By PhD Student Jess McCann
For our October EDI event we welcomed Steve Storey, lead clinical pharmacist at Cumbria, Northumberland, Tyne & Wear (CNTW) NHS Trust, to come and speak to us about how we can make ‘Reasonable Adjustments to create Inclusive Consultations for Patients’.
Reasonable adjustments are described as small, sensible changes made so that people who face barriers to accessing and receiving care, due to a disability, mental health condition or other additional needs, are given equal opportunities.
He explained that we accept reasonable adjustments (like physical ramps, interpreters and assistive technology) in many areas of day-to-day life, so why should healthcare consultations be any different? Within healthcare settings, failing to make such adjustments could worsen existing inequities. For instance, people with un‐met communication, sensory or cognitive needs may experience worse outcomes, including higher mortality, simply because the system assumed a “one size fits all” approach.
In Steve’s session, he spoke of examples of what counts as “reasonable” vs. “unreasonable” adjustments. Sometimes, it isn’t about removing all risk or achieving perfect equality in consultation duration and structure, but about taking practicable, proportionate and effective steps to address disadvantages for that person, at that time. He then moved into an interactive exercise with the audience to experience some of the disadvantages people may face. He asked us to solve a complex mental‐math calculation within 30 seconds; then to try reading some text in a different language; then to try reading very small, blurry text. These simple activities illustrated how patients with cognitive impairment, language barriers, sensory loss or low health literacy are at a disadvantage when seeking, accessing or receiving health care. It was eye-opening to experience the frustration, the delay and confusion that patients are subject to.
Steve discussed several barriers for patients accessing care, such as language and language style, communication that isn’t just about language (e.g., neurodiversity, sensory needs, memory, processing speed), physical disability, diagnostic overshadowing and hypersensitivity (e.g., to sensory stimuli, environments, noise, smells). These may mean that reasonable adjustments to consultations are used; for example, longer appointment times, quieter environments, visual prompts, alternative formats, consultation breaks or bringing a support person to accompany.
Steve shared with us some very impactful real-life examples of people he has provided care for who have required reasonable adjustments, and demonstrated what it means to go the extra mile in delivering person-centred care.
He summarised that reasonable adjustments are not something necessarily taught within university or professional training but are central within professional capability. Being aware of additional needs, asking patients what they would prefer and anticipating barriers and how to act on them allows us to demonstrate humility and advocate for the best possible outcomes for our patients.
It was a very stimulating and thought-provoking session, and it was great to see a big audience of attendees, spanning undergraduate Pharmacy students, postgraduate students, members of the NIHR Newcastle PSRC, wider University network and clinical colleagues from Newcastle upon Tyne Hospital NHS Foundation Trust. The talk provided valuable insights that we can apply not only in our current roles but also take with us throughout our future careers. Engaging with reasonable adjustments in consultation settings may allow us to be better equipped to promote person-centred care to diverse, underrepresented patient groups.
Thank you, Steve!
