Hampshire and Isle of Wight NHS: Reasonable adjustments for mental health

The Hampshire and Isle of Wight Integrated Care System is an NHS partnership comprised of 6 NHS Provider Trusts, the Integrated Care Board, Primary Care and the South Coast Ambulance Service, employing 77,500 staff.

Data and conversations with colleagues and disability networks identified that many staff felt that they did not have enough support with their disability, long-term condition or neurodivergence. This led the Hampshire and Isle of Wight Health and Wellbeing programme to establish a specialist service to support these staff.

Employee Disability and Neurodivergent Advice (EDNA) is a service that provides advocacy and signposting for NHS staff who have a disability, long term condition or neurodivergence. Its overall aim is to support these staff to thrive within the workplace. EDNA also offers support, advice and guidance to their managers. Its focus is to improve the overall wellbeing of staff and to enhance their working environment to ensure that their needs are met, remove any barriers, and overcome any challenges or difficulties that they might experience.

EDNA is able to support with Access to Work applications which is a government funded scheme, which offers additional support to staff for reasonable adjustments within the workplace. Support can be offered to their managers throughout this process.

EDNA is a self-referral service. It does not require an official diagnosis to access support.

The service wants to ensure that everyone feels inclusive within the workplace; where their unique differences and talents are valued, accepted, and not misunderstood.

EDNA is passionate about working together so that all staff have the opportunity to shine.

EDNA offers staff a one-to-one consultation and a safe space to talk with a specialist adviser.  Staff living with a disability, long term condition or neurodivergence can seek practical support and advice for difficulties and challenges they might experience within the workplace.

Some examples of advice that can be recommended are:

• alternative working location such as working from home or a quiet working area
• skills development and self-awareness programmes
• a support worker
• noise reducing headphones or hearing aid compatible headset

Following a consultation with an EDNA adviser a detailed report in the form of a letter is provided to the staff member. This outlines what has been discussed and includes recommendations that have been made. It allows the individual to have a conversation with their manager, and an opportunity to share their letter with them to discuss and explore support that can be implemented. At any point, a manager can seek support, advice and guidance in relation to the letter and recommendations made.

EDNA offers solutions that are often cost effective, achievable, and accessible in a timely manner. For example, recommendations for assistive technology, accommodations for protected administration time, assigning a mentor for support, and much more. The solutions are tailored to the individual's needs.

The service can offer follow up consultations for the staff member to allow them the opportunity to share any progress that has been made, and to discuss barriers that might still be ongoing. This provides an opportunity for an individual to seek further support and advice where needed. This might include additional support for them and their manager in relation to Access to Work. Follow up consultations allow EDNA to review positive and negative outcomes so they can foster new approaches.

Managers can often feel wary about having conversations around mental health, disability, or neurodiversity. EDNA offers virtual sessions, such as 'Say Hello to EDNA', which is tailored to help educate managers and help them to facilitate difficult conversations. These also promote an awareness of the service.

Managers can approach an EDNA adviser if they want support implementing adjustments for someone in their team. Training and raising awareness sessions around a disability can also be provided to their team.

Staff survey data revealed that many disabled employees wanted more support. Every organisation in the Hampshire and Isle of Wight Integrated Care System has their own disability network groups who can work with the EDNA advisers to help raise awareness of disabilities, long term conditions and neurodivergence within the workplace.

EDNA advisers liaise with multiple teams across an organisation, such as Health and Safety, HR, Occupational Health and the health and wellbeing teams, in order to create and form a collaborative approach.

The goal of EDNA is to help people with a disability, long-term condition or neurodivergence thrive at work. It can help staff feel more comfortable about disclosing conditions.

EDNA is an open, safe, and confidential support advice service which helps employees have the confidence to speak with their managers and be direct about what support they need. Early data shows that for some staff members the EDNA service has prevented them leaving their role or from seeing their GP.

"We have learnt a lot about the importance of communicating in different ways.

"We have 'Say hello to EDNA' sessions and information on our website, but staff who don't sit in front of a computer need to be reached, so we make sure posters are put up on toilet doors.

"Understanding the preferred methods of communication for individuals when completing a referral is also important. Some like to fill in a form, others like to talk.

"There is a two-part evaluation for the service, so we are learning a lot all the time. First, the employee is sent a questionnaire survey mainly focusing on accessibility. We send out a second evaluation, at least 6 weeks after the initial appointment, to get feedback on whether the intervention has worked, what helped and whether they would recommend the service to their friends.

"We try to follow up with a one-on-one conversation and find out whether things are working, and where they need tweaking. We have always got an open-door policy, should anything change. For example, if their job or manager changes or things are not working out as they hoped.

"The service collects all the demographic data, to make sure it is targeting everybody and to identify the areas that we might not be reaching. There are a number of referrals from our black and minority ethnic colleagues, but there's still work to be done there.

"Our appointments are one hour long. A learning was ensuring there was enough admin time after each. Cases can be complex and need immediate write ups. The advisers have cut down to 2 consultations a day each to make sure each case is given the focus and follow-up it needs."