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Reasonable adjustments must not be ‘legal exercise’, says doctor

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“If you exclude a safety critical role we do not have any mandate for any profession to make decisions based on a fitness to work ‘standard’.”


Such was one of several informative insights from Dr Ali Hashtroudi, clinical director of OHS, Guy’s and St Thomas’ NHS Foundation Trust.

Speaking at a conference held by Government Events on Thursday 23 May, he talked about reasonable adjustments for mental health conditions and disability in the workplace – and gave his own doctor’s prescription of what employers should be doing.

He first stressed that if an employee goes off sick due to depression, doctors can assess them for their ability to function, but their condition is not important for deciding on fitness to work.

“Level of function is very individual, so you may have two depressed people and one of them reaches the criteria for disability and one of them doesn’t. And the main difference is one of them is functioning and the other one isn’t.”

He said that employers therefore need to provide support based on individual needs rather than a one-size-fits all approach.

“It’s relatively easy to make reasonable adjustments for physical disability such as vision or hearing impairment, or for wheelchair users. Others are harder but we still think about how we can adjust for people. Mental health – if someone is depressed, there needs to be a very much bespoke individual assessment,” he said.

Employers need to provide support based on individual needs rather than a one-size-fits all approach

He emphasised that simply talking with the employee in order to arrive at a consensus of appropriate support in the workplace should be done more than it is currently.

“I very much hope that we can move away from this very legal terminology around reasonable adjustment and come up with something a bit ‘greener’ on mutual agreement.”

“Reasonable adjustment has a legal connotation. It is defined under the Equality Act. As soon as you say legal you embark on a legal conversation,” he explained. “You can actually spend a lot of resources on deciding if someone’s disabled or not, the best [approach] is to think rather, what can help someone to work?”

Other speakers at the Improving National Health and Wellbeing conference included Claire Campbell, programme director at Timewise. The company specialises in flexible working as a positive talent strategy and she used her speech to urge companies to get ‘more comfortable’ with not just agreeing flexible working requests, but positively promoting them.

Abigail Hirsch, of conciliatory service, ACAS advised companies to start with ‘what you can do something about’ when it comes to wellbeing, and not to be daunted by the challenge of a wholesale culture change.

The workplace needs to catch up with the changing nature of our society, said Claire Campbell at Timewise

Dean Shoesmith, director of HR at Lambeth Council, shared problems he faces within his workplace including high sickness absence rates (12 days per person on average) due to stress and musculoskeletal issues. “We have retention problems, youth violence in the borough is about as stressful as it gets,” he said.

Rachel Suff, senior policy advisor at the body for HR and people development, CIPD, shared findings its recent Health and Wellbeing at work report. The annual survey found 58 per cent of organisations have seen an increase in common mental health conditions in 2019, a steady climb from 55 per cent in 2018 and 41 per cent in 2016. “Hopefully that also reflects a more open culture and confidence in employers to report an issue,” she said.

Working when unwell (presenteeism) seems to be an issue for a staggeringly large proportion of companies, she said, with 83 per cent of over 100,000 responses saying presenteeism was an issue in their organisation. “Presenteeism is costly and harmful for individuals and the organisation. It spreads sickness in the office, is linked to poor decision making, impaired performance and judgment,” she later emphasised for the audiences’ questions.

Improving National Health and Wellbeing conference was held at the Bloomsbury Hotel, London on 23 May.

For more information about Government Events, please contact Kate May at [email protected] 

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