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  • Positive cultures
  • Individual agency
  • Supporting disabled staff



Approximately 23.6% of NHS staff identify as having a disability or long-term illness which affects their day to day lives (NHS Staff Survey, 2023). However, only 4.2% of the NHS workforce disclose a disability to their employer (NHS England, 2023d). Further, a recent survey found that 69% of disabled doctors feel they are part of a supportive team, compared to 74% of non-disabled doctors (General Medical Council, 2023).

It is essential staff feel safe and comfortable to identify as disabled within their organisations so employers can provide appropriate support and, more importantly, so staff are empowered at work. The ability for staff to be their authentic self and thrive in the workplace is a key lever to ensuring their job satisfaction and role fulfilment, supporting wellbeing, motivation and staff retention.

Oxleas NHS Foundation Trust’s strategy puts making the trust a ’great place to work’ as one of its three core aims. As part of realising this ambition, Oxleas have implemented a range of inclusivity tools used to help staff feel safe and valued. These take into account, and some are specifically targeted at, different protected characteristics. As a result, Oxleas has seen an 11% improvement from their staff survey results in 2021 in staff agreeing the trust takes positive action on health and wellbeing (NHS Staff Survey, 2023), and disability disclosure rates are now above the national average at 5%.

Dr Ify Okocha, chief executive of Oxleas, said: "We have had a strong focus as an organisation to make Oxleas a great place to work and part of this has been to tackle issues of inequality. I am delighted to see that this work has made a difference to our colleagues, and we are committed to taking this work further and deeper across the organisation".


Building a fairer Oxleas

The tools arose from extensive employee listening sessions and the opportunity for staff to submit anonymous feedback about their experience of working at the trust. Oxleas was then able to identify the improvements and innovations that would best enable disabled colleagues to give their best at work. One clear area of feedback was the lack of an inclusive culture in the trust.

The 'Building a fairer Oxleas five step challenge' is one initiative the trust implemented to address this. All staff are supported to complete the following actions of the challenge:

  1. Facilitate a team discussion on any aspect of inclusion.
  2. Have a discussion on any aspect of inclusion every quarter.
  3. Photograph themselves with the five step challenge charter.
  4. Implement something innovative within their team or in their area to improve inclusion.
  5. Include an action on their development plan that is related to inclusion.

"Our Building a fairer Oxleas five step challenge has made a difference to the culture in teams and increased psychological safety which enables people to talk about issues. Alongside this cultural change, teams have taken actions to reduce inequalities both within their immediate teams and across the wide trust," said Rachel Evans, director of strategy and people. Rachel continued: "It is part of a wider programme that is making real change for colleagues and having a positive impact on staff satisfaction and staff retention."

Empowering staff to drive improvements within the organisation and supporting teams to be agents of change has improved employee confidence and trust within teams. One result of this has been an increase in staff declaring a disability at all levels of the trust. Oxleas now has data showing 28 colleagues at bands 8a and above are disabled, and 20% of the trust board have declared a disability. By comparison, over half of NHS trusts have only five or fewer disabled staff at bands 8a and above, and most trusts have no board members who have declared a disability.


Supportive approach to reasonable adjustments

Disabled people, irrespective of the nature of their disability often share a common feeling of exclusion due to barriers at work that prevent them from gaining equal access to employment (Coleman et al, 2013). As such, Oxleas has developed a reasonable adjustment (RA) policy that is more supportive for all staff members with a disability or long-term condition.

The policy promotes open, sensitive and regular conversations between managers and staff to understand what individual team members need to thrive in the workplace. Feedback from staff is that this created an environment that is genuinely positive about disability. In addition, the latest Workforce Disability Equality Standard (WDES) report identified that trusts with a RA policy perform better on WDES metrics than trusts that do not have one in place (NHS England, 2023d).

National-level NHS Staff Survey data shows disabled staff consistently feel more pressured, compared to non-disabled colleagues, to be at work even when they do not feel well. In response, as part of their RA policy, Oxleas has implemented a comprehensive disability leave policy to support colleagues who require time off for this reason. Oxleas' disability leave covers a range of absences from work, both planned and unplanned, for short and prolonged periods. Having a disability leave policy is a powerful way to support disabled colleagues, showing they are valued by the organisation, and giving some of the flexibility needed to support their career aspirations.

To complement the RA policy, Oxleas implemented a central reasonable adjustment budget. Some staff were experiencing resistance from managers who were unsure about the extent of affordability for reasonable adjustments, and this delay in arranging adjustments was impacting disabled colleagues' experience at work. By centralising the budget, Oxleas has eased line managers' concerns about costs affecting their individual budgets and reduced the period between requests and arrangements of adjustments. The latest WDES data also found more staff reporting their employer has made adequate reasonable adjustments when adjustments are funded from central budgets (NHS England, 2023d). This is the most recent additional evidence for the benefits of a centralised approach to reasonable adjustments budgets.



The extensive support and commitment Oxleas employed to understand and work with the differences within teams, and celebrate diversity, has led to a workplace culture that is safe and compassionate. In recognition of this commitment at Oxleas, the trust won the award for the Sunday Times’ top place to work for people with disabilities. Notably, it was Oxleas' own disabled and non-disabled staff who nominated the trust for this award.

Working with staff to create a truly inclusive workplace culture, effectively improving disability declaration rates, and creating a supportive reasonable adjustments policy, have built a greater sense of belonging among staff, supported staff wellbeing, and improved workplace experiences for disabled colleagues. This approach is having a positive impact on the trust's retention rates. Vacancy rates are 6% lower than peer trusts and turnover has reduced and stabilised.