

• Specialist teams will be able to set the Flag – driving up the number of patients recorded on registers, who are identified for and can benefit from adjustments. This will help screening services to adapt services to ensure patients receive screening.

• It satisfies legal obligations under the Equality Act 2010 and NHS contracts and as defined in the NHS Long Term Plan. 

This service is for health and social care workers in any care setting who are treating patients that require reasonable adjustments, ensuring their needs are considered and catered for.

This service is only for use in England, and only for the purpose of direct care.

It does not have a user interface - users must access it indirectly via the National Care Records Service (NCRS).

A Fast Healthcare Interoperability Resources (FHIR) software interface is available for API-based integration with local point-of-care applications.

The Flag is designed to provide staff with information on their duties under the Equality Act 2010. It lists existing adjustments, defined by clinical codes – such as communication needs defined using the Accessible Information Standard clinical codes - as well as the opportunity to create highly individualised bespoke adjustments for patients.

Who is included

The service holds records for all patients in England who have been flagged as needing reasonable adjustments. A record is created for a patient when a health or social care worker first records the patient's reasonable adjustments.

What information is held for each patient

The Flag provides:

• basic context about a patient
• key adjustments and the details related to this
• further information to aid health and care workers

This legal duty is anticipatory which means a service should know about a person’s need for adjustments when they are referred or present for care. For this to happen, and for optimum care to be delivered, adjustments need to be recorded and shared across the NHS. 

The Flag can also record if a patient meets the Equality Act definition of disability - the code is:

• "Impairment with substantial and long-term adverse effect on normal day to day activity (Equality Act 2010)"

It can also optionally contain details of the disability or long term condition that is the source of the patient’s impairment(s) in line with the Equality Act 2010.

The impairment type list shows the impairment types that can be recorded. The Harmonised Impairment Standard enables the consistent, high profile and routine recording of impairment (including the option of ‘prefer not to say’).

Examples of the categories of adjustments, and the types of adjustments within them, that can be recorded on the Flag, are:

This service is mandated for use in all care settings in England.

This is based on:

• the Equality Act 2010
• the NHS Long Term Plan

Recording of impairments - details of disability or long term condition

A Reasonable Adjustment Flag is typically created by a GP, but can also be created by a range of health and care professionals including nurses and therapists from learning disability teams.

The Reasonable Adjustment Flag considers a range of adjustments and requirements for patients, including:

• a deaf patient who requires a communication device or BSL speaker
• a patient who is anxious in clinical settings and therefore may need additional considerations to keep them calm
• a patient who is sensitive to loud noises and would be more comfortable in a low noise environment
• alterations to buildings by providing lifts, wide doors, ramps for those who need an accessible way to access a service
• changes to policies, procedures and staff training to ensure that services work for people with physical or sensory disabilities, learning disabilities or long-term conditions such as dementia

The Flag is part of the NHS Spine and healthcare professionals and administrative staff can view, create, add or remove information from the Flag. This can be done using the National Care Records Service (NCRS). A Fast Healthcare Interoperability Resources (FHIR) software interface is also available for clinical systems to integrate directly 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 individual and/or their carer or in line with existing best interest decision processes. 

This service is live. It has been live since 2019, and has seen wider adoption since its inclusion in the National Care Records Service in 2023.

It is a bronze service, meaning it is supported between 8am and 6pm Monday to Friday excluding bank holidays.

Work is being undertaken to start the process leading to first of type direct integration of the Reasonable Adjustment FHIR API with clinical systems. This will complement the current functionality available in NCRS and lay the groundwork for wider adoption of the Flag across the NHS. Current expectation is that this work on integration will be completed by the end of 2023, after which the capability will be made available for wider use in systems across health and care.

The Flag is part of the NHS Spine and healthcare professionals and administrative staff can view, create, add or remove information from the Flag. This can be done using the National Care Records Service (NCRS). A Fast Healthcare Interoperability Resources (FHIR) software interface is also available for clinical systems to integrate directly 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 individual and/or their carer or in line with existing best interest decision processes.

The following table shows how to contact us about this service.