Disability History Month: Shifting the NHS paradigm towards inclusive leadership

For our second Disability History Month blog, Peter Reading, co-chair of the Disabled NHS Directors Network, argues the NHS would be much improved by seeing disability as an asset that enriches leadership and decision-making.  

Imagine a world where Hitler won the Second World War; where the Confederates won the American Civil War and slavery continued to this day in the American South; where the French conquered Britain in 1805 and phrases 'Trojan horse' and 'Achilles heels' were not in our vocabulary. It is because of disabled leaders that, thankfully, that world is not a reality. Severely depressed Winston Churchill and wheelchair-using polio survivor Franklin D. Roosevelt led their countries to victory; Civil War President Abraham Lincoln had depression and Marfan syndrome; Nelson won the Battle of Trafalgar with one eye and one arm, and Iliad author, Homer, was blind. These are just some examples of how disabled people changed our world for the better. 

How is this relevant to the NHS? Well, you might think these disabled 'greats' achieved what they did in spite of their disabilities. If so, you are in line with the dominant institutional paradigm of the NHS regarding disability among its staff and leaders. This is that disabled staff or leaders must prove to their employers that they can do (or continue to do) the job, rather than employers asking disabled people 'how can we enable you to have (or continue to have) a great career with us?'. This paradigm sees disability entirely negatively and places the responsibility for addressing it with the disabled person, not the employer. This is the regular experience of so many of our disabled staff, who we know from NHS England Workforce Disability Equality Standard (WDES) data are twice as likely to be put into the HR 'capability process' as non-disabled staff.   

When it comes to disabled leaders, the NHS has an awfully long way to go.

Peter Reading    Interim Chief Executive

As a polio survivor who has clocked up 24 years as a trust chief executive, I should say my own career experience has been much more positive – colleagues have gone out of their way to assist and enable me. However, my NHS career was almost stopped before it began when an occupational health department refused to let me take up my place on the National Management Training Scheme until I had a cast iron reference from my orthopaedic consultant saying I "could be an NHS manager in spite of my disability". In fact, he told them "You are jolly lucky to have him", and indeed, I secured my first trust chief executive post just nine years later.  

If you believe disabled people only achieve 'in spite of' their disability, please instead reflect on a few things: 

First, when it comes to disabled leaders, the NHS has an awfully long way to go. The latest WDES data shows that only 4.2% of executive directors and 4.6% of non-executive directors are disabled, and half of trusts do not have a single board member who is disabled. This compares to 23.2% of our workforce who identify as disabled in the NHS staff survey and an equivalent proportion of all working age adults. And it's not as if the pipeline for the future offers much promise – half of all trusts have only five or fewer disabled staff among their senior leaders.

Let's focus on how we can enable disabled staff to have great careers in the NHS, not ask them to prove they can 'do the job'.

Peter Reading    Interim Chief Executive

This belies the idea that the NHS is inclusive when it comes to disability. It also means the NHS is missing out on a swathe of benefits from having more disabled leaders, who: 

• Bring lived experience of being disabled to boards and leadership teams, many of whose patients experience disability (70% of the aggregate patient activity of the NHS). 
• Strengthen the voice of disabled patients in NHS decision-making – all the more needed in light of how the pandemic killed disproportionately more disabled people than any other group, with many (particularly those with learning disabilities) sometimes being denied priority access to vaccination. 
• Encourage our workforce to value difference, by being disabled role models.
• Broaden the diversity of NHS leadership and its diversity of thinking – essential to drive innovation and improvement.
• Increase the number of high-quality applicants.
• Bring positive leadership attributes. Being disabled is great training for management – almost like its own 'management training scheme'. Disabled people are especially resilient and pragmatic, as they spend their lives finding efficient ways of getting round the challenges they face – which is what we have to do as NHS leaders every day. 

So, let's reverse our way of thinking about disability. Let's focus on the positives that disability can bring, let's believe that those great historical figures achieved what they did as much because of their disability as in spite of it. Let's focus on how we can enable disabled staff to have great careers in the NHS, not ask them to prove they can 'do the job'. Let's have more disabled leaders, particularly those with 'hidden disabilities', 'coming out' as role models. Let's sweep away the obstacles to providing reasonable adjustments. Let's drive culture change among our staff about 'hidden disabilities', beginning with autism, learning disabilities and mental health, and the continued roll out of Oliver McGowan training.